2. Rybicki page 3
The country of Afghanistan has gone through many changes over time. There
have been multiple invasions by many countries dating back to Alexander the Great.
Afghanistan continues to have foreign countries occupying their land presently teaching
the Afghan people nothing but violence and suffering. Because of the high volume of
travelers in their country, Afghanistan has many different dialects of language mainly
deriving from Pashtu and Dari. In order for Afghanistan to become a full functioning
democratic nation, the Afghanistan government must continue to seek aid from NATO
for economic relief, political structure, a fair and just legal system, better educational
facilities and teachers, and especially an actual healthcare system with up to date
hospitals that can be found in more locations.
Afghanistan has a long, violent history of different groups trying to take over their
land to control the central trading routes or crossroads. The earliest groups of people
were Alexander the Great accompanied by the Persian Empire around 328 B.C. After that
it was the Scythians, White Huns, and Turks that all tried to invade the country. “In A.D.
642, Arabs invaded the entire region and introduced Islam” (Afghanistan Overview).
This is the most significant change to the Afghan culture because it not only changed the
language throughout the land, people started to adopt the Islam faith as well.
“In 1747, Ahmad Shah Durrani, the founder of what is known today as
Afghanistan, established his rule” (Afghanistan overview). Durrani came into power by
getting elected by a tribal council and was considered to really started to expand his
territories. He wanted to make Afghanistan a solid nation and did so by combining the
3. Rybicki page 4
counties sub-provinces into greater, more concrete areas. This is a big deal for the people
of Afghanistan because they are finally trying to get a nation of their own without being
occupied by some other nation or group. Unfortunately, this time of self preservation
living in a nation they can call their own does not last for long.
The first European influence in Afghanistan was in the nineteenth century when the
U.K. became concerned with Russia’s movement along Central Asia which resulted in
two Anglo-Afghan wars in 1839 and 1878. A man by the name of Amir Abdur Rahman
was considered to be responsible ending the British and Russian conflict and finally
establishing actual boundaries between the two countries. Unfortunately, Rahman was
assassinated in 1919 and then his third son regained control of the country after attacking
India, this was considered to be the third Anglo-Afghan war. It comes as no surprise
today that the Afghan culture is perceived to be very violent because they have been
fighting for their country for centuries.
Most people from younger generations remember the Soviet Invasion the most
because it is still fairly recent and it is the first time the US came to the Afghan people’s
aid. The Soviet Union saw an opportunity after Afghanistan just finished fighting an
awful civil war in 1978. The Soviet Union knew the Afghan army was diminished so
they lied to Afghan officials and pretended to come to their aid and by 1979 tensions
grew thick between Afghans and the Soviet Union. Most of the Afghan people did not
agree nor accept the communist regime and they started to rebel, but it was too late. By
this time the Soviet Union had over 100,000 troops on ground and a very impressive air
4. Rybicki page 5
support.
Like most countries that are being controlled by an unwanted entity, freedom
fighters or patriots are going to defend his or her land at all costs. In Afghanistan,
freedom fighters are known as “mujahideen”. The mujahideen were not foolish and
knew that they were out-numbered and had a much smaller and inferior army, so they
needed aid. “Poorly armed at first, in 1984 the mujahideen began receiving substantial
assistance in the form of weapons and training from the U.S. and other outside powers”
(Afghanistan overview).
The greed of Russia caused many people to die before their time. The Soviet’s
signed the Geneva accords promising to be completely withdrawn from Afghanistan no
later than February 15, 1989. However, the damage was already done. “About 14,500
Soviet and an estimated 1 million Afghan lives were lost between 1979 and the Soviet
withdrawal in 1989” (Afghanistan overview). How can a country ever become a part of a
normal functioning society if all they are always getting invaded by foreign countries?
The Afghan society knows nothing but war and violence and they continue to teach
violence to future generations because war has become a way of life for them.
After the Soviet Union was completely withdrawn from Afghanistan, the
US soon followed and stopped giving military aid to the Afghan Army. “Internal
factions, who had aligned with each other against the Soviets, quickly splintered and
fought for control of the country” (Brennan et al 217). Also, due to the lack of education
in Afghanistan, it was easy to manipulate the minds of the youth by Islamic Radicals
5. Rybicki page 6
make believing that the US did more harm than good. “Many Afghans whom the United
States had trained, supported, and armed during the proxy war against the Soviets joined
the extreme Taliban” (Brennan et al 217). This is what made the “Taliban” stronger
during the mid- 1990’s because they had plenty of young Afghans to recruit after being
lied to by radicals. What would you do if a country of greater power was helping you,
giving you faith and hope about your country, suddenly packed up and left? The Taliban
had most of the country under control by 1996.
