Afghanistan: People affected by the conflict remain our priority

In March of last year, the Afghan authorities and the United States signed a memorandum of understanding to guide the transfer of authority for Parwan Detention Facility at Bagram from the international forces to Afghan forces. In September, a section of the facility at Parwan was placed under Afghan authority. Prior to and during the transfer of authority, the ICRC continued to visit detainees in the facility to monitor the conditions in which they were being held and the treatment they were receiving, the availability of regular contact between the detainees and their families, and respect for legal safeguards. In addition, the ICRC maintained its confidential dialogue with both international and Afghan forces concerning their obligations under international humanitarian law.

Towards the end of 2012, the effects of the conflict were exacerbated by difficult economic conditions and the harsh winter. People displaced by the conflict had to contend with the lack of proper shelter and daily necessities. With the weak economy already making it more difficult for impoverished people to make ends meet, they had the additional burden of having to heat their homes to stave off disease and survive the cold winter. People detained in connection with the conflict or for other reasons were also affected by the harsh weather. An outbreak of communicable diseases that could have been prevented by vaccination also threatened the lives of many people.

After security concerns arose at Mirwais Hospital in June 2012, the ICRC removed its staff from the hospital, which is run by the Ministry of Public Health, but continued to provide medicines and equipment and to maintain electricity, water and sanitary facilities. In November of last year, the ICRC began sending staff back to the hospital. Mirwais, which is the main referral hospital in the south of the country, serves some four million people. The ICRC also provides technical and financial support for Sheberghan Hospital, in the north of the country.

The conflict in Afghanistan has resulted in thousands of people, civilians and combatants alike, suffering disability. Many others have been physically disabled in accidents or through diseases such as polio, which still afflicts a large number of unvaccinated children.

Alongside the security and well-being of the civilian population, access to health care remains the ICRC's main concern in the country. Active fighting, roadblocks, roadside bombs, unnecessary delays, and a general lack of security prevent the wounded and the sick from obtaining health care. Under international humanitarian law, any wounded or sick person, whether friend or foe, must have fair and equal access to medical care. Parties to a conflict must take steps to ensure that those requiring care face no undue delay in receiving it. The ICRC continues to share its concerns with both parties to the conflict in Afghanistan concerning delays faced by wounded or sick people seeking health care. It reminds the parties of their responsibilities under international humanitarian law and makes recommendations for remedying the problem.

Visiting detainees and maintaining contact between family members

In 2012, ICRC delegates regularly visited prisons run by nations contributing to the NATO-led International Security Assistance Force (ISAF), US forces and the Afghan authorities. The aim was to monitor the conditions in which the detainees were being held and the treatment they were receiving, and to give them the opportunity to contact their families. The ICRC also helped family members separated by conflict to stay in touch with one another, and endeavoured to trace missing persons.

During 2012, ICRC staff:

• carried out 378 visits to 109 places of detention around the country;
• monitored 4,055 detainees individually and visited 1,766 of them for the first time;
• paid the transport costs for 37 ex-detainees to return to their home villages;
• collected over 21,500 Red Cross messages and distributed nearly 21,700, mostly between detainees and their families, with the help of the Afghan Red Crescent Society;
• enabled families of people held in the Parwan facilities to make 7,300 video-telephone calls to their detained relatives;
• enabled families to make 3,300 visits to relatives held in the Parwan facilities by providing them with transportation.

Providing health care

Supporting health facilities is a major part of the ICRC's work in Afghanistan. In order to make health care more accessible, the ICRC provides medicines and medical support to Sheberghan Hospital in the north and Mirwais Regional Hospital in the south, both of which are run by the Ministry of Public Health. In addition, it provides 47 Afghan Red Crescent clinics with technical and financial support, medicines and medical supplies. The ICRC also provides first-aid supplies in front-line areas, and conducts first-aid training for combatants and civilians to enable them to treat the wounded.

During 2012, Mirwais and Sheberghan hospitals admitted 45,391 inpatients and held 216,618 outpatient consultations between them. A total of 11,385 surgical operations were performed in Mirwais Hospital alone. In addition, during the same period, the ICRC:

• delivered medical supplies to the front lines to treat people injured in the fighting;
• provided first-aid training for 2,314 fighters, personnel of the national security forces, local police and the Ministry of Public Health, and taxi drivers;
• made monthly deliveries of drugs and other items to three ICRC-run local health posts in the south and east.

