Jalalabad/Kabul June 4, 2007--Lal Bib is not sure how old she is. Her mother tells her she was two when they fled to Pakistan, shortly after the Soviets invaded Afghanistan. That makes her about 30 years old now. And she has spent most of her life as a refugee. "I didn't remember anything about Afghanistan when I was growing up in Pakistan, but it is my homeland. Now I can live here again," she says. She gave birth to her seven children in exile. Number eight is on its way and will be born in Afghanistan.
But so far, home is a hard place. Lal Bib has swapped life in a Pakistani refugee camp for a meager existence as a returnee in eastern Afghanistan. Sheik Mesri Camp, where she lives now, is a township outside the city of Jalalabad, built by 522 families on an open plain where summer temperatures creep up to 120 degrees (47 degrees Celsius). In 2004, when they came here, there were no houses, no water, no food, no doctor, and no school. There was only dust.
In a small tent, Lal listens patiently to the advice of IMC-trained midwife Nazinin Noorzai. Lal is seven months pregnant; she has walked here from the nearby home her family has built in this desert. If she had to go into town, Afghan culture would demand a male family member to accompany her. Transportation for two would be 200 Afghanis ($4) - too much for refugees to commute to the hospital in town. If it were not for the IMC health post, Lal would not have been able to get antenatal care from a health professional.
Since March 2005, IMC has provided basic health care to this returnee community that has been in exile for decades. Every day 80 to 90 patients come to the tented camp that IMC has set up as a health post. In April alone, the medical doctor provided 2,090 consultations. IMC has trained and employed a midwife, a health educator, and a nurse. There is even a pharmacy tent. In a laboratory tent, complete with microscope and patient samples, a technician checks blood, urine, and stool. The waiting area is in the center of this tented health-post and has a proper roof to shield patients from the sun. Emergencies will be brought in the IMC ambulance to the provincial hospital in Jalalabad.
Dr. Ashukullah, who works out of the doctors' tent, says that this time of the year most of his patients have diarrhea, tonsillitis, coughs or ear infections. "The biggest problem for the refugees is the dust, the heat, the lack of hygiene, and the poor sanitation. Many are malnourished and susceptible to diseases but they cannot afford to eat healthy."
Health problems, especially for women and children, are only some of the challenges awaiting many returning Afghans. Not enough jobs, schools, water, or transportation - the list of their problems is long. IMC has assisted the Sheik Mesri community to establish a Shura, a traditional council that discusses community problems and tries to solve them - an important step toward establishing self-reliance and positive change.
On the day of the Shura meeting, men and women, who usually meet separately, gathered in an IMC-donated tent to discuss two important issues: Who will get the homes that are being built for the returnees? And, how to select the women the Ministry of Public Health is going to train? The debate will take a long time, but in the end the Shura will formulate a decision. "We used to be a disorganized community. We talked on the side of the road," says Abdul Rahim, the Shura leader, proud that he is helping his fellow refugees to find consensus.
Primary healthcare and community support are an important component of normalcy. And for people who have been uprooted for most of their lives, normalcy makes all the difference. Home will feel like home again and the message will spread. Dr. Muhammad Jan, the director of IMC programs in Jalalabad, who guided the health support in Sheik Mesri and helped to establish the Shura, says: "When we provide assistance and facilities to the returnees, they will tell their families and friends who are still abroad about this. They will tell them: It is okay; you can come home."