Afghanistan: Appeal No. 01.34/2001 Humanitarian Assistance Programme Update no. 1

This Programme Update is intended for reporting on Annual Appeals.
Period covered: 1 January - 31 March 2001

Appeal Target CHF 7,819,724

Operational Developments:

Drought and conflict continued to worsen the plight of the Afghan people, forcing increasingly higher numbers of Afghans to flee their homes seeking shelter, protection, and assistance in camps around Herat and along river banks in southern Afghanistan and in neighbouring countries. A sudden cold snap with unusually low temperatures reaching 25 centigrade below zero reportedly caused the death of 150 already very vulnerable displaced people in camps in Herat. Conditions were expected to worsen over the coming months.

An earthquake that struck Badakhshan on 25 February measuring 6.1 on the Richter scale reminded many of the devastating consequences of this natural phenomenon when two quakes claimed over 7,000 lives in 1998. The Afghan Red Crescent Society (ARCS) and International Federation offices across the country, including in Badakhshan, were contacted immediately. Fortunately, no casualties or significant damages were reported. Another minor quake was felt on 26 February in Kabul.

Disaster Response

In Afghanistan the Federation and the International Committee of the Red Cross (ICRC) closely coordinated their efforts to support the ARCS in its efforts to respond to the drought emergency. The ICRC, as the International Red Cross and Red Crescent Movement's lead agency in Afghanistan, has.assumed the responsibility for covering the logistical and financial requirements of the Federation-supported activities.

Objective 1: to further monitor the impact of the drought

Assessment in Ghor province

On 19 March, two joint ICRC and Federation teams started an assessment in Ghor province, one of the worst drought-affected areas in Afghanistan. The teams are comprised of nutrition, health and agricultural specialists from both organizations.

Assessment in Nawzad district in Helmand

A joint ARCS, Federation, and ICRC assessment was carried out in Nawzad district in Helmand. The purpose was to verify the living conditions of internally displaced persons who fled their places of origin due to either economic reasons or insecurity. . Although their living conditions are rather poor at the moment, mainly because of the reduction of labour opportunities, most of them still cope well and the overall situation was found to be stable Therefore no need for assistance was identified.

Nutritional surveillance

The food security and nutritional status of people are areas of major concern. Since January the five ARCS mobile health teams have been screening the children they meet. All children under five years are included in the target group, but as in most cases the teams screen only the children that are presented to them because ofsickness, the results can not immediately be used as valid and reliable information. Secondly, although the team members were trained, they had difficulties to produce accurate data from the mid-upper arm circumference (MUAC) measurement method.

The Kandahar mobile health team that vaccinates all children under five was in a position to provide covering data from that age group, . Their findings confirmed that about half of the sick children are moderately malnourished. Regarding all age groups, the data compiled by the teams support other sources findings, particularly Medecins Sans Frontiers - Holland, indicating that between 74-80 per cent of the children are in normal nutritional status, around 20 per cent are at risk or moderately malnourished, and between two to four per cent are severely malnourished.

The general understanding is that malnutrition seems not to be directly related to the drought problems, but more to improper feeding practices and illness. However, constant surveillance is maintained as the situation might change.

Village information

The purpose of data collection was to obtain reliable first hand information, regarding the situation and living conditions in the villages surveyed, especially in relation to health and water needs. The information was collected by ARCS mobile health team members in addition to their other daily activities in the field of health care.

The following compiled results give a general picture of the situation mainly in the southern region, and Farah province in the western region. Up to the present moment a total of 106 villages were surveyed.

Health-related problems include: lack of health care (66 per cent of villages); lack of potable water (25.5 per cent); lack of food (20 per cent); and different diseases. Access to health care is extremely difficult; only 8.5 per cent of villages are within less than two hours walking distance from any clinic, including private sector services (e.g. drug shops). Traditional birth attendants were found only in two per cent of places. The national immunisation days (NIDs) against polio (last round in year 2000) covered 95 per cent of villages.

Food security is a concern in about 90 per cent of villages. Loss of livestock was reported from 80 per cent of areas. The area of cultivated land was clearly less than the previous year.

Recruitment and training of community-based first aid volunteers

Between 1 January and 31 March, ARCS recruited 200 volunteers from villages in Ghor, Nimrooz, Helmand, Uruzgan and Zabul provinces. All volunteers received training in health education, water and sanitation, first aid, disaster preparedness and the ARCS and RC/RC Movement. By the end of March, the total number of volunteers trained under the emergency programme reached 755.

It is estimated that , these volunteers have handled some 943 first aid cases in their villages so far, helped to raise health awareness in the assisted communities and taught people how to make oral rehydration salts (ORS) for treatment of diarrhoea cases. Based on preliminary reports received at the end of March, on the occasion of the first round of the NIDs, 116 volunteers vaccinated a total of 33,351 children under five against polio in two districts of Uruzgan and 10 districts of Zabul province.

Objective 2: to provide preventive and curative community health care to vulnerable communities, especially women and children, in the drought-stricken areas.

Supervision, planning and management

The first mobile health team started to operate in August 2000, and thereafter three other teams were deployed by the ARCS. These four teams continued to work in the four different provinces in the southern and western regions and occasionally visited the camps for internally displaced persons (IDPs) in Kandahar.

In early January, a two-day seminar was organized for all participants of the ARCS mobile health teams, including the head of the national society's health department. The aims were to familiarize team members with the organization and its different activities, to specialize on the drought response programme, to introduce primary health care, and to standardize diagnostics and treatments. One practical new point was to introduce MUAC screening of all child patients under five. Dissemination on the Movement and the ARCS activities was part of the seminar's programme.

