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Topics
Country Background
Why is Medair working in Afghanistan?
Where in Afghanistan is Medair working?
What are the core issues that Medair is aiming to address?
How is Medair addressing the problem?
medair Who is Medair assisting?
medair Future plans
Presence of Medair in Afghanistan
Facts and figures
Related articles
Related links
Make a donation and support
Medair's life-saving activities

Medair in Afghanistan

Facts and Figures
Population 23,897,000
Beneficiaries 182,291
GDP per Capita 417 $
Life Expectancy
(years) m/f 		41/42
Child mortality
(per 1000) m/f 		258/256
Expenditure ($) 2 000 000
Medair staff 7 internationally recruited staff
  125 locally recruited staff (average)
Main donors
Programmes - Health Services (including food aid=
- Water & Sanitation
- Shelter & Infrastructure (including food security and disaster preparedness)


Related links
  AlertNet - humanitarian aid and disaster news READ MORE
  Reliefweb.org READ MORE


 
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Medair in Afghanistan
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Country Background

Afghanistan continues to progress slowly towards peace, democracy, and development after almost 30 years of war. Afghanistan now has a democratically elected legislature, based on elections in October 2004 and September 2005. Additional progress can be seen in achievements in the health and education programmes: the number of children attending school has increased from 600,000 in 2001 to 5 million today, and 233 health clinics have been constructed or rehabilitated in the same timeframe throughout the country.

However, security remains a critical concern in Afghanistan. Insecurity caused by fighting between military forces and insurgents continues to destabilise the southern and eastern parts of the country and prevents aid from reaching many of the most forgotten and vulnerable people. The high level of narcotics trafficking also affects security levels in many parts of Afghanistan and contributes significantly to the overall destabilisation of the country. Over the last two years, there has been a disturbing increase in the use of Improvised Explosive Devices (IED) and suicide bombers targeted at civilians and internationals, coalition forces, the Afghan military, and police forces. The population is increasingly frustrated with the number of civilian casualties, and there is a growing backlash against internationals working in Afghanistan. The threat to humanitarian agencies is significant and growing, with attacks on – and deaths of – aid workers continuing to increase.

While progress on many fronts has been good, there is much work left to be done, especially in rural and isolated areas where over 60 percent of households do not have access to safe drinking water, and often do not have access to health care. The international community has made many commitments to Afghanistan, not the least of which was the US$10 billion pledged at the London conference in February 2006. However, Afghanistan requires much more effort to overcome decades of destruction, and to combat the years of neglect to its infrastructure.

Why is Medair working in Afghanistan?

While recognising that in accessible locations a lot of progress has been made, Medair seeks to focus on areas which are remote and where the population have critical needs either caused by years of conflict or by natural disasters. As a result, Medair runs health care projects with a focus on maternal care; food aid and food security projects for families whose coping mechanisms have been reduced by the results of conflict and drought; and Water & Sanitation projects to increase the health and survival of the most vulnerable population, especially children.

In the central highlands, Medair is working in the remote areas of Surkhjoy in the Bamyan province and in three isolated valleys of Marak and Dashtak in the north of the Wardak province. While access to the main valley of these regions is quite good, Medair’s target villages are only accessible by foot via a small trail, which can take up to two days walking.

Where in Afghanistan is Medair working?

Medair is currently working in two main locations: Badakhshan in the northeast, and the Waras and Behsud areas of the central highlands. 

Badakshan is one of the more remote provinces in Afghanistan, bordering Tajikistan.  Medair is working in four of its most inaccessible districts, which are only accessible by horse or foot in the winter months. The area is also frequently affected by earthquakes and landslides.

In the central highlands, Medair is working in the remote areas of Surkhjoy in the Bamyan province and in three isolated valleys of Marak and Dashtak in the north of the Wardak province.  While access to the main valley of these regions is quite good, Medair’s target villages are only accessible by foot via a small trail, which can take up to two days walking.

What are the core issues that Medair is aiming to address?

Badakhshan is undoubtedly one of the most underdeveloped and remote provinces of the whole mountainous region of Central Asia. Home to an estimated one million people, the restricted access caused by such disparate and rugged geography has resulted in it being one of the last areas of Afghanistan to benefit from the various regimes which have ruled the country over the last 100 years. During Taliban times, Badakhshan was one of the few areas of the country that resisted the dominance of Taliban forces.  The Taliban were unable to penetrate this mountainous region and, as a result, it remained surrounded and cut off from the rest of the country.

In Afghanistan, Badakhshan has the highest level of production and addiction to opium, as well as the highest level of incidence of natural disasters, with frequent occurrences of flooding, landslides, and earthquakes. Badakhshan is also the province with the highest ever recorded maternal mortality rate (6,500 per 100,000 live births, UNICEF) and an extraordinarily high infant mortality rate (U5MR 397 per 1,000, Ragh - Medair, 2000). While the mortality rate has improved in the last few years, it is still very high.  This is due to the lack of access for the majority of the population to basic health services, which is caused by the lack of health facilities in many areas, lack of qualified competent medical professionals (especially female staff), and lack of communications infrastructure which constrains referral systems.    
 
