“Humanitarian and Medical Aid|
---- 22 Years in Afghanistan”
Good afternoon, ladies and gentlemen. I am honoured to be invited here to talk to you today. Thank you very much for this opportunity.
The title, “Humanitarian and Medical Aid”, is so big that it tends to end in abstract arguments. Instead, I would like to talk about it by giving concrete examples of what I have seen and what I have done and by summarizing the Peshawar-kai’s activities carried out in Peshawar, Pakistan, and in Afghanistan for the past 22 years.
As you know, the Taliban regime fell under the U.S. attacks five years ago. Soon after that, Afghanistan became a land of lawlessness and anarchism instead of becoming a better place to live. The current situation in Kabul, the capital of Afghanistan, can be compared to a small boat floating aimlessly on a sea of magma in a crater. Many warn that, if the foreign troops withdrew from Kabul now, the capital wouldn’t last even for a week.
Immediately after the collapse of the Taliban regime, a number of international aid organizations rushed to Kabul. Five years later, the majority of the NGOs operating in Afghanistan are still concentrated in Kabul, protected by the international troops. As a result, the information about Afghanistan that people are getting outside the country is mainly provided from Kabul City, a quite exceptional place in Afghanistan. What I actually see and feel in the country’s rural areas is the opposite of what people outside Afghanistan are being informed of.
Nevertheless, since the U.S. invaded Iraq, more than half the aid and media organizations located in Afghanistan moved on to Iraq, and international concern over Afghanistan has faded away. I hope my lecture today will be informative enough to help you better understand the true and current situation in Afghanistan.
Peshawar-kai has its local base in Peshawar, a north-western city of Pakistan, and we operate in both Pakistan and Afghanistan. Currently, we have three clinics in Afghanistan which have been operating for over 16 years. We also run a clinic in northern Pakistan in addition to our main hospital in Peshawar. We have a total of 80 medical staff working at these facilities. Last year, we treated 100,000 patients in total. In addition to medical work, we run a water supply programme. At our branch office in Jalalabad, Afghanistan, we have additional 80 staff working exclusively for this programme. Afghanistan has been severely hit by drought for the past six years and people are struggling with scarce water sources. I will later explain how we, a medical aid organization, decided to commit ourselves to a water supply programme.
In Afghanistan, there is a proverb that says, “One can live without money, but not without snow.” It is true. Snowfall during the winter, along with the glaciers from tens of thousands of years ago, produces water streams when it melts in summer, promising a good harvest in areas along the rivers. Humans, animals and plants around the Hindu-Khush Mountains have enjoyed the benefit of this water for a long, long time.
Snow is literally a lifeline for the Afghan people. However, in recent years, snow has been disappearing from these mountains, presenting a serious problem to the population.
Global warming is a major factor that is causing the drought in this region.
Often times, troubles are solved by a local elders’ council called “Jirga” at a mosque. Afghan communities are completely self-sufficient and self-governing societies where residents respect unwritten common laws. They don’t, and perhaps don’t need to, have modern police force or psychiatric hospitals in their communities. At the same time, Afghans show quite high tolerance toward authorities of time as long as their core values are honoured. Another aspect that stands out about Afghan people is their solidarity. Afghan men are strongly united by the blood and the territorial bond, and they act fearlessly to protect their own people and land. Afghans are quite an independent and brave people. The Afghans put higher priority on their traditions than on new rules introduced by the central government. This part of Afghan way of thinking is totally different from that of Westerners and, as a result, foreigners often find it difficult to understand these people.
I was assigned to the leprosy department of a Christian Hospital in Peshawar, Pakistan 22 years ago in May 1984. At that time, 2,400 leprosy patients were registered at the hospital. However, patients could only be admitted to the hospital after they developed serious complications since the leprosy ward had only 16 beds for admission. Treatment of leprosy requires various medical skills such as reconstructive surgery, plastic surgery, neurosurgery, dermatology as well as knowledge in social care services.
However, what they had at the hospital 22 years ago were one broken trolley, one gauze kettle, several broken pairs of forceps, one stethoscope that would hurt my ears when I wore it. Their method of disinfecting gauzes was to place them in a metal bowl and put it in an oven toaster. When the gauzes started to smoke, we would take them out of the oven quickly. If the gauzes had turned brown, they were disinfected. If they were still white, they were not. That’s where I started. Those who visited me at the hospital during those days were shocked to see the situation.
Now, we have a well-equipped hospital where essential treatments for leprosy complications are available, including reconstructive surgery. With the help of local governmental organizations and agencies, our hospital has become a reassuring presence to those 7,000 registered patients throughout Afghanistan and north-western Pakistan.