Team activities

In January and February, 11,173 patients were treated and through this period, the total number of patients treated by the teams was 33,867.

The Kandahar team started the period working in certain camps in Panjwai district, where the displaced Baluch families reside, working in co-ordination with other NGOs also currently providing mobile health services in the area. This visit coincided with the Federation/ARCS distribution of winter assistance materials to 2,456 internally displaced families. The camps were also covered by mass measles campaign by the MSF-H vaccination team.

Morbidity

Respiratory infections (common cold, bronchitis, pneumonia, throat infections) were the main ailments during the winter months. The team from Zabul province also reported a high rate of suspected pulmonary tuberculosis for which there is hardly any appropriate treatment available.

Measles started to be a cause of concern in several locations. The measles vaccination coverage in Kandahar region is reported to be 27 per cent. The ongoing EPI, both fixed centres and outreach areas are very limited, with gaps and delivery delays allowing for the outbreak of epidemics. MSF-H working in the area has been doing a systematic mass campaign since December.

Health education and preventive health care

The start of the vaccination (EPI) programme was the main achievement, but practical arrangements caused constraints. The ARCS Kandahar team started its vaccination programme while the preparations for the other teams are underway.

During the first and second round, the Kandahar mobile health team provided vaccines to 700 children, while about 500 women were immunized against tetanus, in 16 villages outside of the area covered by UNICEF.

The reported health education campaign covered 59 per cent of the patients. The only female nurse of the teams had to cease her work in December, reducing the effectiveness of the health education for women. According to the reports all the teams, however, tackle important women-related issues such as breast feeding and child spacing during the ongoing hygiene education and treatment of women by the teams continues.

During the seminar in January all the team members considered the lack of knowledge and understanding of the causality between diseases and lacking hygiene, and improper use of water sources, as the root causes of many health problems in the communities. Though there is need for improved transfer of this knowledge to the people, various conditions such as the restrictions on the use of pictures and posters, the limitations on communication between men and women, and the lack of continuity and follow-up in this mobile setting, make the task daunting.

Objective 3: to provide access to safe drinking water and sanitation facilities.

One shallow well was deepened and lined in the IDP camp Dost Mohammed, in Kandahar's Maiwand district, serving 25 Baluch families who had fled their residential areas in the Registan desert. Further, one bore hole was completed with a hand pump in Hajyan village in Kandahar's Argandab district, serving 90 families. For both wells, communities actively participated in the implementation of the project by providing unskilled labour, accommodation for skilled labour, sand and gravel.

In Farah province, Qah-lai-Kah district, the drilling of one bore hole is completed, but installation of the filter pack, casings, platform and water pump was not yet done. In the same district a second bore hole is under construction. Drilling for two bore holes in Kandahar's Argestan district was stopped due to caving in (in Cotizai village) and as no water was struck at a depth of 40 metres (in Darmanday village). As hydro-geological data are not available, these problems may occur more often.

In addition, numerous assessment and supervision missions were conducted by the ARCS and the Federation's wat/san engineers and delegate to Maruf, Argestan and Panjwai districts in Kandahar and Anardara and Qah-lai-Kah districts of Farah province. During these field visits and after coordination with partners (DACAAR, UNICEF and the ICRC), appropriate sites were identified.

Constraints that have so far resulted in a relatively low implementation level include the absence of hydro-geological data, the need for intensive coordination with other humanitarian agencies and logistical problems, the latter especially in Farah.

Lastly, a total of seven latrines were rehabilitated in Lowya Wala in Kandahar city for as many households, with active community participation through provision of unskilled labour and accommodation for skilled labour. A survey, in order to identify further sites for provision of latrines as sanitary facilities, was conducted in February in three alleys in Kandahar district no. 3 where sanitary conditions seemed the worst. A team of both female and male members interviewed representatives from 50 households.

Objective 4: to set up stockpiles of emergency shelter materials in the event of drought-related displacements.

In the Afghan context, the ICRC and Federation coordinated especially the appropriate response to internal displacement.

In early January 2001, ARCS and Federation, supported by the ICRC, provided 2,456 internally displaced families with winter shelter assistance; 352 tents, 2,104 tarpaulins and 9,842 blankets were distributed to mostly Baluch families who had to flee the Registan desert previous year due to lack of water and rapidly dying livestock. The assisted families were stranded in 12 camps in Kandahar's Maiwand and Panjwai districts and eight different camps in Garmser and Bust districts of Helmand.

This distribution followed an initial rough survey conducted at the end of 2000 in regions of southern Afghanistan including Garmser, Bust and Nahr-e-Saraj districts in Helmand and Maiwand, Panjwai, Shah Wali Kot and Arghandab districts in Kandahar provinces.

In early February, the Federation helped the ICRC in its distribution of firewood to displaced people in Maslakh camp in Afghanistan's western city of Herat, in response to an unusual cold snap with temperatures reported to 25 degrees Celsius below zero.

The conditions of the displaced population were continuously monitored by the Federation's delegates in both Herat and Kandahar, and the drought coordinator.

Plans are made for an assessment to the areas of origin of these Baluch IDPs in southern Registan, in April.

Objective 5: to develop and reorient, if necessary, further assistance strategies or phase out the emergency response activities.

In all regions, intensive coordination was maintained with other actors in the drought response efforts and the consequences of the drought are being monitored where possible taking into account accessibility and available resources. Initial rainfall data collected in the southern region indicated that precipitation was higher in this region than the previous year, but still less than in a normal year. Concrete data on areas cultivated compared to previous years are not yet available, but preliminary estimates are a cause of serious concern.

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