Amid the hunger, disease and pain, the Afghans know there is one war they have already lost

War on terrorism: Refugees

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Doris Lessing wrote: "A war is always a question of waiting, waiting, waiting for disaster." But in the new war on terrorism there has been no need to wait; the humanitarian disaster has unfolded before a shot has been fired. And this week it grew much worse.

Afghanistan was already in grave crisis before 11 September, with millions dependent on wheat flour, brought in by the World Food Programme, to stay alive. President Bush's declaration of war on Osama bin Laden three weeks ago triggered a far worse mess, prompting thousands of Afghans to flee their homes in towns and villages for the imagined security of the Pakistan border, and leading the ruling Taliban militia to expel all foreigners from the country, including aid workers.

Then this week, while the shape and intensity of the coming attack continued to fascinate armchair generals all over the world, the humanitarian tragedy that had been triggered by the mere declaration of war proved to have a momentum of its own.

Refugees arriving in Pakistan began dying of an ebola-like virus that causes its victims to bleed from every orifice until they die. In eastern and north-eastern Afghanistan, an epidemic of cerebral malaria was reported, while the World Health Organisation (WHO) voiced its fear that cholera, tuberculosis and diarrhoea could reach epidemic proportions.

Health authorities in Rawalpindi, close to the Pakistani capital, worried that the hundreds of new refugees arriving every day could bring communicable diseases including malaria, dysentery, typhoid and polio. A doctor in the Rawalpindi health department said: "It will be a catastrophe if the influx [of refugees] continues at this rate."

Meanwhile, the contingency plan drawn up by the United Nations High Commissioner for Refugees (UNHCR) for coping with an expected influx of refugees once the fighting started ran into immediate trouble. Sites for 23 new refugee camps have been agreed, all in bleak, remote locations close to the Afghan border, but when a UNHCR team went to one of the sites to start work, angry villagers forced them to stop, protesting that the land was theirs.

The spectre of Afghan refugees bringing epidemics that could then spread like wildfire through the home population confronted Pakistan this week when doctors at the Fatima Jinnah Hospital in Quetta, south-west Pakistan, reported eight patients dying of the ebola-like virus, which is called Crimean-Congo Haemorrhagic Fever.

There are at least 75 patients with the disease, some of whom are refugees recently arrived from Afghanistan. The virus is spread by a particular type of tick that infests livestock, and the refugees, mostly poor and uneducated, are especially at risk because they live close to their animals.

At the Quetta hospital, an isolation ward has been set up to try to contain the virus, surrounded by a barbed wire fence. Inside the ward, one of the eight beds was taken by a nine-year-old boy called Ismail Sadiq, whose nostrils were plugged with cotton wool to stem the bleeding. A 65-year-old man lay lifelessly in another bed near by, his face and shirt covered in dried blood.

The virus can be stopped in its tracks if caught early: if lost body fluids are replenished in time, the immune system can recover and kill the virus. But with refugees on the Afghan side of the border weakened by chronic hunger, and threatening to flood through the border in vast numbers in the event of an attack, the threat of an uncontrollable epidemic is a likely one. But according to the WHO, even the common cold can be a killer in the sort of situations in which Afghanistan's internally displaced people are living.

The WHO's emergency and humanitarian action department is on high alert to combat outbreaks of disease in the region, but has received less than 10 per cent of the funds it needs to do the job.

And in Peshawar, the UNHCR's attempt to anticipate a flood of refugees by opening new camps is already in trouble. Pakistan has closed its borders to bar entry to refugees – though sources here claim 800 continue to sneak in through lesser-known paths every day.

To cope with a catastrophic flood in the event of an attack, the Pakistani authorities have presented the agency with 75 possible sites for new camps. Last week, UNHCR teams inspected them, but found only 23 to be suitable. And even these now appear to have considerable drawbacks.

All the new sites are in tribal areas, largely beyond the control of the Pakistani authorities. They are within 10 to 15km (six to nine miles) of the Afghan border, and inhabited by Pathans, most of whom support the Taliban. One agency official, on condition of anonymity, said: "South Waziristan, one of the areas, is where many radical madrassas [Islamic schools] are, the Taliban's recruiting ground. Kurram, another area, is where all the mujahedin's weapons are made... It's impossible to cope in such an environment.

"All the tribal areas are pro-Taliban or have a lot of sympathy with them, and we foreigners are seen as invaders, especially as we represent an international organisation. When the American raids begin, their anger will be even worse."

The week's good news was that, after a hiatus of nearly three weeks, the World Food Programme (WFP) once again began trucking wheat flour into Afghanistan. "We are running against time," a foreign official admitted. The UN agency needs to get 150,000 tons of flour into its warehouses in Afghanistan by mid-November, when the roads become impassable, if millions of people are to be saved from starving to death.

It is a colossal challenge, requiring 200 fully-laden lorries to ply into the war-ravaged country every week. All this with no foreign staff on hand to pull rank and discourage plunder, and with the risk of war breaking out at any moment. The agency is also talking about dropping supplies from the air once the roads are closed. But in a country full of minefields, with a hostile army equipped with Stinger missiles, the fact that such a notion is even on the agenda gives an idea of the size of this crisis.