Afghanistan and Central Asia

Getting health care and health care policy right is a continual battle for developed countries, as one hears cases of doctor and medical mishaps all to frequently, but one thing we have come to count on, at least here in the US, is that the blood transfusions we receive are clean and safe. A new World Bank study titled ‘Blood Services n Central Asian Health Systems– A Clear and Present Danger of Spreading HIV/AIDS and Other Infectious Diseases‘ reports that this is not so in many CA states. For a little background on Central Asia’s HIV/AIDS problems here is a old write-up with some useful resources.

The World Bank study retested 7,500 blood donor samples from Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan and identified the prevalence of several infectious diseases; including .2% for HIV, 2.7% for Hepatitis B, 3% for Hepatitis C, and 3.6% for Syphilis. These results show that current donor screening methods in the region are not fully effective and need improvements quickly. In fact, the report found that some CA health facilities did not even test their blood donations at all!

Radio Free Europe reports that since 2006, hundreds of people, have been infected with HIV/AIDS by tainted blood in CA hospitals, including 149 children in Kazakhstan, 69 children in Kyrgyzstan, and several more in Tajikistan.

Patricio Marquez, the main author of the World Bank report, stated; “Numerous parts of these countries’ blood transfusion systems are in serious need of restructuring, of new investments and of increased budgetary support for operation and maintenance.” The reports official recommendations

A. Establishing nationally coordinated blood transfusion systems and universal unpaid blood donor systems

B. Optimizing laws, regulations, and donor promotion campaigns

C. Effective donor screening strategies, training of medical personnel, and the promotion of using blood and blood products

D. International support to assist the restructuring of these nations health care systems

Lastly, as we have discussed before, there are cultural constraints present in Central Asia (and in many other places in the world) that prevent an open discussion about HIV/AIDS and how to prevent it and the lack of effective blood donor campaigns is a sad result of these beliefs and fears. The people who are mistakenly infected with tainted blood are one thing and one thing only, unfortunate victims, and should be treated with the utmost respect and care.

On a separate note, I would like to acknowledge the passing of Chingiz Aitmatov, a widely popular writer and statesman, who was buried in Bishkek, Kyrgyzstan a couple days ago. Kyrg President Bakiev eloquently eulogized ‘One more star in the sky has faded; the heart that was filled with joy and sorrow, pure feelings and reams o not only the Kyrgyz nation but also of all the peoples of the world, has been stilled, has stopped.’

(Photo: Children were infected at hospitals in Kazakhstan and Kyrgyzstan (Source: RFE/RL)

Just a quick one today folks. If you haven’t checked it out yet, make sure to take a look at the post on May 11 ‘A Autocratic Dawn’, I think it raises an important issue that will and has affected CA and the world.

EurasiaNet has written a scathing report chronicling the Tajikistan government’s voluntary tax request from some of its poorest citizens in order to raise $10 million dollars to finance the Rogun project. The news outlet calls the tax ‘arbitrary’ and ‘confiscatory’ and rightly claims that it will dramatically hurt the poorest of the nation for amounts to a very small percentage of the projects ultimate budget, around $550 million. The people of Tajik deserve better and if this money is raised, the government needs to be transparent of its use, otherwise it will disillusion its populace to an even greater degree.

Kyrgyzistan’s President Bakiyev has provided a one-time compensation payment of $14,600 to 72 children and their families, who were accidentally infected with the AIDS virus in two southern Kyrg hospitals, because of what has been asserted as medical personnel negligence. This is a tragic way for progress to be spurred, but hopefully this is a sign that the Kyrg government is going to start taking HIV/AIDS prevention more seriously.

I ran across this article on the Motley Fool’s philanthropy site.  Here is the first sentence:

Across the world, a profound disaster is unfolding: Over the next 10 years, 1 billion young people in developing countries will be competing for about 300 million jobs.

Okay, so these are the choices: create businesses, hire people, or expect them to figure out an illicit business, or, expect them to starve.  Or, we could teach the next generation of entrepreneurs.  That is foolanthropy’s goal, and Mercy Corps has been granted money from foolanthropy to work in Kyrgyzstan.  According to a Mercy Corps press release, the program pairs high-school graduates with craftsmen such as metal-workers in order to teach skilled labor.   There is also a second program which concentrates upon fruit tree development on a community0wide basis in the Ferghana Valley.  A third program uses microfinance to help entrepreneurs develop businesses and jobs.

Further reading:
Mercy Corp’s report on their Ferghana Valley projects 

UN Secretary-General Ban-Ki Moon has designated 2008 as the Year of Water Sanitation, a worthy effort which dovetails into public health and climate change issues–and which Central Asian states could use to their benefit.

According to the UN, investing $10 billion a year could halve the proportion of people without basic toilet facilities by 2015.  This grimy state of affairs affects 2.6 billion people worldwide, and not just aesthetically.

