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Attacks on Afghan hospitals hit children the hardest

Krista — 2017-03-06T12:09:20Z

An Afghan father recently described how his 15-year-old son lost both feet after stepping on a mine. He couldn't get proper care in Kunduz City – the only trauma centre there had been destroyed – so he took a taxi more than 200 miles to Kabul. By the time his son received treatment, it was too late.

“Both of his legs had to be cut off from just below the waist, because the bones were ruined and he had a serious infection,” the boy's father said. "For one week, he was ok, but then, from the infection, he went into a coma. Ten days later, he died in the hospital."

This is one of the many brutal stories I heard during a trip to Afghanistan, where I travelled in November to research the impact that targeted attacks on medical facilities have on children's health. Children and their parents, health workers and humanitarian staff repeatedly told my colleagues and I how these attacks have compromised access to critical healthcare and devastated children's lives. In a country already among the world's most dangerous for aid workers, clinics have become battlegrounds and medical professionals are on the front lines of the conflict.

New report

Over the last two years, the Taliban, Afghan government forces and other groups have committed more than 240 attacks on medical facilities. These violate humanitarian laws and erode an already extremely fragile health system. In a report released today, we show how these unlawful attacks have damaged or destroyed clinics and hospitals, and killed or injured many health professionals. Others have been forced to leave their jobs or flee, and many patients have been afraid to seek care. Children have suffered greatly: casualties have increased, along with rates of malnutrition, diarrhoeal disease and vaccine-preventable diseases such as measles and polio.

Instead of places of healing, clinics and hospitals have become targets in Afghanistan's escalating conflict. Attacks have been so frequent that one health director told us that many go unreported. Attacks have taken place in at least 20 of the country's 34 provinces, making it difficult, if not impossible, to access healthcare in many areas. In one case, a 15-year-old girl suffering from meningitis took a week to reach a hospital. She died shortly after getting treatment.

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Warring parties have also closed medical facilities, and stolen medical supplies and ambulances. They have threatened, detained and killed medical personnel. A health vaccinator told us that when the Taliban caught him administering polio vaccines, they warned him they would kill him if he continued. He felt threatened again when fighters with the so-called Islamic State entered the area, and he later left his job.

“I have seen with my own eyes, in an area of 100 metres there are three kinds of leaders: Taliban, IS and government,” he said. “Our clinic was in the middle of the conflict, so even though it is my job, I had to stop, otherwise I thought either the IS or Taliban would kill me.”

Such cases of threats and extortions are far from unique. In February 2015, a group of unidentified men shot and killed a social mobiliser for a polio programme run by UNICEF. In August 2016, Taliban fighters abducted a staffer of a NGO overseeing a polio vaccination programme.

Impact

The impact of these systematic assaults on the healthcare system and health professionals has been profound. The World Health Organization reported 169 measles outbreaks in 2015 – a staggering 141 percent increase from 2014. More than one million of Afghanistan's children now suffer from acute malnutrition, an increase of more than 40 percent since January 2015, according to WHO.

In Afghanistan, clinics and hospitals are the only places where children can be treated for malnutrition (unlike in Yemen, for example, where there are standalone nutrition centres). When medical facilities are occupied or forced to close, children lose access to treatment for malnutrition as well as other preventable illnesses, such as acute respiratory infections and diarrhoeal disease. These diseases are easily treated if there's access to healthcare, but become deadly without access. When vaccinators cannot immunise children, disease rates also go up.

In 2016, armed opposition groups carried out 95 attacks on healthcare, while Afghan forces were responsible for 23 attacks, according to the United Nations Assistance Mission in Afghanistan. At Watchlist on Children and Armed Conflict, we are calling on all parties to immediately stop these attacks. We're asking the UN secretary-general to name, for the first time, the Afghan forces among those responsible for the attacks (only Taliban forces have been cited for attacks on hospitals until now). Parties listed in the secretary-general's annual report must enter into an action plan with the UN to be de-listed. Action plans include concrete steps regarding preventing attacks, responding to attacks when they occur, as well as showing that attacks have decreased or stopped altogether.

