Desparate
Need
Afghanistan's
health and human development indicators are among the worst in the
world. The health care system has been in an escalating crisi since
the days of the Soviet Invasion. By year 2000, the World Health Organization
ranked Afghanistan's health care system 173 out of 191 nations. In
Afghanistan, the average life expectancy is an estimated 45 years
for men and 46 years for women. compared respectively with 74.5 and
80 years in the United States of America. (WHO, 2002)
During
the 1980s and 1990s, most educated Afghan health care professionals
were killed or fled Afghanistan. The rule of the Taliban further decimated
the ranks of the medical and professional classes as a result of the
purges of the civil service. Ultimately, women would be denied access
to what little health care remained available. (Lancet,
2002) Today, virtually all medical care is supplied
by international relief agencies. As with all humanitarian aid, rural
areas are underserved compared with urban areas. The health care crisis
in Afghanistan is exacerbated by undernourishment, low or non-existant
immunization, and poor access to clean, potable water and sanitation.
) The precarious security of the provinces beyond Kabul have made
it difficult for NGOs to provide health care assistance. NGOs often
suspend their activities because of robbery, murder, intimidation,
and rape at the hands of armed factions.
Challenges
The
following list summarizies the most immediate and accute challenges
facing the health care sector in Afghanistan:
-
reproductive
health : one woman in three dies of pregnancy-related complications
every 30 minutes in Afghanistan. There is a dire need for emergency
obstetric care, female doctors, nurses, and midwives. 90 % of
the maternal deaths during child-bearing would be preventable
with adequate health care.
-
child
health : Afghanistan has one of the highest rates of infant
mortality in the world. One-fourth of Afghan die before the age
of 5. Acute malnutrition in children is estimated to be around
10% and chronic malnutrition malnutrition is about 50%. Afghan
children are also extremely vulnerable to diarrhoeal disease due
to the lack of clean water and sanitation. There is no routine
immunization.
-
communicable
disease control : Afghanistan suffers from a high proportion
of illness and death due to communicable diseases such as cholera,
tuberculosis, malaria, menigitis, hepatitis, typhoid, childhood
respiratory infections, and diarrhoea. (WHO, 2002)
-
mental
health : due to 23 years of incessant warfare, most Afghans
are suffering from some level of stress disorder and depression.
Malnutrition has contributed to the rates of mental illness among
children. Mental health resources are sorely lacking with only
three mental health units to serve the entire country. A recent
WHO count found only 8 psychiatrists, 19 psychiatric nurses, and
20 psychologists in all of Afghanistan. (WHO,
2002)
-
Injuries/disabilities
: injuries and disabilities are commonplace in Afghanistan due
to UXOs, landmines, and gunfire. Afghanistan is one of the most
heavily mined countries in the world and has recently been freshly
mined with American cluster bombs. 600 Afghans are estimated to
be killed or wounded by mines every month. Any significant diability
is guaranteed to increase the odds of a desparate quality of life.
The 2001 Iranian film Kandahar (Safar e Ghandehar) captures this
tragic reality in a scene featuring the air drop of prosthetic
legs in a rural area in Kandahar province as amputees race on
crutches for the prostheses. (ICBL, 2002)
-
collapse
of health care sector : 23 years of war has caused a collapse
of the health care infrastructure in Afghanistan. Health care
facilities have been destroyed and neglected ; the number of health
care professionals has been depleted by war casualties, political
purges, a brain drain, emigration, and the restriction on female
education.
Prescription
for Reconstructing the Afghan health care System
War, poverty, politics, and religious
stricture have all played a role in the health care infrastructure in
Afghanistan. The international donor community must provide significant
financial and technical support to ensure the reconstruction of Afghanistan's
health care system. Afghanistan's future stability and socio-economic
development depend on an investment in meeting both short-term and long-term
goals:
-
education and training of health
care workers, including women
-
delivery of services to rural
areas
-
preventative, curative, and rehabilitative
services
-
emergency obstetric care
-
child immunization
-
inauguration of health management
information systems
-
mental health services
-
rehabilitation services for the
wounded and disabled
-
distribution of pharmaceuticals
-
improvement of water treatment
and sanitation systems
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