After the horrific events that took place on September 11, 2001, the U.S. and its
allies decided to start an antiterrorist campaign against the Taliban in Afghanistan and
around the world. “Because of its extreme political views, plus need for financial support,
the Taliban sheltered and supported the al-Queda, an international terrorist group led by
the now-infamous Osama bin Laden” (Brennan et al 218). What people need to
understand about the citizens of Afghanistan is that not all Afghans are supporters or
members of the Taliban and a lot of the people want a better way of life. “Afghan
factions opposed to the Taliban met at a United Nations-sponsored conference in Bonn,
Germany in December 2001 and agreed to restore stability and governance to
Afghanistan”(Afghanistan Overview). This is a historic event because it marks the
beginning of an ongoing ten year war with the U.S. and allies against the Taliban known
as the War on Terror.
6. Rybicki page 8
Afghanistan is located in Southern Asia. It is about 652,000 square kilometers
which is slightly smaller than the state of Texas. According to the CIA World Fact Book,
Afghanistan has a population of 29,835,392, with the average median age of men and
women of 45. The fertility rate is 5.39 children per woman. Also, it is very difficult to get
a precise count of the population because of the many visitors that are always occupying
their territories.
Afghanistan land is mostly rugged mountainous terrain with few plains in the
North and Southwest. Only about twelve percent of the land is suitable for growing crops
and only half of that land is cultivated. Some of the valuable land cannot be cultivated
due to land mines that are still active. According to the studies conducted by World
Bank, N. Anderson, C. Palha da Sousa, and S. Paredes, “Afghanistan has more land
mines and unexploded ordinance than any other country in the world” ( qtd. in Brennan et
al 217). This affects not only where farmers can plant their crops, but their lives as well.
Also, Afghans have a difficult time with growing crops due to the extreme climates
including dry hot summers, cold winters, droughts, limited or damaged irrigation
systems, and very little use of fertilizer and pesticides. “Overall agricultural production
dramatically declined following severe drought as well as sustained fighting, instability in
rural areas, and deteriorated infrastructure” (Afghanistan Overview).
“Most of the population (85%) is highly dependent on farming or herding”
(Brennan et al 216). The main source of formal agriculture is cereal crops, wheat, fruits
and nuts; and informal agriculture is opium, which is then refined into heroin. “The
7. Rybicki page 9
noticeable characteristic of Afghanistan’s economic structure is the dominance of the
informal sector, not only in agriculture and in the illegal drug industry, but also in most
other sectors” (Riphenberg 508). Due to Afghanistan’s location connecting Central Asia
with Southern and Southeastern Asia, it has led to centuries of trading and migration
paths throughout the country known as “crossroads”. Because of their location, it is easy
to smuggle opium and other illegal goods both in and out of the country. As per reports
done by the United Nations development program and J. Goodhand, it is stated that,
“Partly as a result of the dire economic state, some Afghans have turned to trade in
narcotics and precious stones, such as lapis, and the smuggling of weapons” (qtd. in
Brennan et al 217). In fact, “Afghanistan is thought to account for the production of 87%
of heroin and opium consumed worldwide” (Riphenberg 508).
Research obtained by the Central Intelligence Agency and United Nations
Development Program indicate that, Afghanistan’s “per capita yearly income is estimated
to be between US$200 and $800, making Afghanistan one of the poorest and least
developed countries in the world” (qtd in Brennan 216). The country does have many
untouched natural resources, including natural gas, coal, copper, lead, zinc, iron ore, salt,
and precious stones. “Unfortunately, ongoing instability in certain areas of the country,
remote rugged terrain, and inadequate infrastructure and transportation network have
made mining these resources difficult, and there have been few serious attempts to further
explore or exploit them” (Afghanistan Overview). In the 1980s, natural gas sales were
$300 million a year for export. However, they were capped from fear that the mujahideen
would damage them after the Soviet troops withdrew in 1989. “Restoration of gas
8. Rybicki page 10
production has been hampered by internal strife and the disruption of traditional trading
relationships following the collapse of the Soviet Union” (Afghanistan Overview).
