Fundamental Principles in action

Neutrality

In Afghanistan, the arrival of humanitarian organizations in remote areas is sometimes perceived as an intrusion and met with suspicion. In this context, the Afghan Red Crescent Society stresses the principle of neutrality as a vital tool in bringing humanitarian relief.

After walking one hour carrying her baby in her arms, Aki finally reaches the Afghan Red Crescent Society clinic in Danishman, a village in the Chakad Dera valley in a remote corner of Kabul province. Since the clinic opened this morning, patients have been flocking here, the entrance hall gradually filling up with a noisy crowd. Children run about. A queue of mostly women builds up in front of the pharmacy, where Karima, the person in charge, is handing out free medicines.

Mothers sit on the floor surrounded by their children, waiting their turn in the consulting rooms. Amid the commotion, a man in a white coat calls out: “Polio vaccinations over here.”

Aki jumps up and goes over to Salang Shah. The elderly nurse with a grey beard has been working in the area for 20 years. It is a mere 20 kilometres from the capital, yet the population seems to lack everything. Many villages have no electricity, only the main roads are tarmacked and drinking water is drawn from wells.

Afghanistan remains one of the world’s poorest countries, with an infant mortality rate of 130 per 1,000 births, according to the Afghan Ministry of Health. This exceptionally high rate can be attributed largely to poor hygiene and lack of health infrastructure.

In this context, the Afghan Red Crescent (along with the ICRC, the IFRC and other partners) provides much-needed health care, from vaccinations to consultations, and first aid in areas of the country where most other humanitarian organizations cannot go. An essential part of this access is the National Society’s base of volunteers who live throughout the country — even in areas affected by heavy fighting — and their adherence to principles of neutrality and impartiality.

“We regularly remind staff of our principle of neutrality,” says Zelmalaï Abdullah, director of the Afghan Red Crescent’s Polio Programme. “Political or ethnic affiliations don’t matter to us; we are just here to treat people.”

One of the Afghan Red Crescent’s strengths is that it is well rooted in the local population, he notes. “This clinic and the land it is built on were donated by the local community,” he says. “Without their help, we would not be able to take a single step.”

Salang Shah, the nurse in charge of the district vaccination programme, visits the villagers frequently. To gain people’s respect, he seeks the support of local chiefs. “We go first to see the malek [chief] of the village and heads of household, regardless of their ethnic origins. Even if the village has a mixed population, we speak to the leaders.”

The conflict here is complicated by rivalries between the country’s different ethnic groups. In Chakad Dera, Pashtuns and Tajiks, who clashed violently in the 1990s, live side by side. But Salang Shah has succeeded in reaching all sectors of the population by taking care to respect local customs. He is accompanied by a nurse who treats only women. Without her, many female patients would not be able to benefit from important health services.

Neutrality on the move

Not far from Danishman, a 4x4 vehicle travels up a rutted track, crosses a river and then climbs to a village of mud houses. It’s the first stop of the day for the Afghan Red Crescent emergency mobile unit (EMU). The Kabul-based team does the rounds of the most isolated and destitute villagers in the province. Rahum Dal, a nurse, pours the contents of a capsule into the mouth of a little girl brought along by her mother.

“I am Tajik, but I have no problem because we are doing our work,” he explains. In this Pashtun village, the inhabitants greet the team enthusiastically. The malek says he now wants the Afghan Red Crescent team to stay here permanently.

That the Afghan Red Crescent can blend into the local landscape is largely due to the motivation and training of its staff, as well as its roughly 40,000 volunteers who also respond to the country’s frequent natural disasters. In April 2010, for example, they were on the scene when an earthquake struck Samangan province; the next month they were responding to flash floods that affected 101 districts in 20 provinces.

Still, many people in the country need to see a humanitarian intervention personally before they understand the National Society is there solely to help vulnerable people, says Mohazamat, an 18-year-old student and volunteer. “I am based in Kabul, but last year I was called up urgently to work in Ghazni after the earthquake,” she says. “Someone had crashed his car and was bleeding profusely. So I bandaged him up. To begin with, people didn’t understand what we were doing or who we were. But in the end, they thanked us, because as there was no hospital nearby, without us they would have had no help.”

These overlapping humanitarian imperatives make for an extremely complex aid environment, with National Society staff and volunteers coping with both emergency response and long-term public health issues against a backdrop of ongoing conflict.

During an offensive by the international military forces in Helmand province in 2010, for example, the Kandahar EMU worked in the agricultural district of Marja, helping those displaced and affected by the fighting. As well as treating war-wounded — including women, children and elderly people — the team arranged health-education sessions on issues such as malnutrition and hygiene.

In some combat zones, volunteers are the only ones able to treat the sick, and they can be an essential part of longer-term health initiatives such as polio and measles vaccinations, acknowledges Arshad Quddus, head of the World Health Organization’s vaccination programme in Afghanistan.

“The greatest number of polio cases is in the high-risk areas of Helmand and Kandahar provinces,” he says. “In the mid-2000s the disease spread owing to the upsurge of fighting. The violence prevented us from reaching populations in the south. Fortunately, trained Red Crescent volunteers from the local communities have been able to carry out vaccination campaigns.”

In March, the Afghan Red Crescent was officially asked by the Ministry of Health to carry out polio eradication campaigns in the south, where government and other international teams cannot go due to the fighting. Much of the field-based health work here is done in cooperation with the ICRC, which helps arrange ceasefires between the warring parties for safe passage during vaccination or other health campaigns.

