‘Hell on earth’: Warnings that humanitarian crisis about to engulf Afghanistan

More than 20 million people in the country face starvation this winter, charities have warned, writes Kim Sengupta, Diplomatic Editor

Children bask in the sun next to a wall along a street in Nad Ali district, Helmand province, on Wednesday (AFP/Getty)

The cost for human rights of the western retreat from Afghanistan has been grimly highlighted once again with images of a Taliban parade of trucks carrying hanged men through Lashkar Gah, which was the centre of British operations in the country.

But it is the unfolding humanitarian crisis that has also followed the Taliban victory which the international community is being urged to address, with spreading deprivation and the real threat of famine stalking  the land.

There have been accounts of orphaned children starving to death, families selling their meagre possessions, even instances of selling their daughters, to get money for food. The ban on women working has cut household incomes in the cities while, at the same time, men in the families, especially in the public sector, have not received their salaries for months.

The gradual societal collapse is taking place against a backdrop of a bombing campaign by Isis and tens of thousands fleeing across the borders into Iran and Pakistan and internal refugees moving from rural areas to towns and cities.

The situation is due to get markedly worse with winter approaching. David Beasley, the executive director of the World Food Programme (WFP) has spoken of the “worst humanitarian crisis on earth about to take place”.

“Ninety–five per cent of the people don’t have enough food and now we are looking at 23 million people marching towards starvation”, he told the BBC. “The next six months are going to be catastrophic, it is going to be hell on earth.”

The key issue is one of lack of international recognition of the Taliban as the legitimate government of Afghanistan.

As a result, around $10bn of Afghan foreign reserves abroad remain frozen. Almost 70 per cent of the government budget in the past had come from foreign subsidies which have ended. The World Bank, the main provider of funds for the country’s health service, has suspended payments. The IMF has blocked $440m of new monetary reserves set aside for Afghanistan for the time being.

Along with the shortage of food and essential supplies the healthcare system is under acute strain, with malnutrition adding to the caseload of hard-pressed staff.

The Taliban regime which ruled Afghanistan from 1996 to 2001 put theocracy before public health, barring female patients from Kabul’s 22 hospitals and confining them to one poorly equipped medical facility. Maternity mortality rose to 1,450 deaths per 100,000 women in 2000, the highest in the world.

Since the overthrow of the Taliban in 2001 there has been significant progress in healthcare. Maternal mortality rate decreased to 638 deaths per 100,000 women and life expectancy increased by about a decade for both women and men.

The Taliban has restricted women’s ability to travel and thus to medical facilities since coming back to power. But, publicly at least, it had pledged to focus on healthcare for all citizens.

A health worker administers polio vaccine drops to a child during a vaccination campaign in the old quarters of Kabul on Monday (AFP/Getty)

Leaders at the recent G20 summit agreed to work together to alleviate conditions in Afghanistan, with the European Union pledging $1.2bn for the most pressing needs in the country as well as funding for neighbouring states taking Afghan refugees.

Angela Merkel, Germany’s outgoing chancellor, said “to stand by and watch 40 million people plunge into chaos because electricity can’t be supplied and no financial system exists, that cannot and should not be the goal of the international community”.

Italian prime minister Mario Draghi, added that the international effort must go ahead even if it meant having to coordinate measures with the Taliban.

“It’s very hard to see how one can help the Afghan people without some sort of involvement of the Taliban government. There has basically been a convergence of views on the need to address the humanitarian emergency”, he said.

The foreign donor states have also repeatedly called for the Taliban to form a more inclusive government. The one currently in power is all-male, overwhelmingly Pashtun and made up of those associated with the regime of Mullah Omar of two decades ago or their families. There were calls for the Talibs to cut links with terrorist groups amid deep apprehension about over Isis and al-Qaeda gaining ground since international forces withdrew.

But there is little to show that Taliban are responding to the demands.

You speak to these people sent to us by the Taliban and they know nothing, absolutely nothing, some of them can’t read or write, all they do is obstruct us

Abdullah, a doctor in Kabul

Women remain largely banned from working: Tajik, Uzbek and Hazara officials, including governors, continue to be replaced by Pashtuns. Several members of the regime remain under international sanctions. The newly appointed governor of Kabul province, Qari Ehsanullah Baryal, is widely believed to be a senior member of al-Qaeda.

The Taliban stance on these issues, and failure to fulfil pledges made on women’s rights and persecution of opponents, has hardened the position of many of the foreign donor states.

The World Bank, meanwhile, has stated that it is highly unlikely that direct aid to Afghanistan will continue. It has more than two dozen development projects ongoing in the country and has provided $5.3bn since 2002, mostly in grants. It supports three-fifths of the country’s 3,800 hospitals and medical clinics, including payment for its staff.

David Malpass, head of the World Bank, said the breakdown of the economy had made it virtually impossible to operate as before. "One of the challenges is the payment system, there’s not the ability to have money actually flow, given what the current government is doing”, he said. One possibility being explored by the World Bank is transferring money from its trust fund to emergency humanitarian agencies.

Conditions in the health and food sector inside the country remain chaotic, with the Taliban appointing some officials who are illiterate or semi-literate and with no knowledge of the subjects they are dealing with.  Restrictions continue on women in the aid sector despite an agreement with the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) and aid agencies.

A review by Human Rights Watch found that only three provinces have sanctioned work by female workers out of the 34 who were supposed to do so. In over half the country, women aid workers faces severe restrictions, such as requirements for a male family member to escort them while they do their jobs, making it difficult or impossible for them to do their job effectively. 

Public servants and medical staff complain that more time is spent in organising the daily segregation of genders and discussing religion than on work. A female doctor in the northern city of Mazar-e-Sharif said she was instructed to bring a male relation to escort her from one ward to another. A doctor in Kabul spoke of Taliban-appointed officials taking medicine out of the hospital saying it was needed by their families. Neither of the two doctors has been paid for months.

The doctor in Kabul, who only wanted his first name, Abdullah, used, said: “You speak to these people sent to us by the Taliban and they know nothing, absolutely nothing, some of them can’t read or write, all they do is obstruct us. It would be quite funny if the situation was not so serious. We are having to deal with this while not getting our salary: we don’t have money to get fuel for the generators.

“I became a doctor to help our people. But that is becoming impossible. Of course we need funds from the international community. You should see how many children we have suffering from acute malnutrition on top of everything else here. But we also need some kind of structure to return in the running of the hospitals. I cannot bear to think what will happen in the coming months.”