You may think that our medical activity alone generates a lot of work and keeps us very busy. It is absolutely true, but we have also spent a lot of time and effort in pursuing non-medical activities for the last 22 years, hoping to achieve our ultimate goal which is to help local people attain better lives.
One of such activitities is an effort to better understand the local people and their culture which are very different from ours. According to their custom, for example, young women are supposed to cover themselves with veils to avoid the eyes of male strangers. This tradition made my medical work especially difficult because the early signs of leprosy appear on the patient’s skin. In case of male patients, it is easy because I can simply ask them to take off their clothes so I can examine their skin. If a leprosy patient starts receiving a proper treatment at an early stage, this disease can be completely cured. On the contrary, chances for cure are drastically smaller in female patients because they would refuse to expose their skin to male strangers, even if they are medical doctors.
I often think that we, humans, aren’t as free as we think we are. We are actually restrained by many things in our lives such as traditions, social relationships, nationalities, genders, places of birth, time we are living in and so on. These things restrict us from doing whatever we want to do no matter how old we are and where we live. There are limits in what we can do in life. I find it very important as a clinical doctor to understand that what I can do to my patients is limited yet I must still try to find best available solutions and do the best I can for them under the given circumstances. At the same time, I keep in mind that I should never impose my values on these people or be judgemental about their customs, traditions or cultures.
This is the guideline we strictly impose upon ourselves among the Peshawar-kai workers. To give you an example, we recruit female staff from Japan and have them attend to female patients, instead of criticizing their tradition of not exposing themselves to male strangers and doing nothing.
Thus, providing our medical services in rural areas became one of our most important projects.
To make things more difficult, it was very dangerous to walk around the areas because of the ongoing war but it was the only option we had. The 2,400 km-long border was not completely sealed off. So we walked up and down the mountains to learn about our target areas.
One day my staff and I reached an area called Nuristan, situated at 2,800 meters altitude, half way up the country’s highest mountain, and local men came up to me and said, “Welcome from France.” They asked me if I was French. I had been asked if I was Chinese or Korean before, but never French. Later I was told that they had never seen foreigners before so they randomly mentioned a name of a foreign country they knew.
At any rate, this episode typically describes what it is like in rural Afghanistan. The capital city, Kabul, is very far away from these villagers both physically and mentally.
Hearing about a tiny, vulnerable country in the Far East fighting against a superpower in the Russo-Japanese War must have inspired these people during the past colonial era they experienced. They also displayed a deep sympathy for the Japanese victims of the atomic bombs. It was fortunate for me that they did not know that Japan had followed in the footsteps of her Western “teachers” later on and acted as if they were the forward-thinking guards of the Western countries by invading neighbouring countries.
The Soviet troops started to withdraw from Afghanistan in 1988. After the withdrawal was completed in 1989, Afghanistan remained a centre of the world news. A host of journalists rushed from all over the world with the expectation that they would be reporting on the immediate return of the three million Afghan refugees to their motherland. Contrary to their anticipation, no one went home.
During this time, there were a lot of enthusiastic discussions about the reconstruction of Afghanistan. Over 200 aid organizations flocked to Peshawar from all over the world, spending tens of millions of dollars in two years. Ironically, no refugees returned home despite of all these international supports. Meanwhile, the civil war intensified and the Gulf War broke out. Immediately after this, most aid organizations for Afghan refugees in Peshawar closed their offices and left. This abrupt departure of aid organizations deeply disappointed Afghan refugees. Before long, Afghan communist government collapsed, and various armed political groups flooded into Kabul, seeking to take control of the capital. Meanwhile, the traditional system of autonomous rule made a comeback in rural areas. As soon as the Afghans became aware of this transformation, they began returning home on a massive scale. In only seven months from May through December 1992, two million out of the 2.7 million refugees returned to Afghanistan with almost no foreign assistance. Seeing the refugees coming back, we started opening our clinics, one after another, in mountainous areas. These clinics are still functioning today.
In Japan, we are a voluntary organization or non-governmental organization. But in Pakistan, we are registered as a social welfare organization.
Afghanistan is truly an ill-fated country. On top of what has happened in the past, the country is now hit by the worst drought ever in history. According to the World Health Organization’s estimate in June 2000, the drought has spread from the Central Asia to China, India, Pakistan, Iran and Iraq. Afghanistan is most badly damaged of all.
