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10/13/2003: "Kandahar Chronicles #25 - 11/10/2003"

There are times when difficult decisions are made that either way have short-term consequences. When dealing with the welfare of vulnerable populations those decisions can be a matter of life and death. With attacks on NGO staff increasing in Southern Afghanistan, a decision has been made by the MSF Head of Mission in Afghanistan and the HQ in Amsterdam to suspend our operations in the Zhare Dahst IDP camp until this situation can be improved. This has been done to put the considerable influence MSF wields to protect our staff, both international and national, and to help create a safer environment for the people of this region. Unfortunately, this action, which is directed at initiating a response from the government authorities, could come at a serious cost to the inhabitants of the camp. Doing nothing and accepting the deteriorating security situation could be much worse.

MSF provides the only effective medical care for the estimated 30,000 plus population of the camp. Zhare Dasht lies forty kilometres west of Kandahar, with the last eleven kilometres a graded dirt road winding through minefields. Everyday, an average of sixty of our staff make this journey on regularly scheduled trips in six MSF marked minivans. Our movements are predictable, and unlike the UN, without armed escort. We do this to make our neutrality apparent to all sides in the ongoing conflict that continues to cost the people of Afghanistan so much. We continued to move in this manner despite the repeated murders of NGO staff throughout the country. Forces loyal to Mullah Omer are carrying out his directive to kill both expatiate and Afghan NGO workers with brutal results. The dedication of the aid organizations throughout the country to carry on providing essential services to a devastated population has been commendable.

The daylight killings of two VARA workers two weeks ago on the main road to Heart and the recent attacks on a national demining organization, DAFA, within the IDP camp itself have proved to be pivotal in this decision. Nicky, our Head of Mission, asked Bertain, Kathleen and myself to a meeting in the courtyard to discuss this new development. She was fair and informative but the decision had been made. We discussed all options but despite my initial shock we agreed that it was time to try to pressure the Governors office into realizing this situation was unacceptable. The following morning we would pull out of the camp and not to resume operations until measures were taken. The minimum key indicators that would allow for a resumption of activities would be two professionally manned police checkpoints on the access routes to the camp.

We had meetings at the office with key national staff to inform them of the decision and try to explore all scenarios and reactions to this plan. There was a similar feeling of shock for them but they agreed it was the best course of action. We also talked about alternative ways we could continue to provide a level of care to the IDPs. Various ideas of “remote control” operation through national partners were also discussed. The Governors Office, UNHCR and its implementing partners, the Ministry of Health and various other NGOs were notified later that night. Reactions of shock, disbelief and finally understanding were evident. Many of the smaller NGOs stated that they supported our decision for the direct benefits it would bring to their work and said they would take similar action if they had the influence of MSF. We were committed and put the luxury of second-guessing to the back of our minds. There would be time to reflect on this action later, now was a time to put a plan together.

The next morning we called an early morning meeting of all camp staff and informed them of the decision. We explained why we were doing this, assured them that their jobs and continued salaries were safe, asked them to work as normal and keep quiet to avoid rumours sweeping through the camp. This was important as it is never possible to gauge the reaction of the affected population when such an important service is being removed. For people that have so little, a negative or even hostile reaction was possible. Nicky would go directly to the camp elders and with a Yacub, a senior respected nurse, would inform them and deal with any backlash. My job was straightforward, get all essential items, such as potentially harmful drugs and a few pieces of important equipment, out of the Health Posts and BHU and organize the staff departure. Tents and bulky equipment were left in place to facilitate a quick exit and to show the IDP people our intention to return as soon as possible.

I moved through the tents talking quietly with doctors, nurses and pharmacists about what needed to be taken and what should be left behind. As I started packing the items into our vehicles, Nicky returned to the BHU to inform me of the meeting. The camp elders supported our decision, as they felt under threat from the armed groups that entered the camp at night. She explained that we felt confident they could give us protection within the boundaries of the camp but the threat lay more along the roads. They also knew that should an aid organization have people killed en route to the camp, it could lead to a very long suspension of activities. This was a huge relief and tension melted away. I didn’t relish the thought of a horde of angry Afghans surrounding our vehicles.

I drove over to one of the Health Posts to supervise their preparations. The Doctor had one final patient to treat before we could start packing. A toddler lay across his fathers lap as0 a terrible wound to his head was cleaned. He had been playing under a tractor when it moved suddenly taking half his scalp with it. He looked at me with huge, brown, tear filled eyes as the doctor fitted a neat bandage to the wound. Until that time, I had been too busy with my job to think about the people. The little boy brought me back to the reality of the situation in this desolate place and the vitally important work that we do here. I waited until he left, clutching onto his father with one hand and touching his clean bandage with the other. I don’t know for how long he will be the last patient we will treat directly within the camp. I can only hope that now the authorities will make the right decision and quickly put their resources toward rectifying this dangerous environment.