In the war zones of contemporary intrastate conflicts, the health of the population is severely affected by the accompanying humanitarian crises and complex problems, which often result in excessive morbidity and mortality amongst civilians. The primary causes of these are direct killing, injuries and the disruption of economic and social systems that lead to food shortage, infectious disease, damage to health facilities and to the forced mass displacement of the population.
Health is not only adversely affected by conflict, it is also inextricably linked to peace, human security and development. Good health enables people to exercise their choice, pursue social opportunities and plan for the future. In contrast, illness, avoidable death and health inequality resulting from violent conflict create enormous grief and lead to economic and other development catastrophes, and insecurity at the individual and collective community levels (Commission for Human Security 2003).
In the midst of many conflicts, the health sector has played a significant role in humanitarian responses to complex emergencies, contributing to the protection of life and alleviation of human suffering (Arya 2007). There is also a growing awareness that health sector initiatives have the potential to make meaningful contributions to building trust, cooperation and sustainable peace in conflict regions. Addressing the health needs that lie behind some of the root causes of conflict can help to alleviate the symptoms.
This article evaluates the role of health in peacebuilding, analysing post-Taliban health interventions in Afghanistan as a case study. It argues that the health sector has actors, potential resources and unique characteristics that can be used for peacebuilding. Moreover, health intervention in a post-conflict environment can improve government legitimacy and serve as a overriding goal to create opportunities for conflict resolution or reconciliation, which can contribute to sustainable peacebuilding.
This article will highlight the impacts of the conflict in Afghanistan on health, and will examine post-war health intervention attempts to address the health problems in Afghanistan. Next, the rational behind the role of health for peace will be discussed, enabling post-war health interventions in Afghanistan to be analysed through a ‘peace lens’ in line with the pre-existing assumption of the role of health in peacebuilding.
Afghanistan is selected as a case study for two reasons. Firstly, the nature of the Afghan conflict has some similarities to complex conflicts going on elsewhere in the world. Secondly, multi-type and multi-level health sector actors are participating in Afghanistan post-war health sector reconstruction. Both these reasons offer the opportunity for lessons to be learnt by others; they also mean that Afghanistan is a useful environment in which to assess the role of the health sector in peacebuilding, and to help understand the challenges.
- Brief Overview of the Conflict
Since the invasion by the Soviet Union in 1979, Afghanistan has experienced decades of unrest. Over twenty-five years of violent conflict have affected the very foundations of society. More than one million people have been killed, approximately 3.5 million are refugees in Pakistan and Iraq alone, and millions have been forced into internal displacement and impoverishment (Mooney 2002:1; UNHCR 2006:1). Moreover, significant parts of Afghanistan have been identified as heavily mined, and the death rate from mine accidents prior to 2002 was 150-300 people per month (UNDP 2002:13). The total number of land mine survivors in Afghanistan is unknown; in 2006 it was estimated at 60,000 (Landmine and Cluster Munition Monitor 2010). In 2009, the Landmine and Cluster Munition Monitor identified 859 new casualties due to mines and the explosive remnants of war.
Following the Soviet Union withdrawal in 1989, the Taliban government came to power in the mid-1990s. The Taliban administered most parts of Afghanistan according to Islamic Law, until they were brought down by the forces of the United States forces in 2001 (Swanström and Cornell 2005: 1-8). Currently a new modern Islamic government is being built, with presidential elections held in 2004 and 2009 (Independent Election Commission of Afghanistan 2009). However, in Afghanistan, the informal cultural and tribal structures still hold immense power, and in parts of the country constant low intensity and sporadic high intensity violent conflicts remain (NATO 2009; International Crises Group 2009). In addition, ethnic divisions, warlords, the opium trade and smuggling remain long-standing problems in Afghanistan (Swanström and Cornell 2005). These multi-layered and complex problems make the Afghan conflict extremely difficult to resolve, and pose great challenges to building a strong central government and a functional health care system.
- The Afghan Health Care System
The lack of a strong centralized government and the effects of protracted violent conflict have almost destroyed the pre-existing health care system, which was already extremely weak. Consequently, health care service delivery is fragmented and the population experiences extremely poor health (Thompson, Gutlove and Russell 2003). Amongst the most serious health problems in Afghanistan are chronic malnutrition and infectious disease such as malaria and tuberculosis (Strong, Wali and Sondorp 2005). Health indicators during the immediate post-Taliban period showed that maternal mortality rates and those of the under-fives were the worst of already poor levels in the region (DFID 2004). Moreover, women are disproportionally affected by weak and inadequate health care because of gender segregation and restrictions imposed by local traditions, such as the restriction on women receiving medical care from male providers, restriction on movement, and attitudes that discriminate against women (IRIN 2009).
*Published in Journal of Conflict Transformation & Security (JCTS) Vol. 1 | No. 2
** Wossenyelesh Kifle holds a BSc from Dilla University, a Masters in Public Health from the University of Addis Ababa, Ethiopia, and an MA in Peace and Reconciliation Studies from Coventry University, a postgraduate programme for which she won a scholarship. She has seven years’ work experience in health and development programmes specialising in programme evaluation, women’s health, social aspects of HIV, and sexual and reproductive health.
© Copyright 2011 by CESRAN