It is a quiet day in the emergency room of Andar district hospital in the Taliban-controlled part of Afghanistan’s southeastern Ghazni province. The sole surgeon at this rudimentary hospital serving some 100,000 people is only on his fourth operation of the day, a standard appendectomy.
But he knows it will not stay quiet for long.
War-wounded patients arrive on most days, both fighters and civilians.
The doctor recounts a recent incident when 22 civilians, mostly women and children, were admitted following a bomb blast in neighbouring Paktika province. The five-bed emergency room was inundated.
Chaotic scenes ensued, with frantic efforts to triage and find space for the wounded.
The Taliban’s provincial health officer laments the lack of capacity to provide adequate health care for the population.
Some 35km away, through the no-man’s land separating Taliban and government control, I visit Ghazni provincial hospital.
With the sound of gunfire clearly audible in the distance, I was told during my visit earlier this month that 1,000 people wounded by war arrived over the previous 10 months – and that numbers have been increasing.
On both sides of this frontline, health authorities make it clear that since intra-Afghan peace talks started in Doha, Qatar, in September, hostilities between government forces and the Taliban have in fact intensified – especially in provinces such as Helmand, Kandahar and Ghazni, but in other parts of the country, too.
After almost two decades of a complex war that has so far eluded all military and diplomatic efforts to end it, most Afghans I met – at all levels – are understandably wary about the prospects of peace, seeing a disconnect between what is being said in Doha and what is happening on the ground.
Regardless of the peace talks, urgent humanitarian needs cannot wait. Even if a peace agreement is reached tomorrow, this is no panacea to heal decades of suffering and deep-rooted needs that in some cases span generations. The lasting mental trauma of long-term exposure to violence is just one example.
The healthcare system in Afghanistan has been a victim of successive conflicts over the past four decades. A lack of investment and relentless insecurity have led to dilapidated facilities, poor water and electricity supply, obsolete equipment and a dearth of qualified medical staff.
Infant mortality is among the highest in the world and life expectancy of an Afghan is around 65 years. Many people struggle to get to hospital at all – either because they cannot afford transport or because it is too dangerous. Healthcare facilities, staff and patients are too frequently the direct targets of attacks.
Covid-19 is adding yet another deadly threat – even if, in the absence of reliable testing and data, many Afghans seem to be downplaying it. Or as one healthcare worker told me: “when people are faced with so many challenges, just surviving day to day, they are less likely to worry about an invisible enemy like Covid.”
Without doubt, access to health care is among the most pressing humanitarian needs in the country – across front lines and without discrimination against political affiliations.
As long as the fighting continues, the parties need to do everything they can to protect civilians – in accordance with international humanitarian law, which is non-negotiable in the framework of any peace initiative.
Where there is no protection – and civilians continue to be attacked and killed – there clearly can be no peace or development.
But if the two sides are sincere about peace, they could start with confidence-building measures where they matter – on the ground.
These could be mutual agreements related to issues such as, for example, evacuation of the wounded, the transfer of human remains or respect for the medical mission.
Such practical measures would go a long way to creating trust across lines and might just help pave the way to a durable political solution.
The international community will come together in Geneva on November 23-24 to make new commitments promoting sustainable development, prosperity and peace in Afghanistan.
The pledging conference, which takes place every four years, hosted this year by the governments of Afghanistan, Finland and the United Nations, will effectively determine how much financial assistance will be allocated to help Afghanistan realise these ambitious goals.
The opportunity must not be missed to also commit adequate and sustainable funding for humanitarian programmes – even while pursuing a ‘joined-up’ approach towards peace, prosperity and self-reliance for the Afghan people.
Robert Mardini is the director-general of the International Committee of the Red Cross
