The Effects of War on Afghan Women, Children and Refugees Public Health Essay Example for Free

The Effects of War on Afghan Women, Children and Refugees Public Health Essay INTRODUCTION Armed conflicts have been major causes of disease, suffering and death for much of human history. The fatalities, injuries and disabilities suffered on the battlefield are obviously direct effects of conflict. But there are also health consequences from the breakdown of services and from population movements. The diverting of human and financial resources away from public health and other social goods contributes to the spread of disease. These indirect consequences of war may remain for many years after a conflict ends. Both the experience of conflict itself and the impact of conflict on access to health care determine the physical health and the psychological well-being of women and girls in very particular ways. Women are not only victims of the general violence and lack of health care they also face issues specific to their biology and to their social status. To add to the complexity of the picture, women also carry the burden of caring for others, including those who are sick, injured, elderly or traumatized. This in itself is stressful and often contributes to illness. Defining Terms Gender: The term gender includes both masculinity and femininity, not just one or the other. Across continents and cultures, established gender norms and values mean that women typically control less power and fewer resources than men. Not surprisingly, this often gives men an advantage in the economic, political, and educational arenas, but also with regard to health and health care. Certainly, there are instances where gender differences hurt mens health as, for example, when greater risk-taking among young men leads to higher accident rates, or higher levels of violence between men leads to greater death and disability . But, by and large, many health professionals believe that gender inequalities have led to a systematic devaluing and neglect of womens health. Children: are those who are still under the care of their parents. Who is below the legal age. After more than two decades of war, the health of Afghanistans people is ranked among the worst in the world. More than 800 children die every day, largely from preventable diseases. Nearly 1 in 4 Afghan children will not reach his or her fifth birthday, and their mothers do not fare much better. An Afghan woman is 100 times more likely to die of pregnancy-related problems than her American counterpart. These deaths are preventable. Since the fall of the Taliban, the Afghanistan Ministry of Health has been working steadily to improve access to basic health services specifically focusing on reaching women and children. Since early 2002, with funding support from the United States Agency for International Development (USAID), Management Sciences for Health has been working with the Ministry of Health to establish a foundation upon which a national health care system can be built and health services can be delivered within Afghanistan. The Effects of War on Afghan Children and Women Public Health War is one of the most destructive human activity. It destroys not only the physical side of a person but it degrades the human dignity. These happens to Afghanistan. Today it has one of the world’s poorest human development. Among the population of 24 million roughly 10.7 million are children under the age of 18 and half of the remaining population is women. The crisis of more than 23 years has left devastating effects on the health and well being of millions of women and children. It has killed over 1.5 million people, including more than 300,000 children. An extensive review of   social, physical, and mental health of Afghan children with an aim to depict the severity and complexity of the situation induced by war of more than a decade. Child Vulnerability Indicators in Afghanistan Series of wars and drought for more than three years have threatened the survival and existence of tens and thousands of women and children. According to a survey 60 % of Afghan children have lost their family member, and 39 percent have lost their home. The burden of poverty falls heaviest on the children, who frequently abandon education in order to contribute to family income. They work on farms, collect water and firewood and scavenge the garbage cans for food scraps. In Kabul alone, more than 50,000 children work as shoe polisher, selling fruits or newspaper or begging on the streets. More than five million people with a huge proportion of children are internally displaced. More than 6 million displaced Afghans represent the largest single group of refugees world-wide. Alone in Pakistan approximately three million Afghans have taken refuge in the last few years. Children comprise 20 % of the total number. Poverty prevails, with 80% of people living below the poverty level. Adult life expectancy is 45 years for men and 47 for women. According to the UNICEFs estimations more than 5 million people-70 percent of them women and children rely on humanitarian aid to survive. 