The conflict between Afghan and international forces and armed opposition groups in Afghanistan has significantly intensified and spread over the past 12 months, no longer confined to the south, but spreading to parts of the east, west and north. Official sources put the number of casualties for 2006 at 4,000, of which 670 were civilians.
The ICRC has increased its support to hospitals to deal with large influxes of war-wounded, as well as providing emergency assistance to people newly displaced by the escalating conflict. The humanitarian operation was plunged back into emergency mode last year and this phase is far from over in terms of medical and relief assistance required by the Afghan population.
Pierre Krähenb=FChl, who worked in the ICRC delegation in Kabul from 1993 to 1995, described the Afghan people as proud, stubborn, feuding often, but deeply humble and moderate at the same time.
"Afghanistan serves as an example that tells us so much about why the humanitarian gesture is something truly universal," he reflected. "The first people to respond to an immediate need are of course neighbours, the Afghans themselves, who welcome a displaced family in their midst."
Mr Krähenb=FChl paid tribute to all those Afghans involved in humanitarian action, particularly the surgeons and nurses who have run the hospitals for years on their own, but also the 11,000-strong team of volunteers of the Afghan Red Crescent Society (ARCS) and ICRC expatriate (62) and national staff (over 1,100).
The deteriorating humanitarian situation is due to a proliferation in roadside bombs, suicide attacks, targeted killings, sustained and significant aerial bombing raids and military operations that have increased in frequency and spread to different parts of the country.
Afghanistan today is far from stability. The intense fighting has led to a significant increase in the number of war-wounded and there is a general, spreading sense of insecurity among the local population.
"The primary concern of ordinary Afghans today in most parts of the country is how to stay away from conflict zones and avoid being caught up in the violence," said Krähenb=FChl.
The hostilities have caused increased displacements of people, mainly in the south around Kandahar, where fighting has been particularly intense and takes place on a regular basis.
Many of the emergency situations over the past year have been compounded by natural disasters, namely a continuing cycle of flooding and drought.
For many people affected by the conflict, the remoteness of where they live or where they have been displaced to means that many are at times unable to access quality medical care.
For this reason the ICRC has increased its support to hospitals to bolster their capacity to deal with large influxes of war-wounded. The organization has also stepped-up support to the Afghan Red Crescent clinics and volunteers who go out into delicate regions of the country to form community-based first-aid teams. Over 1,700 war-wounded people were treated in 14 ICRC-supported health facilities over the past 12 months.
The organization's constant challenge remains working with all parties to help them understand their responsibility to respect and apply international humanitarian law (IHL).
"Specifically this means monitoring the conduct of hostilities in the field by international forces, the Afghan national army, Afghan national police and groups belonging to the armed opposition in Afghanistan," said Krähenb=FChl.
Mr Krähenb=FChl illustrated his point with the example of an attack that took place in the province of Herat a month ago, where a sustained series of bombing raids and fighting on the ground resulted in several dozen deaths, including civilians, over 2,000 people displaced and 170 houses wholly or partially destroyed.
Mr Krähenb=FChl went on to highlight the ICRC's increased reach thanks to a very effective partnership with the ARCS.
"What allows us today to be more effective than we were four or even two years ago, is our strengthened partnership with the Afghan Red Crescent Society," he said. "To the credit of the ARCS and its leadership, great efforts have been made to position the organization equally with the ICRC as an independent and neutral humanitarian actor, with country-wide access through its 11,000 community-based first-aid volunteers."
The ICRC continues its visits to nearly 7,000 detainees in 34 places of detention. It has assisted more than 15,000 displaced people in and around Kandahar in the beginning of 2007 alone. Vital orthopaedic work continues, with over 76,000 people being treated since 1988, of which more than 32,000 were amputees. The ICRC is also carrying on with its activities to improve water supplies in some of the poorest urban neighbourhoods in Afghanistan.
Pierre Krähenb=FChl confirmed that 20 years on, the ICRC remains in Afghanistan with an unwavering level of commitment to assist and protect those most in need.
"The fact that we've had 20 years of work in Afghanistan underlines a trend that we observe in many places in which we work around the world, and that is the tendency today of many conflicts to go on and on," said Krähenb=FChl. "Therefore, we have to find a balanced way of addressing both emergency situations and the chronic nature and impacts of conflict."
Mr Krähenb=FChl said that resilience and trust had been essential to the effectiveness of ICRC activities over the past two decades.
"The readiness to stay over time, even during the phases where no one was particularly interested or committed to Afghanistan, and trusting in local initiative and competencies are two aspects that have been fundamental to our work over all of these years," he concluded.
Afghanistan remains the ICRC's fourth-largest operation after Sudan, Iraq and Israel OT/AT.