 

Badakhshan is also the province with the highest ever recorded maternal mortality rate (6,500 per 100,000 live births, UNICEF) and an extraordinarily high infant mortality rate (U5MR 397 per 1,000, Ragh - Medair, 2000). While the mortality rate has improved in the last few years, it is still very high
In the Central highlands, many isolated villages have not yet benefited from the increase in development.  The consecutive periods of warfare, the insecurity around this region, and the rugged terrain have isolated this region, discouraging an adequate level of humanitarian assistance.  The lack of safe water supply, road access, and health clinics challenge the health of the isolated communities, while years of drought and lack of development have created the worst food insecurity in the country.  The Ministry of Public Health, through partner organisations, has begun to implement a health programme in the region, but until now, little work has been initiated in the Water and Sanitation sector. The lack of established health care, along with lack of adequate clean water and sanitation, indicates an urgent need for WatSan interventions in the project area where the risk for outbreaks exist. 

How is Medair addressing the problem?

Medair is addressing the issues through:

  • A Primary Health Care project in four remote districts of Badakhshan
  • An Emergency Centre (maternity care) in one of Medair’s Health Centres
  • Support for rural health services to improve access to health care, including the construction of a new health facility.
  • Sustainable Outreach Vaccination campaign
  • Rural water supply, sanitation, and hygiene promotion in central highlands
  • Food aid before winter for at least 2,000 people in both the Central region and Badakhshan province. Food security projects for a more sustainable solution to food needs in both the Central Highland region and Badakhshan region..
  • Emergency Response to natural disasters in Badakhshan. So far, this has been by responding to actual disasters, but Medair will also be focusing on disaster preparedness and mitigation.

Who is Medair assisting ?

109,100 people in four difficult-to-access districts of Badakhshan depend on the Medair Basic Package of Health Services (BPHS) programme for access to Health Services.

 Over 9,000 children and pregnant women in remote locations of the above districts -- which are far from health facilities -- benefit from the SoS vaccination campaign.

Approximately 1,200 families or 8,400 people are being assisted in the rural villages in the Central region targeted by the WatSan programme.

2,000 vulnerable people (landless households, households with insufficient land to support the family, and households headed by widows or disabled men) in both the central region and Badakhshan province received food aid before the winter set in.

9,500 people from economically vulnerable families will benefit from food security activities, ranging from income generated through work projects on roads and irrigation channels, to the provision of seeds and support with cultivation.

Medair incorporates training in basic hygiene, health, and nutrition into its programme design.

 

Future plans

Medair is seeking funding to implement a community-based disaster preparedness program for three districts in Badakhshan which are prone to floods, landslides, and earthquakes.  This program will help isolated communities in high risk areas to identify their own vulnerabilities to natural disasters. It will also assist in the development of mitigation strategies at community and district levels, while strengthening the disaster management system at the provincial level.  Beneficiaries include the 89,900 people living in the districts of Yawan, Raghistan, and Baharak in Badakhshan Province.

Medair is also seeking funding to construct a Comprehensive Health Centre in the extremely remote district of Khwahan, where almost 25,000 people are unable to access health care during the five winter months, when heavy snow and avalanches cut off access to neighbouring districts.

Medair is further seeking to start its effective Water and Sanitation work in unsupported regions of Badakhshan and the Central Highlands.

 

Presence of Medair in Afghanistan

Medair has been working in Afghanistan since October 1996. It implemented non-food item relief distributions, water and sanitation assistance, shelter projects for returning refugees, food-for-work for urban vulnerable families, drought relief and medical programmes. The medical programmes have included hospital support and health education amongst the poorer communities in Kabul; mobile clinics for IDP affected communities; a baseline health survey; an immunisation campaign in a remote district of Badakhshan province; and providing support to the National TB Institute, while running a large TB treatment programme in the Central region and Badakhshan.

Medair has been working in Badakhshan following an initial baseline survey in 2000. From an initial mobile vaccination team, the programme has developed into a steadily expanding fixed clinic programme supported by an ever larger network of “health posts” run by Community Health Workers.

Over the course of the programme, Medair has been encouraged by the changes that they have been able to witness in the remote areas. In the extremely conservative parts of Badakhshan, women were initially prevented from visiting the clinic, due to the conservative ideas of their families, even when the women were in a life-threatening medical condition. Now, many women attend all the clinics regularly and Medair staff have been able to see momentous behavioural change in this area. Previously there was hardly a single male doctor but currently the Medair programme can boast 10 full-time female medical professionals based in the remote clinics alongside their male colleagues.



Source:
1600 per 100,000 live births (95 5 confidence interval= 1100-2000, UNICEF, CDC-July 2002



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