In Afghanistan, “the humanitarian community cannot be the only actor providing aid to the population”
More than half of Afghans need humanitarian aid in a country where the health system collapsed a year ago after the Islamic Emirate of Afghanistan (IEA) came to power. A change in governance that has also changed the working conditions of NGOs on the ground. Interview with Justyna Bajer, head of mission of Première Urgence Internationale in Kabul.
More than half of Afghans need humanitarian aid in Afghanistan where the health system collapsed a year ago I © Première Urgence Internationale
What were the consequences of the change of regime in Afghanistan on the health system?
Immediately after the return of the IEA to power on the 15th of August 2021, international aid stopped and we witnessed the near-collapse of the health system alongside other public services, as 75% of the government’s expenditure was financed by international community before that date. Today, health staff are not paid through on budget system, but by NGOs directly, that implement the delivery of healthcare. There are many challenges in terms of quality of services, availability of supplies including pharmaceuticals and above all, availability of funds to ensure that minimum standards are maintained. During a field visit this year to Ghazni province (in south-eastern parts of the country), I visited a health facility in a relatively remote area: there was no running water and an electricity grid that often does not provide power. This case is not isolated and occurs oftentimes in areas farther away from a few key urban centers. More generally though, one year later, we have made a lot of progress in terms of involving different stakeholders and building a common understanding that humanitarian aid must be unconditional.
Has the arrival of the IEA in power led to any changes regarding Première Urgence Internationale’s activities, particularly those aimed at women?
We only interrupted our activities for one day last year (on the 15th of August) and only in one of the locations (Jalalabad, eastern Afghanistan) where we are present, out of fear for safety of our teams. Of course, many adjustments in the way we operated were made in the period leading to the regime change itself, and this due to picking conflict. For instance, we aborted repeatedly our daily activities in Laghman Province, in the eastern part of the country, that witness intense fighting for a relatively extended time.
On the whole, we maintained continuity of our operations, primary thanks to dialogue we had with different parties to the conflict, including the IEA members, as well as high level of acceptance that PUI enjoys in the areas being there and serving people for the past 42 years.
It is difficult to assess the impact on our beneficiaries. Traditionally, our mobile health teams have seen many more women than men arrive; nothing has changed in this respect. In some areas, I have noticed that there is a growing demand from the health authorities to ensure a separation of women and men within the health structures, but there is no official decree for the moment.
What about the female staff of Première Urgence Internationale?
In larger cities, some changes have already begun. For example, in Kabul – a little less so in other cities – the general environment has evolved. Our female teams have to be more careful in the way they dress and in their movements. A decree was issued on 26 December 2021 obliging women to be accompanied by a chaperone when travelling more than 72 kilometers: in practice, it is for every journey that a female team member can be stopped and questioned. So far, we have not recorded a significant incident: in the case of Première Urgence Internationale, it usually helps a lot to explain that we provide health care and that we are an NGO. This is enough to get our teams through the checkpoint but we have to see how the situation develops.
In our offices, we have been asked to make sure that women and men work in different spaces. In some of the areas where we work, it does not make any difference because this system was already in place. In Kabul, we had to have it put in place but we let our female colleagues choose.
WhICH developments have you seen in terms of security and access to the whole country?
Regarding access to the field, from a security point of view, the situation has improved considerably. Before August 2021, there were about a hundred incidents recorded per day across the country: today this figure went down to around 6. The roads are open, we can move around quite freely at least for now and noticing increasing bureaucratization and demands for permits and authorization including for the travels. This does not mean that we can go everywhere, especially in isolated areas, the country’s terrain makes some travels very complicated. Nuristan, where a few NGOs operate, including us, is one of the examples where access is not possible during the winter season. We are one of the few humanitarian organizations providing aid in Nuristan province, a mountainous area that is not accessible in winter. Further to that and because of the 40 years of conflict, the infrastructure – roads, communication are in large parts of the country in very poor condition.
Then, there are new considerations: we are still trying to understand to what extent the current government can respond to security incidents, as the ‘safety net’ that was provided by the international community before, with diplomatic representations in Kabul, no longer exists. We have also had constant discussions with the IEA authorities to try to protect the humanitarian space in the face of their increasing interference, which has consequences for access to certain areas or populations. During one of the surveys we conducted in northern parts of Ghazni province, we were denied the access having female staff in the team. There are also many cases where the IEA authorities want to interfere with our recruitment process or our procurement process.
What is the priority for Afghanistan today?
The country needs to stabilize economically. The humanitarian community cannot remain the only actor providing services and livelihoods to the population. It is very likely that humanitarian aid helped the country avoid famine last year, through great efforts, but this cannot continue indefinitely especially as the overall humanitarian situation continues deteriorating.
Read more about our humanitarian mission in Afghanistan.