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Promoting healthier living among Afghanistan's urban poor

29-04-2004 Feature

The ICRC's 'Environmental Health and Sanitation' programme is helping improve the health of the urban poor in Afghanistan by raising awareness about hygiene. To date, around 14,000 households have been visited in Kabul, Herat, Jalalabad and Mazar-i-Sharif. Jessica Barry reports.


Shanaz, of the women's hygiene promotion team, teaches healthy living©ICRC/ref. AF-E-00225 

The two landcruisers pull up at the edge of a busy road in one of Kabul's poorest neighbourhoods and a group of well-dressed women get out clutching bags and clip boards. Nearby, several ragged children are collecting water in buckets and tin cans from a dusty stand pump beside the kerb.

Behind them, the brown, rock-strewn land rises steeply. Mud-brick houses cling to the precipitous hillside, interspersed with narrow footpaths, some of them little more than goat trails. It is up these winding tracks that children have to stagger home with their splashing buckets.

Donning their burqhas, the women -- members of the ICRC's 17-strong hygiene promotion team -- set off up the hill, stepping over the channels of raw sewage and helping each other up the more difficult parts of the route. Reaching the first, dilapidated houses after a five-minute climb they split up into pairs to begin the day's work.

For Malalai and Husay, the first stop is at the house of a returnee family from Pakistan. A few thin chickens peck about among a pile of unwashed crockery as the two hygiene promoters enter the yard. Torn plastic sheeting flaps from the window frames of the mud-walled dwelling. Inside, the small living room is bare but for a carpet, some thin mattresses and a pile of cushions.

Two young women – sisters in their early twenties – usher them in. One of them, dressed in a traditional purple, embroidered dress sits rocking a six-week-old baby in her arms as the hygiene promoters bring out their picture books and charts, and introduce themselves.

 Encouraging signs  

From this visit, it appears the health and sanitation programme is working well. Certainly, the two young sisters are following advice given to them during a previous visit about covering water jars and leftover food, and about burning rubbish in the yard.

Zermina (second from right in the middle row) and her family listen to Shanaz's hygiene promotion lesson   ©ICRC/ref. AF-E-00226 

At the end of the visit, Husay goes to the corner of the compound to inspect the pit latrine, installed during the first phase of the ICRC's health and sanitation programme. It is covered and clean. Packing away their charts and clipboards, the two women look ple ased and promise to call again.

In another equally poor household, 33-year-old Zermina sits attentively beside a neighbour and her six children while hygiene promoters, Shanaz and Moshakari, show off the drawings in the training manual.

At the end of the session, the neighbour asks timidly if they are going to receive some food. " When I got hurt during the war, " she said, pulling down the waistband of her skirt to reveal a huge, pale, jagged scar, " I was given a sack of flour when I was released from hospital. "

When it is explained to her that this is a programme about health promotion, not food assistance, Zermina's neighbour nods and says no more. But her remark is a stark reminder of the absolute poverty of so many families.

 Life is getting better but there is still much to do  

Today, the extraordinary industriousness of individual Afghans is evident in every major town. In Kabul there are thriving small businesses along every back street -- from metal workshops to bicycle repair shops, tailoring booths to cooked-food stalls. The bazaars are overflowing with merchandise.

Even so, it is estimated that most Afghans are still living on less than $1 a day, and it is this group that the hygiene programme is trying to assist, by helping families to ward off illness and unpayable doctors'bills through promoting healthier lifestyles. And it is this, in part, that prompted the women of the hygiene team to take on the work. Speaking of behalf of all of them at the end of the morning up on the hill, Jamila, a former lawyer, says simply: " We want to help our people. "  

Such is the devastation of more than 20 years of conflict in Afghanistan that even the better off have not escaped unscathed. With in the hygiene promotion team itself, two of the women are war-widows, the husband of another one has been missing for seven years, and all the women lost their freedom during years of seclusion.

After living through so much it is only now, with the new order of things in Afghanistan, that they are beginning to pick up the threads of their lives; and, in so doing, are helping other, less advantaged women, to do the same.