Access to technology is very limited in Afghanistan because for a long period of
time it was controlled by the Taliban and also because it is still a very poor nation, one of
the poorest and underdeveloped countries in the world. Everything from the internet,
television, radio stations, and even newspapers are controlled by corrupt politicians and
rebels that still remain. “Many Middle Eastern states fear two consequences of the
internet in particular: diffusion of Western political thought and the spread of
pornography” (Riphenberg 512). Most of the population lives in the rural areas that have
no electricity which prevents Afghans from communicating with the outside world. For
Afghans who live near or in the larger cities such as Kabul, have limited or no access to
telephone, television, internet, or radios. “Afghanistan faces severe challenges after its
years of upheaval, from devastated roads to electricity supply that reaches less than 6% of
the population and then for only a few hours every other day” (Riphenberg 518). Not
only does most of the population having no electricity, they also have no access to clean
running water. The water wells that were existing were damaged or have been dried up.
“As a result of the present drought, the worst in years, many regular aquifers that supply
ground wells have dried up, forcing the use of irrigation canals as the only source of
water” (Brennan et al 216).
9. Rybicki page 11
With all the turmoil that has been ongoing in this country throughout many years,
Afghanistan needs serious rebuilding in every aspect from criminal justice, social class,
infrastructure, and healthcare. Their poor economic structure and political order has to be
improved in order for the country to be self sufficient. Education and healthcare needs to
be available to Afghans in the small rural villages. Because of all the internal conflict,
there were many healthcare professionals that were either killed or forced to leave the
country. As indicated by author Gebreel AO in the article titled, “Afghanistan: a nation
beset by war”, “The Taliban attempted to purge all civil servants, including physicians,
who had any link with the former government or who did not support their “Holy War”,
thus further depleting the already decimated medical and professional classes” (qtd. in
Brennan et al).
One of the many health issues that Afghanistan’s internal conflict has affected is
that there are too many unnecessary maternal and infant mortality deaths. “The infant and
under 5 mortality rates are 165 and 257 per live 1000 live births" (Ahmad 1301). For the
maternal mortality rate according author Abir Ahmad in the article “Health and Money in
Afghanistan” it is said that
The maternal mortality in Afghanistan (1600 per 100 000 live births) is
one of the highest in the world; every 20-30 minutes a women dies
because of pregnancy related complications. Badakshan, in the northeast
of the country, has the worst rate ever reported: 6500 maternal deaths per
100 000 births.
10. Rybicki page 12
Badakshan has “more maternal health facilities than many of the less peaceful
provinces such as Helmand. For its population of 351,000, Badakshan has 106 midwives,
10 female obstetric experts and 73 health centers” (Bainbridge 447). Many of the rural
villages have limited or no essential obstetric care services to be sure the mother and
baby are doing well. “Health facilities had been damaged or destroyed during the years
of fighting and, in many rural areas, neither facilities nor trained health workers were
available” (Ameli and Newbrander 920).
Not only were the health facilities damaged or destroyed, but so were the few
paved roads that the country has, making it even more difficult for pregnant women to get
medical treatment. “The country only has about 2000 miles (3218 km) of paved roads”
(Riphenburg 519). For most of the rural area, the only ways of travel is by donkey or
horse. With the limited number of clinics, lack of transportation and impassable roads
makes it almost impossible to get the necessary medical treatment that is needed for
mother and baby in a reasonable amount of time. “Only 8% of women receive prenatal
care, and only 8% of births are attended by trained personnel” (Brennan et al 218).
Afghanistan is divided into 330 districts, “only 35 % of the 330 districts have maternal
and child health clinics” (Brennan et al 218).