75% of the population living in rural areas have no access to any kind of health facilities. According to the UNICEF, 2001 the total number of under five population in Afghanistan is 728049. War induced displacement and famine have forced large populations to move towards big cities in search of food and shelter. Among the internally displaced populations majority is under five, approximately 429567 in Kabul, 80930 in Logar, 126000 in Wardak, 49700 in South Parwan and 41852 are in Kapisa. Displaced populations are exposed to an unprecedented scale of disease, deaths and disabilities. Reports show that one in every four children dies before his or her fifth birthday and one in five children is born in a refugee camp. Infant mortality is 165 (per 1000 live births), under five child mortality 257 (per 1000 live births) and prospects for improving child health are still dimmer. Maternal morality is one of the highest in the world, i.e., 1700 per 100,000. Poor obstetric care and illiteracy have been proved to have a direct relation to the infant mortality. The deteriorating child health has been out of focus for decades. Repeated wars, political turmoil and disasters have left grave effects on the physical and mental health of children. Post traumatic disorders, widespread infectious diseases, malnutrition have increased the sufferings of Afghan children to an unacceptably higher level. The situation of internally as well as externally displaced Afghan children is grim. The trend of childhood mortality in Afghanistan from 1955 to 1990 has remained almost static and has shown very little improvement change so far. Neighboring countries like China and Iran, both have achieved considerable decline in the under five mortality ranging from 225 to 38 and 239 to 45 respectively while infant mortality in Afghanistan is still 165 (per 1000 live births) and childhood mortality 257 (under five per 1000 births)11. Nutritional Crisis and War injuries among children According to UN agency around 120,000 Afghan children currently face famine. Iodine and vitamin A deficiency is largely noticed. Report from Terre Des Hommes determined that chronic malnutrition remained high, with 53.7% of children between 6–59 months stunted, including 27.3% severely stunted making children more vulnerable to disease. An estimated 7.5 million children and adults are currently at risk of hunger and malnutrition. Rights of children were seriously and widely violated. Girls’ right to education and sports is still overtly denied. Socio-cultural norms put additional restrictions on women and girls. Because of the current crisis it is predicted that about 20–40 000 children could die and around 10 million people will be forced to live on US$1 a day. It certainly impacts access to health services, health allocations by the governments, access to drugs against HIV/AIDS, TB and malaria, and child health. There are currently estimated 5.3 million vulnerable people inside Afghanistan. Country’s health system performance is paralyzed and extensively damaged during the war on terrorism. None of the children growing up today in Afghanistan has ever known peace. It is estimated that over 2 million Afghans suffered from mental health problems. UNICEF-supported study in 1997 found that the majority of children under 16 years in Kabul suffer from psychosocial war trauma. Ninety-seven per cent had witnessed violence and 65 per cent had experienced the death of a close family relative. Experts say that approximately 30%–50% of a population undergoing violent conflict develops some level of mental distress. There are estimated 10 million land mines, the equivalent of roughly one for every child. Reported by Save the Children survey, 85% of all unexploded ordnance (UXO) victims were children in Kabul, during the years 1990-94. Alone 3,000 injuries from landmines and UXO in 1999 have been reported. More than 130,000 Afghans under the age of 18 have been killed by land mines so far. Disease Profile Measles, cholera, tuberculosis, malaria, meningitis, hepatitis, typhoid, childhood respiratory infections, and diarrhea are the major killer diseases. Diarrhea alone causes the death of 85,000 under five children per year. Two to three million malaria cases with 6% P. falciparum were notified to the health authorities in the last few years. Similarly leis mania affects seriously women and children in Afghanistan. Immunization coverage is profoundly low. Lastly noticed overall mortality due to measles and related complications was 10.8% in Kabul. In South Asia, over 40 percent of the total confirmed cases of polio occurred in Pakistan and Afghanistan in 2000. The mass migration of Afghans to Pakistan and to other neighboring countries has posed serious threat to the global polio eradication program. Moreover a tuberculin survey in Pakistan revealed that the prevalence of tuberculosis infection was 13.8% (May 1985) in a sample of 4108 Afghan children (average age of 8 years). Thirty-three percent had not received their BCG vaccination. A survey during the 1990–94 on cancer reported 22 % prevalence of 1655 children. 69% were males, 31% females Afghan refugees referred to the cancer hospital in Northern Pakistan. The Afghan Women In recent years more and more societies all over the world have begun to recognize the vital contributions of women to commerce, their communities, and civic life. Whether it be Afghan women voting in a presidential election or women starting micro-businesses in Ethiopia, the worldwide trend toward greater equality is clear. Yet the denial of womens basic human rights is persistent and widespread, as a 2005 United Nations Population Fund statement put it. ON DECEMBER 13, 2003, 502 members of Afghanistans constitutional Grand Council, or loya jirga, met in the capital, Kabul, to begin writing the document that would henceforth shape governance of an Islamic, representative democracy. Three weeks later, after at least two rocket attacks near the councils