Providing limb-fitting and physical rehabilitation services

Thousands of Afghans have been injured or disabled during years of conflict. To provide physical rehabilitation services for amputees and others with disabilities, the ICRC runs seven prosthetic/orthotic centres throughout Afghanistan. The centres help disabled people to walk again and support their social reintegration by providing vocational training, micro-credit loans and home education for children. A home-care service offers medical, economic and social support to paraplegics.

In 2012, the seven ICRC centres:

• registered 7,929 new patients, including 1,218 amputees;
• assisted 80,528 patients;
• fitted 14,841 prostheses and orthotic devices;
• held 241,379 physiotherapy sessions;
• granted micro-credit loans to 695 patients to help them start small business ventures;
• provided vocational training for 265 patients, 239 of whom completed their training before the year was out;
• conducted 7,083 home visits to treat patients with spinal cord injuries.

Distributing food and other aid

In cooperation with the Afghan Red Crescent Society, the ICRC provides people adversely affected by conflict or natural disaster with food and other necessities. In some provinces, the ICRC organizes food-for-work projects to enable breadwinners to support their families. It also offers training to provide livestock owners with basic veterinary skills.

During the course of last year:

• 7,861 families participating in food-for-work projects received 1,107 metric tonnes of wheat, rice, ghee and beans;
• more than 40,000 families displaced by conflict or natural disaster received one-month food rations and household items;
• 660 women were given chicks, chicken feed, feeders, drinkers and medicine to help them support their families by raising chickens;
• 15,070 livestock owners in the whole country participated in training sessions to help improve animal husbandry;
• 2,500 families in various locations were granted micro-credit loans to help them boost agriculture production.

Improving water and sanitation services

The ICRC works closely with local water boards to help bring clean water to rural and urban communities by drilling wells, installing pipelines and training communities in hand-pump maintenance. The ICRC also helps prison authorities improve standards of hygiene and sanitation in places of detention.

In 2012, the ICRC:

• installed pipelines and drilled wells as part of an effort to bring clean water to over 25,700 people in urban areas of Khost, Nangarhar, Herat, Farah, and Kandahar provinces;
• installed hand pumps and trained people to maintain them, and upgraded spring catchments as part of an effort to bring clean water to almost 301,000 people in rural areas of Kabul, Kapisa, Parwan, Bamyan, Paktika, Khost, Ghazni, Nangarhar, Herat, Balkh, Kandahar, and Kunduz provinces;
• carried out hygiene-promotion sessions for some 21,000 people in Kabul, Herat, Farah, Laghman, Jalalabad, Kunduz and Balkh (Mazar-i-Sharif);
• helped improve water supplies and sanitary conditions for 8,150 detainees in 12 provincial prisons;
• continued renovation work on the water system at Mirwais Hospital in Kandahar.

Promoting compliance with international humanitarian law

Reminding warring parties of their obligation to protect civilians is a fundamental part of the ICRC's efforts to promote compliance with international humanitarian law. The ICRC also spreads knowledge of international humanitarian law among civil-society groups, government bodies and academics.

During 2012, the ICRC:

• gave presentations on international humanitarian law to over 3,100 members of the national army, the national police and local police units, and the National Directorate of Security;
• held briefings on its mandate and work for over 26,000 people, including community elders, religious scholars, members of provincial councils, political authorities, NGOs and beneficiaries of ICRC assistance programmes;
• trained nearly 210 national army instructors in international humanitarian law;
• held three-day sessions on international humanitarian law for almost 1,700 personnel of the national army, the national police and the National Directorate of Security.

Working in partnership with the Afghan Red Crescent Society

The ICRC provides the Afghan Red Crescent Society with technical and financial assistance to help it deliver services to the community and to implement a range of programmes.

In 2012, with ICRC support, the Afghan Red Crescent:

• held its general assembly to approve its constitution;
• held four workshops to train 68 community-based first-aid trainers.

Afghanistan is the ICRC's biggest operation in terms of committed resources. The organization has more than 1,630 national staff and 130 expatriates based in its main delegation in Kabul and in five sub-delegations and 11 offices countrywide. In addition, it operates seven prosthetic/orthotic centres.