Public Health vs. Polio:
In Pakistan and Afghanistan, polio, spread by fecal-oral contact, continues to be a public health problem.  Afghanistan has had an immunization program over the past year at enormous effort; Pakistan needs one desperately.  Dr. Chan at the UN’s World Health Organization has stated that the last pockets of polio incidence are also the most expensive and difficult to reach–Pakistan, India, Afghanistan, and Nigeria.  Cultural differences, difficulty in understanding the vaccine regime, and security and transportation problems  frequently hinder efforts.  Hardline preachers in the Pakistani tribal areas have forbidden health workers to immunize children, as late as August of this year.

Rotary International, a long-run enemy to polio virus, and the Bill and Melinda Gates Foundation, are jump-starting the continued effort with a grant to WHO of USD 2 million.

“An estimated 42,000 people die every week from diseases related to low water quality and an absence of adequate sanitation,” U.N. Secretary General Ban Ki-moon said in a statement announcing 2008 as the Year of Sanitation.   Water-borne diseases such as botulism, cholera, and typhoid mostly affect children.

Climate change:
Add to the fact that climate change hits poor countries the hardest–and water quality in poor countries is the worst.  What this means is that water sources themselves become exploited in a heightened fashion, because water itself is not taken care of downriver.  The effects of climate change in Central Asia’s aquifers and in Xinjiang make it more important than ever to safeguard and safely treat/sanitize the water that is available.  It’s a great program for 2008.  I hope Central Asia officials are busy writing their grants for water sanitation projects–Today–at the very latest., for their major rivers and their dead lakes, their sewage infrastructure, and whatever else that they can think of that will bring water quality up for human use–and for human industry–and human health.

Further Reading: Wikipedia on Poliomyelitus, a disease spread by poor sanitation

Photo: BBC

Before NATO, there was Afghanistan’s Taliban movement (you can’t call it a government, because it offered no protection and no services to its people).  And the new Taliban, neo-Taliban, or whatever we call them have the same, tawdry, consistent practice of gratuitous cruelty in this regard–

Here’s the whole story from AFP wire, as printed by the Pakistan Daily Times:

WANA: Local Taliban militants seized and burned thousands of kilogrammes of food destined for pregnant women from a hospital in South Waziristan, officials said on Sunday.

The food, mainly lentils and cooking oil, had been supplied by the aid charity Save the Children to feed pregnant women suffering from malnutrition.

A Taliban activist said they were destroyed because “foreign NGOs want to harm our future generations.” An administration official, Tariq Salim, said the Health Ministry officials had not consulted him before distributing food directly to the women. Meanwhile, in North Waziristan, three people were killed and five wounded when troops conducted “retaliatory” strikes on suspected militant hideouts in Mir Ali, local officials said. Several houses were destroyed in the strikes that came after militants hit a checkpost with a missile barrage. One soldier was wounded in the rocket attack late Saturday, they said.

Well, if you could’ve seen me, I’d hopped right onto my local soapbox.  And then I stepped right back off again, to think instead of react. 

1. NGOs
It’s past time to honor the NGOs such as Save the Children whose work is dangerous and difficult.  Those who deliver aid on-site face numerous disappointments and trials, but they are there, putting human concerns first.  As of October 29th, the United Nations has documented the death of 34 aid workers in this troubled state for 2007.  They are soldiers too–we need to look at it just like that.

2. Donors
It’s also past time to honor those who donate funds to worthy NGOs working in Afghanistan.  Stories like this often make people wonder if their charitable impulses do any good–and this leads to what is often called “donor fatigue”.  But worthy, well-run programs do make a difference.  Not everything we do has the immediate effect we want it to, even with people we know.  But in the long term, the expression and relationship makes a difference.  In Afghanistan, where malnutrition, poverty, and childbed mortality are large problems, donations make a big difference.

3. In Unrelated News? Or, related News?
You can miss it if you read fast, but what is the relationship between the Waziristan official’s gripes about food distribution and the story of Taliban destruction of the warehouse?  These are two separate issues, related only by being in the same story. But it brings some questions to mind:

What is the relationship between warehouse protection by regional officials and Taliban incursions? What is the relationship between NGO/government for coordinating aid efforts?  What is the obstruction to aid efforts that are posed by regional officials?  Questions like this can make you mad, but they should also remind one of the difficulties in getting an aid effort moving and its mission to the target recipients. 

4. Evening out the competition
It’s strategically intelligent of the Taliban to bomb aid–because they don’t offer any.  By decimating our ability to help Afghanistan’s people, the contrast between “them and us” becomes one only of who’s the meanest person around–a life full of fear and no benefit.  We can’t give up on aid, or else Afghanistan’s people will have no horizon for the future.  The fact that babies are involved only underscores the need for aid today.