meeting place and even more explosive politicking among the councils members, the council emerged with a new constitution. Among those who watched the process with attention were Afghan women and their activist partisans in other parts of the world, who wanted the new constitution explicitly to reflect the rights and needs of women. They had particular reason to worry that the assembly gathered in Kabul would be hijacked by conservative extremists who would interpret womens rights narrowly using religion as an excuse, or who might eliminate mentions of womens human rights altogether. The Grand Council met just two years after the United States toppled the Taliban, the extremist party that had been in control of Afghanistans capital since 1996. The American objective was to destabilize a regime that had given refuge to Osama bin Laden and the leaders of Al Qaeda, whose bases were in Afghanistan. At that time, the United States linked its military agenda in Afghanistan with the need to liberate Afghan women from oppression. As First Lady Laura Bush put the matter in a national radio address in November 2001, The brutal oppression of women is a central goal of the terrorists. Long before the current war began; the Taliban and its terrorist allies were making the lives of children and women in Afghanistan miserable. The first lady went on to assert that the removal of the Taliban from power would mean the liberation of Afghan women. For the next year, Afghan women were big news: There were books and reports, and pictures on the front pages of newspapers showing formerly illiterate women learning to read. Women began the work of reconstructing their lives by returning to the streets, to school, to work. Then the war in Iraq began, and Afghan women, and Afghanistans reconstruction, became old news. By the beginning of 2003, warlords in provinces who had been allies of the United States when it went to war against the Taliban were instituting measures themselves that were reminiscent of the Taliban era. Human Rights Watch reported in January 2003 that in the Western province of Herat, girls and boys would no longer be permitted to go to school together. Because most teachers are men, the ruling effectively shut girls and women out of an education. Other restrictions against interactions between the sexes were imposed; girls or women seen in public with a male might be taken against their will to a hospital to check for their chastity. These alarming trends coincided with a sharp drop in international scrutiny, although Afghan women themselves continued to seek access to good health, higher education, and equal pay for their work. Their experience in the last two years has made it clear that simply removing a dictatorial regime and installing a democracy does not automatically guarantee womens rights. Indeed, the challenges facing womens effort to make sure their rights are legally enforceable in the future highlight broad conflicts in Afghanistan between conservative and liberalizing factions of the future government and between forces competing to control interpretations of Islam in the public sphere. Islam is the prism through which human rights are articulated in Afghanistan, and it is it is therefore crucial for women that their rights to education, work, and freely chosen marriages be articulated in its terms. The importance of the relationship between Islam and rights is one supported by women. Indeed, Ninety-nine percent of Afghan women are Muslims, and their faith is extremely important to them. Most feel their rights are available to them through Islam, says Masuda Sultan, the spokesperson for Women for Afghan Women (WAW), a New York City-based grassroots organization of Afghan women and their supporters. Sultan explains that the number of women who frame their rights in secular terms is much smaller. Womens rights doctrine that would take Islam into account was in evidence in the making of the Womens Bill of Rights, authored in September 2003 by a representative group of 45 women who found ways to interpret relevant Islamic edicts in ways that amplified their human rights. The bill of rights was the achievement of a unique conference on women and the constitution sponsored by WAW. Organized with the help of the Afghan Womens Network and Afghans for Civil Society, the Kandahar conference brought women together to deliberate over how their rights could best be reflected in the constitution. Kandahar, unlike the more liberal capital, is one of Afghanistans most conservative provinces, and it was unclear until the day of the conference whether it would be secure enough for the gathering to take place. It was, but only under heavily armed guard. The conference participants comprised elite female decision-makers as well as largely illiterate everyday women from all over the country. For some, simply completing the trip, whether alone or in the company of a male relative, was itself a triumph. Over the course of three days, these women reviewed the 1964 constitution on which the 2003 draft was based and began composing the 16-point bill of rights, framed by the demand that the rights be not simply secured in the constitution but implemented. Some of the demands are basics on the menu of modern human rights: women require mandatory education, equal pay for equal work, freedom of speech, and the freedom to vote and run for office and to be represented equally in Parliament and the judiciary. But other points are specific to the situation of Afghan Muslim women and responsive to the recent