Helping the disabled in Afghanistan: "Enough work for the next 40 years"
Decades of war have left tens of thousands of amputees in need of care and support to help them build a future. Alberto Cairo has been running ICRC orthopaedic programmes in Afghanistan for nearly 20 years; in Kabul, he spoke to the ICRC's Claudia McGoldrick.
It might be reasonable to assume that anyone who has chosen to risk life and limb for the past almost two decades in a war-torn country, thousands of miles from home, is either a missionary or a mercenary. Alberto Cairo is neither of these.
Arriving in Afghanistan in 1989 on his first assignment for the ICRC, just after the Soviet withdrawal from the country, the lawyer-turned-physiotherapist from Piedmont, Italy, had been told by a well-meaning colleague that Kabul was " like St. Moritz " . He was soon to learn that the only similarity was the altitude.
Passing now through the front gate of Alberto's Kabul residence, which he shares with his three cats, one cannot fail to notice the holes peppering the metal. " Oh, that was from when a rocket landed just here " , he says almost cheerfully, pointing to a filled-in crater in his driveway. " But that was nothing compared to the one that landed in the garden and ma de the whole house shake. That time I was really lucky. But that was ages ago now. "
Sitting in his living room – festooned with gaudy plastic flowers and fruits, ornaments and coloured lights ( " pure kitsch " , he laughs, " but all presents from people, so I can't offend anyone by hiding them away " ) – Alberto muses on his life over the past 18 years.
Working initially in a hospital for war-wounded in Kabul, his first impressions of the country were discomfiting. " I really felt it was a sad place " , he says. " Life for many people was going from bad to worse; they were becoming poorer and more desperate, and ma ny of those who were able to leave did so. "
Within three years, the country had descended into civil war. Alberto was evacuated for a few months in 1992, and then returned to reopen the ICRC orthopaedic centre in Kabul, which had first been established in 1988. At that time it offered physical rehabilitation services, including prostheses and physiotherapy, exclusively to amputees – most of them mine victims.
" The situation remained extremely difficult, because at times the front line of fighting literally followed us from place to place around the city, and we were forced to move frequently " , remembers Alberto. " Sometimes we were barricaded inside the centre, unable to move. "
However, under Alberto's direction, the ICRC's orthopaedic programme steadily grew, eventually expanding to five other main cities across Afghanistan. Today, the Kabul orthopaedic centre is by far the ICRC's biggest physical rehabilitation facility in the world. It employs 250 local staff – all of them disabled – and has treated some 40,000 patients since 1988, three-quarters of them amputees. The centre produces thousands of prostheses and walking aids such as crutches, walkers and wheelchairs every year.
" From the very beginning we implemented a policy of positive discrimination, employing only disabled people to work in the centre " , says Alberto. " To me this was a perfectly logical decision, which benefited everyone. Having dedicated staff who know the problems and needs of disabled people first-hand is a source of motivation and hope for all concerned, including me. "
The need to open the centre to people with all kinds of physical disability soon became apparent. " When you had a situation where 50 disabled people were queuing at the gates of the centre, but perhaps only 20 of them were amputees, it became embarrassing to have to turn the others away – especially knowing we could do something to help them " , says Alberto. " These days, the majority of our patients are victims of car accidents, polio victims, people with congenital deformities, paraplegics… In fact, only about one out of five patients now is war wounded. "
" We soon reached a point, however, when we clearly didn't have enough jobs at the centre for all those who needed one " , he says, " so we started vocational training and micro-credit programmes. "
" At first it took a lot of convincing to make people believe this could work, but I was absolutely determined " , he says with a bemused look. " We started in the mid-1990s with perhaps the most vulnerable category – paraplegics – whose situation is really devastating, not only for themselves but also for their families. "
A new programme was set up to assist paraplegics and their families inside their own homes. At the same time, teachers were sent to the homes of children who were unable, because of their disability, to attend school. By 1997, small loans were being given to those few paraplegics who were willing to get out and engage in some kind of petty trade.
" One problem is that disabled people are often treated as victims in this society, people give them pity but not rights. As a result they end up sitting at home doing nothing " , sighs Alberto.
" We made slow progress, with sometimes poor results, but eventually the micro-credit programme took root and expanded to all disabled patients. To date we have given out at least 4,000 small loans, for a whole range of enterprises, from tailoring and carpentry to selling firewood and vegetables " , he says.
A typical working day entails around three hours spent with patients, " sometimes just laughing and joking " , but more and more of his time, he says, is spent dealing with management and administrative issues. It is not unusual for him to work a 14-hour day. " I do get stressed, and quite frustrated sometimes, especially when I can't achieve results as quickly as I'd like " , he admits.
" But I really have such a satisfying job " , says Alberto earnestly. " I see patients arriving here terribly depressed, unable to walk, and we can help them to find strength within themselves to get started again. That is enough to keep me motivated. "
At the same time, Alberto is sure that his job will never be done. " Yes, there has been definite progress in terms of addressing the landmines situation in Afghanistan, and important targets have been achieved under the Ottawa Treaty " , he says. " But even if from now on there is not a single new mine incident, we would still have enough work for the next 40 years. With around 40,000 amputees in the country, needing on average a new leg every 3 years, that's a big job. And that's without addressing the continuing social and physical barriers for the disabled. "
" I see my life in Afghanistan forever " , he says. " I've come to love the country as much as I love my job. I see it as my mission to help the most destitute and disabled people here, and believe me, there are plenty of them. "
And does he not miss anything about life back in Italy? " Oh, I do miss the cinema and bookshops… I adore Harry Potter for example, but with the internet these days everything is possible " , he says laughingly. " I do go back to Europe at least three times a year, to see my parents. Sometimes it helps to get a perspective on your life when you reflect on it from a distance. "