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BMJ No 7124 Volume 316 Letters Saturday 3 January 1998
Humanitarian issuesPaediatrician needed in Kabul
Editor, Extreme poverty induced by 18 years of conflict in Afghanistan has
led some families to place children in the state orphanage in Kabul.
This institution contains 396 boys and 52 girls aged 3-15 years; 78%
of the children have at least one living parent, 14% have close
relatives, and 8% are without a family. They exist in a partially
destroyed building with one outside hand pump for water and no sewerage
system; faeces litter the floors. The children wear little more than
rags and few have shoes (usually the plastic kind worn by our children
when on the beach). Hygiene is poor, with five children sharing one
towel. Serious and recurrent infection is common and results in
children being admitted to the Indira Ghandi Children's Hospital,
where similar conditions prevail. There is no heating and during the
winter the temperature inside the building reaches -20°C. Access of
girls to the open air is restricted to the roof (which has a 1 m ledge
around it and is their open toilet). Eighteen girls have recently
'fallen' 20 m to the ground below. In bedrooms 6 m by 7 m there
are 23 beds.
Maliha, aged 13, has written:
'When I was eight my father was on his
way to work when a rocket hit him and he died. We cried a lot, but no
hope. Three years after his death my mother was also martyred by a
rocket. We were with our uncle; he is a very kind man. He is
taking care of us much. After one year of the death of our mother
he put all four of us (two brothers, one sister, and me) in the
orphanage. We suffer a lot, but what to do. Our uncle is coming on the
weekend and taking us home for two days.'
The Department for International Development(2) has provided
funds to Children in Crisis and Child Advocacy International to return
as many as possible of these children to their families or to foster
homes. A paediatrician is needed (see paediatrics section, classified
supplement) to examine the children, treat illnesses, monitor growth
and development, and educate local nurses and social workers to sustain
the programme.
This is an opportunity not only to address an issue of human rights but
also, if it succeeds, to highlight a way of helping the many thousands
of other children within similar institutions around the world.
David Southall,
Professor of
paediatrics
email: cai_uk@compuserve.com
References
1 Nathanson V. Humanitarian action: the duty of all
doctors. BMJ 1997;315:1389-90. (29 November.)
2 Secretary of State for International Development.
Eliminating world poverty. A challenge for the 21st
century. London: Stationery Office, 1997.
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