Another issue with the health care system in Afghanistan is children not having
the needed immunizations for preventable deadly viruses. Even if infants survive
delivery, there still have been thousands of preventable deaths of children under the age
of five years old due to lack immunizations. “After the fall of the Taliban government in
11. Rybicki page 13
December 2001, there were concerns about a widespread measles outbreak against a back
drop of low routine measles coverage, poor access to health care and crowding among
displaced persons” (Salama et al 257). Measles is a very contagious virus that can lead to
death, especially with undernourished and unimmunized children. Since measles is a very
contagious, it can spread rapidly through these small overcrowded rural villages
devastating many lives. Author Peter Salama et al, indicates according to statistics
obtained by the CDC and WHO:
From 1998-2001, only 40-47 per cent of infants aged less than one year in
Afghanistan reportedly received one dose of the measles vaccine (CDC,
2003); coverage was low because of the collapse of the public health
infrastructure, insufficient material and human resources and logistical
difficulties connected with the terrain. During this time, measles
accounted for an estimated 35,000 deaths per annum in Afghanistan,
nearly all preventable by immunization (WHO, 2001). A 2001 survey in
Kohistan District revealed that 15.7 per cent of all deaths in children less
than five years in the preceding six months were due to measles (Assefa et
al., 2001)
These deaths, as well as deaths caused by acute respiratory infections, diarrheal
diseases, malaria, and malnutrition could have been prevented if more or improved
healthcare facilities were made available to these poverty stricken villages. According to
studies by the World Health Organization in 2000, the healthcare system in Afghanistan
12. Rybicki page 14
“ranked 173 out of 191 nations” (qtd in Brennan et al 218). Afghanistan had 823 medical
facilities, hospitals, or clinics for their large population, some that were not even
functioning because of all the damage that was done during all the conflicts. “In 1996, 8
of the 14 hospitals in Kabul were not functioning because of damaged infrastructure and
lack of critical supplies and staff” (Brennan et al 218). Unfortunately, damage to the
facilities and lack of staff is still a major concern for their poor healthcares system.
13. Rybicki page 16
In order for any improvements to be made to the health care system in
Afghanistan, its economy and political order needs to be stabilized. There have been
efforts to help women, infants, and children that are in the most need of medical
treatments. As stated by Omid Ameli and William Newbrander:
To improve the health care rapidly, the Ministry of Public Health (MOPH)
of Afghanistan developed the Basic Package of Health Services (BPHS) to
deal with those areas in which the country faced its most pressing health
related problems: maternal and neonatal health, child health immunization,
nutrition, communicable diseases, mental health, disabilities and the
regular supply of regular medicines.
This campaign was implemented after the fall of the Taliban in 2001 to see what
it would cost per person to get the much needed healthcare for an individual. Many
agencies volunteered to be donors to this cause including United States Agency for
International Development, the European Commission, and the World Bank. Researcher
Kahbir Ahmad, indicates Afghanistan received $67 per person from foreign aid in the
years 2002 and 2003, which is considerably less than other countries that were in need of
foreign aid.
Another organization in 2001, The Ministry of Health (MoH) of the Transitional
Islamic State of Afghanistan, implemented a campaign to help children by giving the
vaccination for prevention of the measles virus. Volunteers had traveled throughout
14. Rybicki page 17
Afghanistan and vaccinated an estimated 11.5 million children ages 6 months to 12 years.
This organization also did a follow up campaign as well in the year 2003.
Foreign Aid from “hundreds of other groups have been providing emergency
assistance and development program in health, food relief and education” (Brennan et al
220). According to World Health Organization, 70% of Afghanistan’s health care is
received from an outside agency. It is unfortunate that as “a consequence of the fall of the
Taliban there is less security” (Brennan et al 221). These humanitarians put their own
lives at risk daily to help and “armed gunmen have hijacked cars, trucks, and
ambulances” (Brennan et al 221).
15. Rybicki page 19
In conclusion, even with all the efforts from foreign aid that is provided to
Afghanistan, this country still needs assistance to help rebuild the health care system.
When their economy and political conflicts can be stabilized, the start of rebuilding of
damaged healthcare facilities and building of new facilities can be implemented. Before
this can be done, the whole country needs to start out with the basic essentials to improve
their quality of life. They need to have electricity and sanitary running water needs to be
maintained throughout the country in order to begin this long process. Also, everyone
should have access to a good educational system for both men and women. I feel if this
can be provided, Afghans should be able to function as a whole and boost not only their
self esteem, but economy as well.
There are many things that I would suggest to help to implement a functioning
health care system. The first thing that would have to be done is to have all the existing
facilities repaired and staffed, especially with more women since that is a big concern for
Afghan women. Secondly, have all the roads that were damaged repaired so the Afghans
would be able to travel to the facilities. Thirdly, there would have to be both more roads
and facilities built to reach all the Afghans in the rural areas. Finally, it is impeccable to
educate Afghans on basic sanitation to prevent future disease and illness.
This country has been in turmoil for centuries and even though the need for health
care improvements is very important for the survival of the people, there are many much
needed steps that need to be taken beforehand. As far as where to start can be debated,
16. Rybicki page 20
but something needs to be done. Unfortunately, it is going to be a long process and many
more years before Afghanistan will ever be considered a full functioning nation. The
proper health care facilities are desperately needed for the survival of Afghans. The
ongoing internal conflict between all the people that call Afghanistan their home has been
the biggest obstacle going on for centuries and still continues to this day.