The Afghan government must establish a permanent and dedicated body to investigate these incidents. The government can help stop these attacks by training troops, investigating any incidents and holding government troops accountable. Even during wartime, basic elements of humanity must prevail, and few are more important than ensuring sick and injured children can get medical care.

(TOP PHOTO: MSF hospital in Kunduz, Afghanistan, after the bombing. CREDIT: MSF)

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MSF hospital in Kunduz, Afghanistan Opinion Conflict Attacks on Afghan hospitals hit children the hardest Christine Monaghan IRIN Asia Afghanistan

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The cheat sheet: Somalia famine, Trump orders, and chemical weapons in Syria

Krista — 2017-02-10T17:12:02Z

Every week, IRIN's team of editors takes a look at what lies ahead on the humanitarian agenda and curates a selection of some of the best reports, opinion, and journalism you may have missed:

What's coming up?

Somalia – lessons learnt from 2011 famine?

At some point this month, famine may again be declared in Somalia. Whether or not the “f” word is actually invoked, the country is facing disaster. Five million people, roughly 40 percent of the population, do not have enough to eat because of four consecutive years of drought, exacerbated by fighting between the jihadist group al-Shabab and the Western-backed government.

The emergency has all the hallmarks of the 2011 famine in pockets of Somalia that killed 260,000 people. Have lessons been learnt? We now know that early warning is not enough. Incentives for early action are needed. “There is consensus that the humanitarian response to the famine [in 2011] was mostly late and insufficient, and that limited access to most of the affected population, resulting from widespread insecurity and operating restrictions imposed on several relief agencies, was a major constraint,” said an FAO and FEWSNET study.

The 2011 crisis was politicised by both al-Shabab and donor governments. The various agendas of donors, regional powers, and the warring authorities within Somalia were incompatible with the prevention of famine and hindered the ability of the UN-led cluster system to operate independently and effectively. The bright spots? Market-based interventions (cash and vouchers in particular) worked reasonably well, and non-traditional donors contributed at unprecedented speed and volume, according to a desk review by the Feinstein International Center.

The fate of Trump's ban

The Trump administration's efforts to restrict US admissions of refugees and visa-holders from certain Muslim-majority countries were dealt a blow on Thursday when an appeals court upheld an earlier ruling that the travel ban was unconstitutional. Although most coverage has focused on the impact on people from the seven countries affected, the legal wrangling also has major implications for the US refugee resettlement programme, which had been suspended for four months by Trump's executive order but is now running normally again. A spokesman from the International Rescue Committee, one of nine NGOs contracted to manage resettlement in the United States, told IRIN his organisation had received 350 refugees this week and was expecting 350 more next week. That could change if the Trump administration successfully appeals the ruling at the Supreme Court. With one seat still vacant though, and four Democrat and four Republican appointees, there's a high chance no majority decision will be reached.

To conflict-free or not to conflict-free?

If you haven't been reading a lot about the Democratic Republic of Congo and conflict minerals, you better start now. There are reports of another imminent Trump executive order, this time rolling back a rule aimed at reducing violence and promoting “conflict-free” minerals in Congo. The rule in question sits inside section 1502 of the Dodd-Frank Act, the law that overhauled financial regulation in the wake of the 2007-2009 global meltdown. The draft executive order, obtained by The Guardian and Intercept, claims to be acting out of concern over “mounting evidence” that instead of preventing minerals from fuelling conflict, the law is actually causing harm and contributing to instability in the region. International aid and activist groups, including Global Witness, are in uproar, claiming Trump's move will embolden criminality and corruption. But many experts beg to differ and suggest the president may actually have a point. Stay tuned. Next week, we'll be publishing a months-long IRIN investigation into this issue. Good timing indeed!

