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Critical condition


An interview with Reto Stocker, ICRC’s head of delegation in Afghanistan.
The dramatic rise in war casualties taken to Mirwais Regional Hospital in Kandahar, supported by the ICRC, is just one sign that the situation in Afghanistan is worsening. The proliferation of armed groups, the recent killing of aid workers and continued conflict make delivery of humanitarian assistance a daunting challenge. For civilians caught in the crossfire, the situation is even more dire. Every day, mothers bring their sick children to the Kandahar hospital too late because they are afraid to travel or are held up by roadblocks.

“This is just the tip of the iceberg as those who suffer other sorts of injuries or contract disease as an indirect result of the conflict far outnumber weapon-wounded patients,” says Reto Stocker, head of the ICRC delegation in Kabul. “The result is that children die from tetanus, measles and tuberculosis — easily prevented with vaccines — while women die in childbirth and otherwise strong men succumb to simple infections.” In a recent interview, Stocker spoke about the challenges facing aid delivery and suggested that humanitarian assistance in Afghanistan faces a precarious future.

What is the main challenge for the ICRC in its humanitarian work?
Being close to those in need is the most important and the most challenging aspect of our work in Afghanistan. We can only deliver our services by physically being where it matters most.

In Afghanistan, most places were easily accessible until the military intervention in 2001. Early in 2003, the country became significantly more dangerous for humanitarian personnel, a development that culminated in the murder of an ICRC delegate. That marked the end of humanitarian access as we knew it, and the beginning of a fully-fledged insurgency.

By initiating or resuming substantive dialogue with all warring parties, not taking sides and not discriminating among those we set out to serve, we at the ICRC have managed to assist war-affected people in many places — often in partnership with the Afghanistan Red Crescent, which is active in most parts of the country, and to expand our presence in the north and south. The ICRC’s humanitarian operation in Afghanistan is currently its largest in the world in terms of resources committed.

The ICRC often refers to itself as a neutral intermediary in armed conflict. Can the ICRC also help other organizations to deliver important services to people in this dangerous environment?
Yes, we do sometimes help other humanitarian organizations that have a crucial service to offer but find it hard to deliver it due to the complex and unsafe environment. For example, for some time now we have been helping out with a crucial vaccination campaign by getting parties to the conflict to agree that it is needed and to allow it to go ahead. International humanitarian law recognizes the need for a neutral and independent intermediary that all parties to conflict can turn to. In precisely that role, we assist in hostage releases, evacuate battlefield casualties and put families in touch with relatives detained by the opposite side, to mention just a few of our activities.

Has it become easier or more difficult for humanitarian organizations to reach people in need of aid?
The degree to which we have been able to reach people in Afghanistan in order to deliver crucial humanitarian services to them has evolved considerably over the years since 2002. Immediately after the 2001 military intervention, many humanitarian organizations were encouraged to integrate humanitarian activities into the overall military and political strategy of stabilization and reconstruction, an approach that we at the ICRC did not follow. That led to some aid agencies being perceived as not having solely humanitarian objectives. As a result, their access to certain parts of the country was hampered.

Recently, however, many humanitarian organizations have sought to distance themselves from the political and military realm, in order to work along purely humanitarian lines while adopting a neutral and impartial approach. This is a recognition on their part that the only way for humanitarian organizations to operate across front lines is to have exclusively humanitarian motivations and not to take sides. This has led over the past three to four years to greater acceptance of some of the organizations, which, as a result, have had better access.

This year, several medical staff from an international aid agency were killed in the north of the country. Have you considered using armed guards or taking similar measures to protect your staff?
First of all, there is no such thing as absolute security in Afghanistan — not for us at the ICRC and not for anyone else. To come back to your question, the answer is no. We do not have armed guards protecting either the offices or the residences used by our 1,600 staff, and we do not use bullet-proof vehicles. We believe that our security derives mainly from the trust and acceptance we enjoy in Afghanistan. Building higher walls around our offices or hiring armed guards would, in our view, be counter-productive and would distance us from — rather than bring us closer to — those we are here to serve.

What’s the outlook for the months and years to come?
Two main factors are likely to influence what happens. On the one hand, the degree to which ordinary people and the warring parties come to accept that humanitarian organizations are truly neutral and impartial, that they are performing their tasks for purely humanitarian reasons, will matter a lot. On the other hand, armed groups and other parties to the conflict seem to be proliferating. In our experience, it is easier to reach people in a given place when you have only two or three distinct parties to negotiate access with than when you have a different armed group for each region, district or even village.

Ordinary people, as always, pay the price. More armed groups usually means more violence and suffering, and therefore more need for the aid provided by organizations such as ours. More armed groups also means significantly more difficulty faced by organizations like the ICRC seeking to reach the victims, therefore leaving even more people needing help, and so  on. It’s a tragically vicious circle. Unfortunately, we are concerned that that is the way things could be headed.

1 Reto Stocker ©
Marko Kokic/ICRC





“Those who suffer
other sorts of injuries
or contract disease as
an indirect result of
the conflict far outnmber weapon-wonded patients.”





At Kandahar’s Mirwais hospital, ICRC and local medical staff treat an increasing number of war wounded, as well as those suffering indirectly from the conflict.
©Jan Powell/ICRC





Casualties double
The number of war casualties taken to Mirwais Regional Hospital in Kandahar for treatment is hitting record highs. Supported by the ICRC, the hospital registered close to 1,000 new patients with weapon-related injuries in August and September 2010 as compared with just over 500 during the same period in 2009.

New prosthetics centre
The ICRC opened a seventh prosthetics/orthotic centre in the country, in Lashkar Gah, Helmand province, to address the drastic increase in the number of weapon-related amputations in southern Afghanistan.

First-aid training
Since March, the Afghanistan Red Crescent has trained over 500 Red Crescent volunteers in first aid as part of its community-based first aid (CBFA) programme. There are more than 23,000 CBFA volunteers around the country. Often, they are the only trained persons capable of providing basic health services in their areas.

©Jan Powell/ICRC



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