Twelve million people, more than half the population of Afghanistan, have suffered and are suffering from it. Four million Afghans are on the verge of starvation and one million might starve to death in the near future.
Most of the drought victims were children. The outbreaks of gastro-intestinal infections such as dysentery, amoebiasis and typhoid affected their young lives. So many children died of dysentery after drinking contaminated water. Their deaths are the results of the lack of clean water and malnutrition. We have seen many children expiring in their mothers’ arms in our clinic’s outpatients’ waiting room. It wasn’t an exaggeration when WHO warned that one million might starve to death due to the drought. Medicines can’t cure malnutrition or solve water shortage problems. The situation was so desperate that simply trying to stay alive became a very difficult challenge for the Afghans.
Given this situation, feeding and keeping them alive became our biggest concern. We decided to worry about treating their illnesses later after their lives are saved from death.
In July 2000, we mobilized the remaining villagers and started digging wells to obtain clean water. This was the beginning of our new project. Although the locals already knew how to dig a well, they did not know what to do when they hit a large piece of rock. The water level was continuously going down. We had to keep digging to compete with the descending water level. We used land mines to break huge stones into pieces.
This was our very unique way of using landmines: We used them for a peaceful purpose.
This project is still going on. By June 2003 we had worked at 1,000 sites in total.
Currently, over 1,400 sites provide water to local population. Thanks to this project, nearly 300,000 villagers are still being able to remain in their villages.
This picture was taken in September 2000. It shows the surrounding area of our clinic.
No one would be able to believe there used to be lush green rice fields here only a year earlier. We have irrigated these fields. The next picture was taken 7 months after the first picture was taken.
This is the same place in February 2001. One thousand families had come home voluntarily. Green fields had spread quickly.
This way, a water project has become a very important part of our activity.
In January 2001, the UN imposed sanctions against Afghanistan. Ordinary Afghans could not understand why they had to be punished in such a way. Before the sanction, I had believed that the world would not ignore the large-scale devastation the Afghans were experiencing for the first time in history. Contrary to my belief, the U.N. imposed sanctions on Afghanistan instead of providing aid to them. To make things even worse, they tried to impose sanctions on food in the beginning. Imagine how those starving people in Afghanistan felt about this. International aid organizations started evacuating their foreign personnel, although there were already very few of them that were still operating in the country. These sanctions definitely shunned Afghanistan from the other parts of the world. From then on, distrust toward foreigners spread among the Afghans.
In March 2003, we launched the construction project of 14km-long canal in eastern Afghanistan. The canal is expected to irrigate more than 5,000 hectares of farmland which had turned into a desert because of the drought in the last several years. When the canal is completed, 150,000 farmers will be able to cultivate their land and stay alive in their villages. As of April 2006, the canal was completed up to 10 km. So far, 1,500 hectares of devastated land have been revived into farmland, and lush green field will continue to expand year after year.
Inlet from the Kunar River: This is a copy of Japan’s classic “oblique dam” which has been working for more than 250 years.
The main irrigation canal (2 years after construction); Jakago (stone cages) are used in many sections of the canal to protect the canal from rapid stream. 100,000 willow trees were planted so that their roots will protect Jakago from falling apart.
A water reservoir for sedimentation; muddy water becomes clean here.
A Japan’s traditional water gate: Water flows over the wooden plates and the volume of water will be control here manually.
[photo: Japan:s traditional water gate]
Every time I give a lecture on Afghanistan, I show some slides to tell my audience that the Afghan people don’t always look depressed. To me, the people in developed countries such as Japan often look more depressed or unhappier. The Afghans have such great smiles that those of us who are helping them get inspired and encouraged in return.
When I first heard someone say that, I asked the person how many people had died of starvation because of the recession. His answer was that no one starved to death, but over 30,000 people had committed suicide.
When I first started my medical services in Pakistan 22 years ago, what brought me there was a “humanitarian motivation”. I wanted to save people in need over there. Looking back at the past 22 years, however, I came to realize that the more important thing than the fact that we helped those people is that we, those who helped these deprived people, have been helped by them in many ways. At least, I could free myself from an illusion that violence and money can solve any problems that men face in the world, thanks to my experience. Also, I am not fooled by the justification that violence is necessary for the sake of democracy and modernization. True happiness for mankind should be realized not through violence or money, but in a humane way.
What has happened in that country also reveals to us that our civilization is nothing more than a thin layer over barbarism we, humans, have exercised for a long, long time since ancient times. The real enemy we have to fight is in our minds, not outside.
With this, I would like to conclude my presentation. Thank you very much for your attention.