Syria's new “red line”

Next week's also a good time to keep an eye on the UN and Syria: On 16 February, the secretary-general issues his monthly report on the humanitarian situation in the country – generally a long catalogue of where aid has and hasn't made it, plus an updated official list of sieges (if you look hard enough). The day before, expect a report from the Joint Investigative Mechanism – that's the panel meant to investigate chemical weapons use in Syria. It has so far investigated nine cases, concluding that the government of Bashar al-Assad used chlorine gas three times, and so-called Islamic State mustard gas once. It said there wasn't enough information to make a call on the rest. All this comes a month after the United States blacklisted 18 Syrian officials for their involvement in the chemical weapons programme, and France and the UK pushed a resolution to sanction al-Assad for using the prohibited weapons. Russia, no fan of the JIM, reportedly circulated its own draft that focuses on use by non-state groups. It's not clear if any of these drafts will come to a vote in the politically paralysed Security Council, but, with a new sheriff in town in Washington, Obama's old “red line” is once again one to watch.

Changing Humanitarian Action?

Finding references to Buddha and Heraclitus in humanitarian literature is rare, but so opens the background paper to the 20th anniversary conference of the humanitarian learning and effectiveness network ALNAP. Themed around change in the humanitarian sector (Buddha said that “all component things in the world are changeable” and Heraclitus that “change is the only constant in life”), next week's meeting of aid agencies, donors, and others in Stockholm takes something of a different spin on the now common mantra of change in the humanitarian sector. Rather than repeat the long list of changes that should take place, organisers aim to zero in on the anthropology of change: “Despite the time, money and energy that is spent on change, there has been little attention paid to how change actually happens,” they note. Against the backdrop of efforts to implement reform agendas introduced at the World Humanitarian Summit, the conference takes a reflective approach to creating systemic change, hitting on everything from localisation to accountability, from information technology to country-based pooled funds along the way. Full agenda here, including a panel moderated by IRIN Director Heba Aly; audio recordings will be available on ALNAP's website after the conference.

Did you miss it?

Afghanistan's land problem

Millions of Afghans have been forced or pressured to return home over the past couple years, mainly from neighbouring Pakistan and Iran. Aside from the obvious moral issue of sending people to live in a war zone, the influx of returnees has raised a very practical question: where can they live? Funded by the United States, the Land Reform in Afghanistan Program was meant to help resolve this. But according to the latest report by the Special Inspector General for Afghanistan Reconstruction, which is mandated by Congress to track US reconstruction aid, it's been a dismal failure. Hundreds of thousands of people who've been unable to claim land they left when they fled the country are now squatting in the outskirts of urban areas. Land values have shot up and “many current and former members of the Afghan government, including judges, ministers, and parliamentarians, have stolen public and private land.” Already crippled by a war that killed record numbers of civilians last year, Afghanistan's land issues are a source of even further violence. Ownership disagreements are “involved in approximately half of personal and communal disputes”.

For more on Afghanistan's migration crises, see our in-depth page.

What to do with refugees?

As global refugee figures continue to climb, NGOs and the UN have been pushing wealthier countries to increase resettlement – currently a solution for less than 0.5 percent of the total refugee population. Although the fate of Trump's executive order, issued late last month, is unclear, his administration still looks set to reduce the US intake dramatically this year – a major setback for those efforts. The timing of the latest issue of the Forced Migration Review could not, therefore, be better. It features 33 articles on the theme of refugee resettlement, written mainly from the perspective of the agencies that facilitate resettlement programmes around the world, and academics who've studied them. Several articles challenge the assumption that resettlement is the most effective or desirable durable solution, even for the tiny percentage of refugees for whom it is an option. For example, Alexander Betts, director of the Refugee Studies Centre at Oxford University, points out that 70 percent of 100,000 Syrian refugees approached about resettling in Canada in late 2015 said they weren't interested. Other articles consider the question of who gets resettled. Lewis Turner, from SOAS University of London, finds that in the case of Syrian refugees, it is rarely single men, despite their often highly vulnerable and insecure situations in neighbouring host states, while Katherine Knight, from Queen's University, Belfast, looks at how the US's broad definition of providing material support to foreign terrorist organisations has excluded many victims of terrorism from resettlement. The issue also includes several articles on the issue of post-deportation risks and monitoring.