forms of deprivation imposed by the Taliban and long-standing excesses based on tribal convention. There is, for example, the demand that women and children be protected against sexual abuse, domestic violence, and bad-blood price when one family compensates a second for a crime by giving them one of the familys women. There is a request for the provision of up-to-date heath services for women with special attention to reproductive rights. Under the Taliban women were denied healthcare by male doctors, who were not allowed to touch the bodies of women to whom they were not related, and severe restrictions on womens movements made it difficult for female doctors to supply healthcare. Women made it clear they wanted the right to marry and divorce according to Islamic law. At the end of the conference, the document was presented publicly to President Hamed Karzai, and women were promised that their rights would be incorporated explicitly into the new constitution. However, when the draft constitution was released in November 2003, there was no explicit mention of womens rights. Instead, the constitution granted rights to all Afghan citizens. As Ritu Sharma, the co-founder and executive director of the Womens Edge Coalition and Afifa Azim, the director of the Afghan Womens Network, argued in a joint editorial on the eve of the councils meeting, lumping together men and women in the text of the constitution, rather than clearly designating rights for women as well as men is an important distinction because Afghan women are not issued the identification cards given to men. Therefore, some men argue, women are not citizens and entitled to equality. A crucial question at the Grand Council was whether women would be identified separately from men in the final constitution. It was a triumph when the constitution that was released contained an article stating that The citizens of Afghanistanwhether man or womanhave equal rights and duties before the law. At the same time, other challenges remain. The introduction of womens rights to the national political agenda cannot itself be taken for granted while control of the country is still in question. Although it is true that on paper, the government of Afghanistan is headed by President Karzai and moving toward democracy along well established lines such as the creation of a constitution, the actual situation in many parts of the country do not reflect this shift in power. The Taliban have reasserted power in Southern and Eastern parts of the country. Indeed, in the few days leading up to the meeting of the constitutional Grand Council, coalition forces waged their largest attacks to date on Taliban members who threatened violence against the proceedings. As a recent Amnesty International report also noted, Northern Alliance commanders who committed human rights abuses under the Taliban government now hold government positions themselves (the October 2003 report, Afghanistan: No one listens to us and no one treats us as human beings. Where these commanders govern, womens movements remain as restricted, or nearly as restricted, as they did before they were liberated. So, one of the threats to womens rights is related to the ongoing danger to the entire nations stability as well as to the ability of the most conservative or militant actors in Afghanistan to influence the political process. Extremists exploit claims to Islam to intimidate women. This means that although women themselves frame their rights in terms of Islam, they can also be intimidated into making claims for interpretations that dont serve their needs at all. Sultan explains: Security is still a huge issue, and regional warlords and extremists are around. A woman who doesnt speak in terms that acknowledge Islam will face trouble. The affirmation of being Muslim is important because otherwise theyll be called infidels or be threatened or seen as secular or non-Muslim. in the view of Sultan and others who work closely with Afghan women, is to promote the education of women in Islamic law and history so that they can express their own rights as well as refute interpretations that do not serve them. As the legal system begins to hammer out laws that confirm the bases of the constitution, such knowledge will be increasingly important. Jurists are qualified in Afghanistan through higher education or training in Islamic law. As Sultan notes, these qualifications leave open the door for those trained informally by radical Islamist clerics to shape law. Womens education in the language, tradition, and law through which they understand their rights and themselves is a practical and necessary step in this context. This may appear counterintuitive to onlookers in the United States and Europe, whose recent revolutions in rights have often taken place in social and political contexts that opposed democracy to religion. Enhancing the rights of women by encouraging their access to religious education may also seem counterintuitive in the present media environment, which is saturated by the idea that Islam is inherently undemocratic. But women working for their rights in Afghanistan make it clear that both Islam and democracy are evolving practices that permit competing interpretations. It is their right to shape both in ways that confirm their identities as women, Afghan citizens, and Muslims. The needs of women and children; Refugees in Iran Since at least the 1970s Afghans have been coming to Iran, some in search of work, others to seek protection. The political dominance by the Taliban since 1995 has