I am angry–I am thinking about those expectant mothers who will not eat this week.  But I am also humbled by the consistent heroism of those who are making aid happen in a world where “serving the people” seems to be a huge risk.  I am thankful for those who have served so consistently, by deed and by donation, in Afghanistan. 

I regret that I haven’t been writing recently on Afghanistan:  especially since it’s past time to write about trouble that aid workers are having in delivering food and services.  Here are some aid statistics for the last ten months:

– 34 aid workers have been killed. 
– Seventy-six have been abducted. 
–Fifty-five convoys have been attacked, by either Taliban or criminals, six times higher than last year.  The UN World Food Programme has lost 1,000 tonnes of food aid due to these depredations.
–Due to the convoy attacks, six weeks have passed since food has been delivered between Herat and Kandahar.  And in another six weeks, snow will make many of these roads impassable for aid delivery–according to the UN director on the ground, Mr. Corsino, this will mean starvation for 400,000 Afghan citizens.  This would be about 0.8% of the five million people who need some sort of food aid in Afghanistan.

Furthermore, according to Declan Walsh’s article in The Guardian (who reported all of these statistics):

The Afghan education ministry says 400 schools in the south and east are shut because of violence. Taliban fighters have burned down 20 schools in Helmand in the past 15 months.

Further reading:
UN Secretary-General Ban Ki-Moon’s Special Representative Mr. Koenigs on Afghanistan’s aid delivery
UNICEF press release on the plight of Afghanistan’s children from the Child Alert: Afghanistan report
UNAMA–UN Aid Mission to Afghanistan Web site

Photo: Luke Powell for the UN

Every year a couple of stories come out about serf labor in the cotton fields of Central Asia, right about the time that the cotton crop gets harvested.  That day has again arrived this year, but with new, tougher problems for Central Asia’s agricultural laborers and for the state leaders that have made this choice.

The wreck of human capital equals the wreck of state capital
Some judicious reading over the past six months has taught me that the conditions for agricultural labor are poor: the accommodations are inadequate, the food is lousy/not enough.  The pay is small, it is paid less than 100% of the time, and paid whenever the state feels like it, which is Not Right Now.  All sorts of people, including those better utilized elsewhere, are pressed into cotton harvesting.  These include: schoolchildren; teachers; university students.  None of these impressed workers are moving forward in their own lives.  Nor are they moving the state forward as part of an educated, thinking, and contributing populace.  their lives and their studies are interrupted in order to fund today’s dwindling state export dollars on a crop which is essentially ruining Central Asia’s ecology and future ability to earn income from agriculture. 

Yet there’s more than one train wreck here
The newest problems are those which concern those that want to work and can’t.  Little by little, the options of the desperate but willing continue to disappear.  The cost of working — and the barriers to it –become higher and higher.

Uzbekistan, for instance, has recently forbidden its agricultural workers to enter Kyrgyzstan to find work.  According to this Ferghana.ru article, the cotton crop in Uzbekistan is already harvested, and Kyrgyzstan is just beginning its work–jobs are available.  This would be a prime chance for agricultural workers to bring money home to their Uzbekistan families under the remittance economy model.  Security fears post-Andijan fuel this directive.   The cost to the people and to the state for heavy security continues to mount–and increasingly fails to work.   Without outlets for legal commerce, only illegal commerce becomes available.

Previously, Uzbekistan has been charging its migrant workers to leave: an exit visa of sorts, and then taxing their remittance monies to the family, and then charging them when they enter the country again.  Immigration is further limited by Uzbekistan’s strange sense of public relations: denying that the people need economic assistance and/or jobs, they have created policies where people cannot act as if they need work.  Thus, people who need work cannot find work, and people who could bring money to Uzbekistan cannot obtain it.  This circular reasoning contributes to a spiral of economic instability and eventually, security instability.

Government response: more limits, less opportunities
CIS labor ministers are concerned about labor migration, but they have only one-half of the equation.  One can possibly stop illegal migrants, but the urge to migrate for economic reasons occurs when there are less opportunities at home.  Building state capacity in these states will reduce the enforcement cost of stopping them. 

For many of us, these stark facts form an object lesson in how governments have the power to impede markets, virtue, and even the pursuit of necessity.  For those that live it, it is a grim reality that means lost opportunity, lost earning power, malnutrition and for some, death.  The cycle of lost capacity continues to drag Central Asia’s economies down.  One thing is certain: the people work.  But the other thing is, their governments frequently ensure that they work in vain.

Further reading:
Short great article on migrant flows in 2006 at Ferghana.ru, with pictures

Map: Washington.edu

Providing for education is a big part of a sustained aid: providing teachers, doctors, and nurses, with the tools and means to bring knowledge and self-help to Afghanistan’s citizens and to the nation as a whole.  Frequently with aid we think of supplies.  Yet knowledge is something that cannot be taken away, from the mentoring of a surgeon in an Afghanistan city to counseling mothers in a small town. 