(TOP PHOTO: Donald Trump speaking with supporters at a campaign rally at Fountain Park in Fountain Hills, Arizona. CREDIT: Gage Skidmore/Flickr)

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The humanitarian cheat sheet: Trouble in CAR and WhatsApp for crises

Krista — 2017-02-03T16:45:26Z

Every week, IRIN's team of editors curates a selection of some of the best humanitarian reports, opinion, and journalism you may have missed and looks ahead to give you the inside scoop on hot topics coming up:

Did you miss it?

The nearly man

The death of opposition leader Étienne Tshisekedi this week has deprived the Democratic Republic of Congo of a unique political figure who was at the forefront of the fight for democracy for over three decades.

Arguably, his voice is needed now more than ever. His death plays into the hands of President Joseph Kabila's supporters, who have consistently sought to delay elections, threatening a New Year's Eve accord with the opposition in which Kabila agreed to step down this year and not run for a third term. As African Arguments points out, “his departure robs the opposition of a leader able to combine genuine street-level popularity with an ability to squeeze out political deals. As popular anger mounts, the opposition will have to work hard to rebuild a credible leadership.”

Branding the Taliban

The Taliban cared little about their image when they conquered Afghanistan in the 1990s, and that didn't change after they were overthrown in late 2001 and began a long and ongoing insurgency. But the group seems to have “woken up to the importance of organisational symbols and their political meaning”, according to this report by the Afghanistan Analysts Network. Perhaps the Taliban are inspired by their newest enemy, the so-called Islamic State, which has launched a barrage of propaganda since moving into the region, as we reported this week. This AAN report is part of a series focusing on changes the Taliban are undergoing, and it focuses on their use of a white flag inscribed with an “Islamic statement of faith” and sometimes their official name, the Islamic Emirate of Afghanistan. Unlike the group's previous iterations, the flag is now constantly on display. Among other reasons for this is to “demonstrate to the population that they, not the government, are the legitimate rulers of Afghanistan”, says AAN.

Getting the message

Messaging apps like WhatsApp, Snapchat, and Viber are already being used by more than 2.5 billion people around the world, but humanitarian organisations have yet to get to grips with these new communications technologies and figure out how they can best be used to improve their work, while avoiding potential pitfalls. This report from the International Committee of the Red Cross considers unresolved questions that have held back the use of messaging apps in humanitarian crises, particularly in conflict settings, such as concerns about data protection and security, which messaging app to use, and patchy network connectivity. It looks at how some humanitarian organisations are already using messaging apps to reduce communication costs, coordinate with other staff, and to maintain contact with people in transit, such as refugees, or in conflict or post-disaster situations where other communication methods are unavailable. The report also flags up risks and challenges and provides a handy comparison of privacy-friendly features on various apps.

One from IRIN:

EU strategy stems migrant flow from Niger, but at what cost?

In researching this story on the EU-funded and EU-inspired crackdown on migrants and smugglers in Niger, IRIN Migration Editor Kristy Siegfried unearthed an unexpected news nugget. The EU had been boasting about the effectiveness of its policy of partnering with African countries by using the incorrect main stat that only 1,525 migrants headed northwards from Niger during November. This represented a stunning 88% drop on the previous month's figure of 12,654 and a staggering 98% decline since a summer high of 71,904. Okay, the figure was taken from International Organization for Migration reports, which were later amended, but why did the EU not interrogate such a dodgy figure further and why was it still being used to promote the expansion of the EU's policies to other African nations after the IOM had corrected it?