been a significant factor in the acceleration in the flow of refugees. Refugees who came in the 1980s were given green cards’ which entitle them to live and work in Iran, and to benefit from schooling and health care. In the early 1990s the government’s policy towards refugees changed in the face of the worsening domestic economic situation. After 1992 the authorities stopped issuing refugee cards. The vast majority of Afghans who arrived in Iran since 1992 are considered illegal and have no right to asylum. Furthermore, between 1992 and 1994 many thousands of refugees lost their legal status in a systematic campaign of confiscations of green cards from Afghans living in Khorassan province (bordering Herat). It is not uncommon to find families who repatriated under the UN-sponsored programmed in 1996 and 1997, who have returned to Iran because of hardship or fear of persecution. These families had to give up their refugee cards when they repatriated and now live as illegal’ refugees who risk being arrested if found. In such a situation it is extremely difficult to keep accurate figures on the number of refugees in Iran. According to recent official figures, there are about 1.4m Afghans in Iran at present, of which only 22,000 (1.7 per cent) are living in camps. The vast majority of Afghans live integrated into Iranian society scattered around the country, mostly in cities where they can get jobs but also in villages and settlements in rural areas. The refugees areas are Kerman, Shiraz, Sistan- Baluchistan, Mashad, Teheran and Shahriyar (Teheran province). The area in which refugees face the most difficulties (in the south- eastern province of Sistan-Baluchistan), and highlighted the neglected issue of child labor. The most common types of work done by women and children and the income they earn. Work done at home includes shelling pistachios, cleaning wool, making brooms, cleaning saffron, making chains and carpet weaving. Children usually start work at an early age (sometimes as young as five years old). Once they reach school age, those who can get into school study about four hours a day at school and work between four and ten hours every day. Many Afghan children attend schools not formally recognized by the Ministry of Education and run by the Afghans themselves. There are at least 10 informal Afghan schools in Mashad and about 24 in Teheran, serving from 50 to 500 children each. NGOs such as Ockenden Venture and Global Partners have been supporting such schools for over a year now with their own funds and some funding from UNICEF. They have provided books and teaching materials, and have conducted eye tests for children and provided spectacles. Ockenden Venture has also organised some teacher training. MSF France has been carrying out a school health project in Mashad, and a local Afghan NGO (Relief Committee for Destitute Afghan Refugee Families) is helping to identify Afghan schools in Teheran and distribute books. Many questions remain unanswered as to why some children attend these schools and others do not. Aspirations versus reality The aspirations of Afghan women and children contrast heavily with the reality of the back-breaking, repetitive and poorly-paid jobs. The reasons for taking poorly paid and low-skilled work are illiteracy, being undocumented, having children to look after, and opposition from the husband or his family. The work has to be part-time, home-based and not requiring a green card’. One obstacle which the women identified also suggested its own solution. They said that their lack of familiarity with Iran, and particularly with job opportunities, means that they tend to take on the same jobs that other Afghan women are already doing. It was suggested that a job-search service would enable them to access information on other job opportunities. Education: the top priority Having seen the poverty of many refugee families at first hand, Afghan women needs to put income-earning opportunities as their top priority. In fact the top priority identified by almost all the groups was education: for the Hazaras it was education in general, but especially literacy; for the Pashtun women it was skills- training. They all believed that they could improve their own lives if they had some education. Solutions The impact of previous conflicts and recent war on children’s social, physical and mental health is enormous and needs a great deal of attention and commitment from the Government. While the debate of reconstructing Afghanistan is currently in progress, saving the future of nation and child health development must be a top priority. Joining these efforts, international assistance is direly needed to handle the deteriorating child health situation. Improving child health in Afghanistan is certainly a daunting task and will require committed and holistic efforts over period of years. Every aspect of child health needs to be dealt with an appropriate strategy. As evident from the facts that infectious diseases and war induced injuries contribute heavily to the current burden of disease, deaths and disabilities in Afghanistan. Therefore WHO’s strategies need to be universally adopted in the country. The strategy of integrated management of childhood illness (IMCI) addresses five major killer diseases with a simple and cost effective manner. War has left tens and thousands of orphans. Fewer than five children currently make a large proportion of Afghan’s population and immediate attention. In the prolonged period of war tuberculosis control program was severely