Salaries:
The UK’s Department for International Development (DFID) will expend funds to pay teacher’s salaries as well as those of doctors and nurses in the state.  The total funding of 55 million pounds will be part of the UK’s already-stated 500 million pound commitment over three years.

Medical Assistance:
Captain Everdean reports via CENTCOM that a Provisional Reconstruction Team  delivered pediatric medical care in a remote province of Zabul, where they saw 200 people and mentored local nurses in health care.  A couple of weeks ago, another team took the donkey-track to a remote village in Panjshir Province, bringing food, toys and medicine.

The International Society of the Red Crescent/Red Cross (ICRC) has been working with Mirwais Hospital for the past eleven years.  In a recent interview, the head of the Afghanistan effort discusses why they have expanded their aid from surgical support to renewing hospital infrastructure.

Legal Assistance:
450 of Afghanistan’s judges are to receive copies of Afghan law books, and the first 37 judges received their copies on August 25th, in Parwan province.

Just an update.

I found this while looking for news for the Central Asia Beat of last week, but it was well worth returning to:  accounts of torture in Naryn by the police.  The International Helsinki Federation for Human Rights works to raise awareness of human rights violations in Central Asia, improve local human rights defenders personal security and their access to policy-making, and interact between local and international communities.  And indeed August 13th looks like a day of decision: two police officers were acquitted of torture, perhaps wrongly.  One new investigation was formally started on torture charges.  And one more prisoner died.

According to the International Helsinki Federation and the Kyrgyzstani human rights center Kylym Shamy, several arrests by Naryn’s GOVD (a department of the Ministry of Interior) have ended in prisoner deaths.  This is pretty much verbatim from the IHF/Kylym Shamy Press Release:

Alykbek Sakeev, a 48 year old man, was arrested by two officers of GOVD, Chyngyz Kerimkulov and Taalajbek Chypaev, on suspicion of cattle theft on 20 November 2006. After several hours, he was delivered to the emergency room of the casualty hospital in Naryn where he died without regaining consciousness.

According to Sakeev’s relatives and doctors he had five broken ribs on each side, skull trauma, a bruise on the head, and many other traumas. . . .  the GOVD officers that Sakeev simply fell down from the bench several times.

On 25 November 2006, a criminal case was initiated against the two law enforcement officers for torture under articles 305 and 305-1, but in three days they were released after signing a statement that they would not leave the state. In February 2007, Sakeev’s relatives withdrew their appeal after receiving 200,000 Soms from the GOVD officers, and the Naryn city prosecutor’s office tried to close the case.

Under pressure from human rights defenders, the case was reinitiated. On 13 August 2007, the two police officers were acquitted.

It certainly looks as if justice fell off the bench several times, and it also looks like human rights defenders are at some risk:

Several days before the court decision, human rights defender Aziza Abdurasulova, who monitored the trial, was attacked in the court hall by unknown women.

The investigation of Bektemir Akunov’s death began August 13: 

Also on 13 August, the court started the trial to determine the cause of death of Bektemir Akunov, who reportedly hanged himself by his own shirt in the pre-detention cell in GOVD department of the Naryn city on 14 April 2007. The unsettled circumstances surrounding his death have attracted public attention in Kyrgyzstan after an independent commission headed by Aziza Abdurasulova had concluded that Akunov did not commit suicide.

 And another prisoner died.

On the same day of 13 August 2007, Kurmanbek Kalmatov, a 55-year old man, died after he was beaten by the senior investigator of the Naryn city.

Ms. Abdurasulova also reports seeing 14-and 15 year old youths with slash marks on their hands who reported also being kicked while wearing gas masks–in order to get them to confess to a crime they did not commit.

The Kyrgyz Committee for Human Rights is also keeping track of these cases, but it looks like the Kyrgyzstan national government will have to get involved in order to make sure that justice is done and that a policy of torture is no longer pursued in Naryn, or indeed, anywhere else in Kyrgyzstan. 

This video is from Worldvision, and documents the actual living conditions of homeless children in Mongolia.  Film conveys a lot: but like almost all art, it does not convey touch, smell, taste; this video does its best to include at least a verbal document of those miseries of children’s street life.  Along the way, it is also an essay on public health issues.

I checked, and according to CharityNavigator, Worldvision and Save the Children are two highly-rated charities for seeing to children’s needs across the world.  Worldvision is a non-denominational Christian charity based in Washington State and around the world.

Cassie over at the FPA Children’s blog is doing a wonderful job of bringing children’s issues forward: everything from child soldiers to child weddings to the quality of toys.  Go check out what she’s up to: it’s the stuff of real family values.

Further Reading:
Charity Navigator
Child Sponsorship Charities at American Institute of Philanthropy’s Charity Watch site