A complex humanitarian space

The perception of the Afghan Red Crescent’s neutrality is critical in a country where many health and redevelopment efforts are being carried out by agencies and non-governmental organizations that combatants perceive as being associated with the agenda of the Afghan government and the international forces. In many areas of the country, for example, United Nations’ health initiatives are severely hampered by the organization’s perceived lack of neutrality due to its role in authorizing and supporting the foreign intervention and the construction of the new Afghan state.

Still, respect for the Afghan Red Crescent Society’s unique mandate cannot be taken for granted. Every mission is risky and many areas of the country are still considered too dangerous for even locally based National Society volunteers to work freely. Given that the Afghan Red Crescent’s top leadership is appointed by the Afghan government, acceptance of its neutrality cannot be assumed to be universal.

Over time, however, the Afghan Red Crescent has won considerable respect on all sides due to the impartiality of its work on the ground. A case in point is its commitment to evacuate the bodies of fallen fighters from the ranks of both Taliban and government forces — and returning them to their villages or families for burial. Along with the ICRC, they also provide prisoners with a means of communicating with their families: each year, more than 10,000 messages are conveyed between families and detained relatives.

 But in a country embroiled in a constantly evolving conflict, even hard-won understanding with warring parties is never entirely on solid ground. When the leaders of opposition forces are killed in the conflict, communication with those forces becomes more difficult. As younger leaders take over, the Afghan Red Crescent must make new connections, build respect and explain the mandate to the next generation of fighters.

At the same time, there has been a proliferation of armed groups, many of which don’t know about the Afghan Red Crescent’s role and mandate. “A year ago, in order to get clearance for our activities in a region, we had to call on one or two people; now we have to contact 30 or 40,” says Walid Akbar, who is director of communications at the Afghan Red Crescent Society.

Dangerous work

Neutral or no, working in the crossfire carries extreme risks. “It happens that the intelligence services sometimes arrest and question our volunteers,” says Akbar. Volunteers can also be killed just by being in the wrong place at the wrong time. In 2010, 11 volunteers lost their lives (most due to fighting).

One of the most recent tragedies was the death in May 2011 of 22-year-old Mohammad Rafiq Azizi, who was killed by a suicide bomb attack in the western city of Herat while on his way to the youth club where he taught English to other Red Crescent volunteers.

This atmosphere of constant danger is one reason Afghan Red Crescent personnel receive intensive training on the principle of neutrality, says the organization’s president, Fatima Gailani (see interview). But it has also happened that staff and volunteers break with the Fundamental Principles. “In the last six years, two of our employees were found guilty of not respecting our rules and they were expelled,” Gailani says.

 This type of neutrality is not only essential when working between opposition fighters and coalition forces, but also while serving people in a vast region composed of numerous ethnic groups and tribes to which volunteers may also belong.

“The most important thing for us is knowing how to help people,” says Mohazamat, the young female volunteer who believes the principle of neutrality is well respected within the volunteer corps. “We make no distinctions within the Red Crescent.”

Despite the danger and complexity of the work, her enthusiasm is not dampened. “Neutrality has a great significance for me,” she says. “It means helping every person. My greatest wish in Afghanistan is to help people.”

Salang Shah, a nurse at the Afghan Red Crescent clinic in Danishman village, speaks with a young mother, Aki, who wants her child to be vaccinated against polio. One of 37 similar facilities around the country, the clinic is a vital resource for basic health care in an area of desperate need.
Photo: ©Vincent Pulin

An Afghan Red Crescent doctor with one of the National Society’s Emergency Medical Units explains to a cholera patient’s husband how to best care of his wife.
Photo: ©Ali Hakimi/IFRC

INTERVIEW

Fatima Gailani

President of the Afghan Red Crescent Society

Neutrality is one of the key Fundamental Principles of the Movement. What does it mean to be neutral in Afghanistan? In a conflict situation, if we don’t stay neutral, we undermine our purpose and gain no respect.

Is it difficult to convey your mandate to the country’s authorities? When the current war broke out ten years ago, we had a lot of trouble gaining recognition of our work. Very few people understood our neutrality. But today the authorities know what our duties are towards all people, be they pro-government or otherwise.

We often have to remind ministry officials and provincial governors of our role when they take up their functions. I tell them that we are auxiliaries to the government and that we must act in a neutral manner and thus take care of everyone. In 90 per cent of cases, this goes down well. We have encountered a few more problems with the next level down, where tribal allegiances can sometimes prevent us from doing our work.

And how well is it accepted by anti-government groups? Unfortunately, they are increasingly unaware because they are getting younger and younger. The previous generations knew us and caused us fewer problems. However, the new generation can also see, for example, that we evacuate the bodies of insurgents who have been killed in combat. They know that we will take care of their remains and hand them over to their families.

What would happen if the Afghan Red Crescent was not perceived as being neutral? Would your personnel be in greater danger?  Of course. Twenty of our volunteers were wounded and 11 killed in 2010. They were not the targets of attacks; they were caught in the crossfire. To evacuate a body or administer first aid, you have to be in the conflict zones and in these places there is a strong likelihood of being hit by a bullet.

Neutrality partly explains the ability of the Red Crescent to access conflict zones. Are there places that are still off-limits? If we don’t go into certain areas, it is not because we are not allowed to, but because we believe that our volunteers risk being killed. That is why we say that we have 95 per cent coverage of the territory. Heroism has its limits. We do not want to take pointless risks.

Recently the United States Agency for International Development (USAID) wanted to donate funds to the Red Crescent but you refused. Why was that? The only emblems that we bear are those of the Red Crescent and the Red Cross. We prefer to receive money through the ICRC or the IFRC. Maybe it would have helped us in the short term if we had accepted USAID’s offer, but it would have harmed us in the long term. Neutrality requires constant vigilance, and it is not a foregone conclusion… in Afghanistan, we apply this principle every day. It is very clear to us.