In 2002, the International Committee of the Red Cross distributed emergency food aid to Afghans in Ghowr province who were at risk of starvation. This year the situation had improved so greatly that the group distributed seeds instead.
Such improvements show that aid workers and the new Afghan government have been able to concentrate on building a public health system that will ease the plight of Afghan women and children. Humanitarian groups are also working to improve access to clean drinking water and sanitation -- formidable tasks in a country where residual fighting has created an unsafe environment for many Afghans and aid workers.
Their work has also been complicated by the additional needs of refugees who have resettled in Afghanistan. After the Taliban lost its grip on Afghanistan in late 2001, a flood of refugees returned home. In 2002 alone, the Office of the United Nations High Commissioner for Refugees helped about 1.8 million returning Afghans. UNHCR reports that as of the end of July, more than 355,000 refugees have returned in 2003.
The number of refugees returning home has slowed considerably since its peak in May 2002, when more than 20,000 people were repatriated each day. However, the pace remains "significant" according to a UNHCR spokesman and many of those who have returned continue to need assistance.
Kevin Henry, advocacy director for the aid group CARE, told the Online NewsHour that the return of around 1 million refugees to Kabul has strained the capital city and led to overcrowding and unsanitary living conditions. The Afghan government has asked the UNHCR to help prevent the further urbanization of its population by providing assistance to refugees settling in rural areas.
As humanitarian groups aid refugees, a lack of security has threatened the work and safety of those they are helping.
"UNHCR and its partners have worked hard to help more than 2 million people return home over the past year, but the sustainability of those and future returns is now being jeopardized by insecurity in parts of Afghanistan," U.N. High Commissioner for Refugees Ruud Lubbers said in April 2003. "It is absolutely crucial that Afghan authorities and the international community take measures to strengthen security in the country, particularly in rural areas."
In July 2003, The Agency Coordinating Body for Afghan Relief, an umbrella organization representing 60 aid groups, echoed Lubbers' statement and issued a plea for the deployment of international peacekeepers outside Kabul.
Beyond concern for Afghans' security, aid organizations also worry about their own workers. In March 2003, a water supply engineer working for the International Committee of the Red Cross was shot and killed as he drove through central Afghanistan. Afghan police identified the gunman as an Afghan with alleged close ties to the Taliban.
Simon Schorno, the ICRC spokesman in Kabul, told the Online NewsHour that security concerns in southern and southeastern regions of the country have forced the ICRC to restrict their workers in those regions to urban areas.
CARE's Kevin Henry echoed Schorno's concerns, saying the lack of security has delayed large-scale redevelopment projects, such as road rebuilding.
health care situation
Aggressive vaccination campaigns have helped the country's overall health situation. According to a March 2003 U.N. report, "Afghanistan is well on the path towards eradication of polio" due to recent immunization efforts. The U.N. also reported that a measles campaign vaccinated nine million children - nearly 90 percent of the target number. The U.N. has partnered with the Afghan Ministry of Public Health for many of these campaigns, which means the ministry can benefit from the international body's expertise.
Maternal mortality is still a significant problem in Afghanistan. The U.N. estimates that 87 percent of maternal deaths are preventable. The scope of the problem varies significantly from region to region, with the maternal mortality rate in Kabul at 400 deaths for every 100,000 births while in the northeastern province Badakshan the rate is 6,500 per 100,000 - the highest rate ever reported globally. To help ease this problem, U.N.-supported groups are helping the Ministry of Public Health coordinate reproductive health activities.
Children in Afghanistan remain vulnerable. In 2003, the U.N. reported that the mortality rate for children under five is the third highest in the world. Older children are also at risk. Many Afghani children suffer from iodine deficiencies, which lowers the average IQ by 10-15 points and can impair physical coordination. UNICEF is among the groups responding to the situation, supporting the establishment of eight salt iodation plants throughout the country.
A lack of clean water and sanitation also remains a problem in much of Afghanistan and is contributing to high child mortality rates. Many groups are currently working to help improve this situation, including the ICRC, which is working to fix and maintain urban and rural water networks. In 2002, the agency's repair and maintenance work ensured access to clean water for 2.7 million Afghans.
-- By Karyn Schwartz, Online NewsHour