disrupted. Tuberculosis control network need to be immediately restored, drugs provided with the Directly Observed treatment; short course (DOTS) strategy among internally displaced and non-adhered patients. All interventions need to focus equally on providing rehabilitation and treatment for mental illnesses, robustly expand and include program for massive immunization in their essential package of services. All legal measures need to be taken to protect children’s rights and specially that of girls to education, health and social choices at all fronts. For Refugees Using focus group discussions in the context of understanding the problems and aspirations of urban Afghan refugees has given us a great deal of information to which we did not previously have access. In particular, the fact that the refugees were able to participate in drawing up recommendations regarding the future work of NGOs was a very positive experience. It encourages the beneficiaries themselves to think about their situation and to come up with solutions. It also gives the organisations working with refugees a much clearer picture of the hopes and fears of a refugee community. Past experience at ICRI has shown us that involving the refugees themselves in decision making improves the implementation process, bringing about better results. This does not mean that one method should replace the other, but rather that the methods should be regarded as complementary. We know that the single most important factor which determines the living conditions of refugees in Iran is their legal status. In Afghanistan Samar   bring to the forefront the health and human rights challenges that face Afghan women and children. A leading authority on these issues in her country, Samar founded the Shuhada Organization in 1989 to implement innovative programs in health, education, construction, and income generation that improve the lives of women and children in Afghanistan and those living as refugees in Pakistan. The Shuhada Organization has grown to become the largest female-led non-government organization in Afghanistan and operates an extensive network of hospitals, clinics, schools and shelters as well as numerous other programs and services for women and children. â€Å"Boston University is honored to host Dr. Samar as a visiting scholar,† said Gerald T. Keusch, M.D., associate dean of Global Health, BU School of Public Health, and director of the Global Health Initiative. â€Å"Her work to improve the lives and healthcare for Afghan women and children under extraordinarily difficult conditions has made her an icon in global health and her efforts will ideally lead to new policies that will advance the country’s medical and education infrastructure.† The recipient of numerous honors and awards, including the 2004 Jonathan Mann Award for Health and Human Rights, Samar is an international symbol of the steadfast courage required to demand basic human rights for women and children in Afghanistan. In addition to directing the Shuhada Organization, Samar served as the country’s first Minister of Womens Affairs during the interim government, leading the effort to restore economic, political, legal and social rights to women. In her current role as Chair of the Afghan Independent Human Rights Commission, she oversees the conduct of human rights education programs across the country, implementation of a nationwide women’s rights education program, and monitoring and investigation of human rights abuses. The Global Health Initiative at Boston University was established to promote multi-disciplinary research, education, outreach and policy studies across and beyond the Boston University community, and to contribute to reducing disparities in health through the generation of new knowledge, the education of students as â€Å"global citizens,† and the development of partnerships with global health leaders, scholars, and practitioners around the world. In Afghanistans villages, provincial centers, and Ministry of Public Health; in clinics, hospitals, and pharmacies; in classrooms, workshops, and training centers—REACH is empowering the Afghan people to rebuild a health system damaged and neglected during more than two decades of war. A community health worker teaches a mother in a rural Afghan village how to care for her sick child. A young woman improves her literacy level to qualify her for midwifery training. An Afghan midwife attends refresher training about safe motherhood. A provincial health team develops an immunization campaign to protect children against common diseases. The Afghan Ministry of Public Health develops management systems and standards to improve service delivery. Over seven million men, women, and children have access to primary healthcare services. Increasing access to Afghan health services thru (REACH) Through a performance-based grants program and technical support for training and education, REACH has enabled expansion of Afghanistans child health, maternal health, basic obstetric care, and family planning services now accessible to 7.1 million people. REACH grantees have trained over 5,000 community health workers who are working in 14 of Afghanistans 34 provinces. Providing health education in Afghanistan REACH promotes health education and behavioral change that is improving the ability of individuals, families and communities to protect their health. REACH also provides health-based accelerated literacy training to qualify young women to enter nursing and midwifery schools. 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