The bottom line however, as IRIN contributor Ibrahim Manzo Diallo reported from Niger's main transit hub of Agadez, is that the strategy has proved brutally effective at reducing or displacing numbers heading northwards to the Libyan coast, hoping to get passage to Europe. What is less clear though is whether the hundreds of millions of euros the EU is ploughing into development aid to pay for the crackdown will do much in the long run to compensate for what had been a thriving industry. “Before this witch hunt for migrant smugglers began, the young people of Agadez had work,” explains Abdourahamane Koutata, president of the Agadez region's youth council. “Each Monday, they would transport migrants into Libya or into Algeria and earn a lot of money. But now, most of them are in prison.”

What's coming up?

CAR trouble

The UN secretary-general's special representative to the Central African Republic, who also heads the UN's troubled MINUSCA mission, is due to address the Security Council later this month. Parfait Onanga-Anyanga's address comes at a precarious time for CAR. The government of President Faustin-Archange Touadéra has extremely limited control outside the capital, Bangui, and efforts to convince the Muslim-dominated ex-Séléka and Christian anti-Balaka rebel groups to disarm and give up their hold on territory has failed. MINUSCA has also proved incapable of providing the required security.

What to do? This Security Council report lists three possible options: MINUSCA adopts a “proactive approach” and is appropriately financed to expand the areas under its control; countries in the region cooperate and implement the existing sanctions regime to eliminate illicit arms trafficking to the rebel groups and crack down on natural resource exploitation; the sanctions regime is widened to include additional individuals and entities.

The report acknowledges that CAR is not a “top priority issue for the Council”. But it also notes that while “some” Council members are concerned over the financial implications of a more resolute MINUSCA, “there seems to be a consensus that achieving security and stabilising the CAR will necessitate a long-term engagement from the Council” and its peacekeepers. Read into that what you will.

New Yemen appeal

Donald Trump's first special op as commander-in-chief was a disaster by almost all accounts, except of course for that of the new president himself – he's called it a success. The botched 29 January raid on al-Qaeda in the Arabian Peninsula (AQAP) in al-Bayda, Yemen left as many as 23 civilians dead, including 10 children, as well as a US commando. Media coverage was largely drowned out by Trump's actions (and his detractors) at home, but this was still the rare occasion when Yemen made a few headlines, likely a result of the death of a member of SEAL Team 6. Here's hoping the tragedy will also draw a few eyeballs to the country's ongoing humanitarian crisis, because while AQAP is stronger than it has ever been, it's just one of the dangers Yemen's civilians deal with. You can read up on the group and the role it plays in the country's complicated conflict in this detailed and timely report from the International Crisis Group. So what's new? The UN is expected to launch its appeal for 2018 donor funding to Yemen on 7 February. It's said to be asking for $2 billion dollars, up from last year's $1.8 billion ask – that one is only 55% funded. Meanwhile, the bombing and the fighting are surging, and the needs are only growing.

A climate union?

If you're in London and interested in the labour movement's take on climate change, attend this one-day conference on 11 February featuring sessions on migration and the role of unions and civil society in responding to the crisis. Why are unions getting involved? “Climate change is devastating peoples lives and livelihoods and whole economies, and is a growing concern to trade unions for whom effective responses are now a fundamental issue of justice – economic, employment and income security,” say the organisers. One purpose of the conference, they say, is to discuss the need for legal protection of people displaced by the effects of climate change, and to build a movement that will advocate for political leadership on the issue.

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(TOP PHOTO: Ex-Seleka combatants waiting for their Chief in a meeting in Bambari, 400km northeast of Bangui on 8 August, 2014. CREDIT: UN Photo/Catianne Tijerina)

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کابل پرس

Attacks on Afghan hospitals hit children the hardest

Table of contents

New report

Impact

The cheat sheet: Somalia famine, Trump orders, and chemical weapons in Syria

Table of contents

What's coming up?

Did you miss it?

The humanitarian cheat sheet: Trouble in CAR and WhatsApp for crises

Table of contents

Did you miss it?

One from IRIN:

What's coming up?