Time is running out to save millions of lives in Afghanistan

Kabul (ICRC) – The international community must step up urgently to stop Afghanistan's rapid slide towards total collapse and all-out humanitarian disaster, warned international Red Cross leaders on a five-day visit to the country.

Six months after the Islamic Emirate of Afghanistan took control, resulting in international sanctions and the freezing of aid, the continuing reluctance of many international donors to engage with the current leadership is worsening the desperate plight of millions of Afghans already worn down by more than four decades of conflict, repeated droughts and the COVID-19 pandemic. 

"In my 25 years as a humanitarian worker, I have never seen anything quite like this. The magnitude of the crisis facing the people of Afghanistan – and the speed with which it has worsened – is really alarming," said Robert Mardini, director-general of the International Committee of the Red Cross (ICRC), accompanied by the heads of the Danish and Finnish Red Cross societies. "Afghan lives must not be hostage to political manoeuvres. It is vital that donors distinguish between the type of development aid that might be used as political incentive and aid that will help ordinary Afghans to survive – by ensuring that government institutions can deliver basic services and prevent economic collapse. There is no time to lose." 

Healthcare services are among those in most urgent need of support. Perhaps nowhere is this more evident than at the ICRC-supported Mirwais regional hospital in the southern city of Kandahar. Serving a population of up to 9 million in the region and beyond, demand far outstrips capacity, with some 4,000 sick or wounded seeking treatment in the 650-bed facility every day. This is partly because the current crisis caused some smaller healthcare facilities to close down and many practitioners to leave the country.

All the wards are overcrowded. Bed occupancy in the paediatric ward, for example, is at almost 300 per cent, with often two or three children per bed. Many are severely malnourished, and numbers are rising – not only in children but in young adults as well. Some are the victims of improvised explosive devices, like one boy whose hands were blown off when he picked up what he thought was a toy. One ward is full of children suffering from measles, a disease endemic across the country.

"Seeing the levels of suffering here is really very distressing," said Kristiina Kumpula, secretary-general of the Finnish Red Cross society. "Afghanistan was already one of the most difficult places in the world to be a mother or an infant. Now it is harder than ever. And the people we are seeing here might be considered the lucky ones – with many health facilities not functioning at all, sick and vulnerable people are forced to travel long distances, which few can afford. Many simply don't reach the care they need."

"Access to healthcare is clearly one the most pressing humanitarian concerns in the country," said Anders Ladekarl, secretary-general of the Danish Red Cross society. "Supporting teaching hospitals and nursing schools is one of the most effective and sustainable ways to save an already-debilitated health system from collapse and help secure its future. The urgency of putting the right support in place cannot be overestimated."

While there has been welcome progress on some restrictive measures that help facilitate humanitarian response, including a December 2021 UN Security Council resolution allowing some exemptions in the sanctions regime, Robert Mardini is clear that States need to go much further.

"Humanitarian response, while vital, simply cannot replace a functioning public sector and ensure service delivery for 40 million people," he said. "The most urgent next steps are salary payments for some 500,000 public sector civil servants, ensuring that critical services are able to function, and resuming technical support to the Central Bank to relieve the banking and liquidity crisis."

For its part, the ICRC is supporting 28 hospitals across the country, through the Hospital Resilience Project, including directly paying the salaries of around 10,000 health professionals. This support ensures access to healthcare for up to 20 million people.

Working closely with the Afghan Red Crescent Society and other key partners – from within the Red Cross Red Crescent Movement and beyond – they are ready to scale up and replicate this model, including in other key sectors. Work has started to ensure the uninterrupted supply of drinking water in urban centres through support to public water and electricity utilities.

To this end, in March the ICRC will launch a budget extension appeal of close to 50 million Swiss francs (USD 54 million), most of which will be used to help provide assistance to the country's hospitals and medical staff.

"What is needed now is decisive action by donors to put the lives and livelihoods of Afghan people above politics," said Mr Mardini. "The cost of inaction will be very much greater, and the ensuing disaster difficult, if not impossible, to reverse."