Return of refugees to Afghanistan catches agencies by surprise

BMJ 2002; 325 doi: (Published 26 October 2002) Cite this as: BMJ 2002;325:924

Peter Moszynski looks at the problems that Afghanistan is facing a year after the United States started its war against al-Qaeda

A year after the United States began its campaign to remove the Taliban from power, Afghanistan still has some of the worst health indicators in the world. Despite concerted international aid programmes and massive funding pledges, lack of infrastructure and trained personnel mean that substantial progress is likely to take years or even decades to achieve.

“Developing a functional healthcare system must be a top priority in the reconstruction of Afghanistan,” said Dr Mohammed Jama, regional coordinator for the World Health Organization. “As long as hundreds of thousands of Afghans continue to die from preventable diseases, a stable future for the country cannot be guaranteed.”

A recent report from the WHO said: “Afghanistan suffers from one of the poorest health conditions in the world. Six million Afghans have no access to medical care. Women are particularly vulnerable, with more than 16000 women dying each year from pregnancy-related causes. One-fourth of Afghan children die before their fifth birthdays, often from preventable diseases such as measles.”

A massive return of refugees from neighbouring countries such as Pakistan and Iran caught agencies by surprise, and continuing insecurity in the provinces has led to an over-concentration of services in Kabul. Currently 50 of the country's 220 districts have no medical facility available and half of Afghanistan's 44 hospitals doing surgery have no means of testing …

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