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Afghanistan Region

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Afghanistan Region

The security situation remains unstable. The new government, which came to power in June 2002, is facing armed opposition from warlords in different areas. Tensions have been particularly high in the south-east where there has been fighting between government-backed forces and those of warlord Padsha Khan Zardan, and also in Samangan province in the north, controlled by warlords Abdulrashid Dostam and Ahmad Kahn (AFP, 03/10/02). A bomb attack in Kabul city caused more than 20 deaths and about 100 injured (WFP, 13/09/02) and there was an assassination attempt on the Afghan president (Reuters, 05/09/02).

The number of returnees has been far larger than expected. The humanitarian agencies have neither the capacities nor sufficient funding to provide the requisite assistance to returnees.

IDP and refugee movements

As of August 2002, an estimated 1.8 m refugees returned to Afghanistan, mainly from Pakistan and Iran. Another 600,000 displaced people were estimated to have relocated again within the country by the same date (see table). The number of returnees from Pakistan has markedly diminished over the past few months: 115,000 returnees were registered in September, compared to 196,000 in August and 412,000 in May (UNHCR, 10/09/02; OCHA, 03/10/02). Several explanations have been suggested for the decreasing numbers of returnees, which include the prospect of a cold winter ahead. Refugees themselves have expressed fears of finding living conditions in Afghanistan difficult including lack of job opportunities, insufficient infrastructure and basic services, and insecurity (OCHA, 03/10/02). Additionally, it seems that some of the refugees who have only recently returned to Kabul may have plans to return to Pakistan over the winter, or to move south to Jalalabad where it is warmer (OCHA, 19/09/02).

IDP and refugee returns (USAID, 16/08/02)

	IDPs (IOM)	REFUGEES (UNHCR)
		Pakistan	Iran	Central Asian states
Voluntary	218,286	1,370,000	136,000
assisted				10,000
Spontaneous	400,000	200,000	61,000
Remaining	858,500
August 2002

Despite the tripartite agreement signed between Iran, Afghanistan and UNHCR stipulating that repatriation must be voluntary, Iran is putting increasing pressure on Afghan refugees to leave (PHR, 08/08/02). Iran also expelled 12,000 Afghans considered to be living illegally in the country because they did not have refugee papers and has urged UNHCR to speed the repatriation of the 2 m who remain (AFP, 12/09/02). It has also been reported that 3,704 Afghan refugees were deported from Iran in the first three weeks of September, double the number in August (Reuters, 04/10/02).

Most of the refugees returning to Afghanistan have moved to the central or northern regions (UNHCR, 17/09/02). Many returnees are resettling to the cities, mainly Kabul, even if they are not originally from there, on the presumption that it may be easier to find jobs in the city than in the country (Eurasianet, 21/09/02). It has also been suggested that while refugees, the returnees experienced an urban lifestyle and hence would be more likely to be attracted to settling in cities rather than in the country on their return.

Concerns about IDP and refugee relocation

The number of returnees has been far larger than expected, leading to a shortage of funds for implementation of humanitarian programmes. UNHCR has been obliged to suspend distribution of non-food items to returnees and to cut its shelter programme by half (UNHCR, 09/08/02), despite shelter needs being particularly important (UNHCR, 27/09/02). WFP is also facing a funding shortfall of about 22% compared to requirements (WFP, 04/10/02).

The relocation of an estimated 56,000 people, who have settled at the Pakistan border because they are denied entry into Pakistan raises concerns among the humanitarian community. Most of those refused entry are either Pashtuns fleeing ethnic persecution or Kuchi nomads who have lost their herds. UNHCR has started to relocate them to a new settlement, Zhare Dasht, about 30 km from Kandahar in the south of Afghanistan. MSF is concerned that these people who were seeking asylum should have had the right to be registered and transferred to the official refugee camps in Pakistan (MSF, 27/08/02). ACF is also concerned about the appropriateness of the chosen settlement area because it is situated in an isolated desert area, where income sources are limited (ACF, 30/08/02).

Food security and nutrition situation

FAO/WFP has released their crop and food supply assessment for 2002/2003 (FAO/WFP, 16/08/02). Due to improved precipitation, cereal production markedly improved in 2002 compared to previous years of drought, and is estimated to be 82% up on last year and equal to 1998 production. All the regions were doing well apart from the southern region, which is still exposed to drought.

Livestock loss has however been very high; it is estimated that livestock numbers may have declined by over 60% since 1998 (see table). The condition of the livestock is reported to be far better this year than last, and trade in livestock is near normal.

Remaining livestock by province (from FAO/WFP, 16/08/02)

Province	Livestock in 2002, % of 1997-1998
	Cattle	Sheep and goats
Balkh	12.8	16.2
Juzjan	14	27
Saripol	30	27
Faryab	12.7	15.8
Average	16.3	20.9

It is estimated that 467,725 MTs of food aid will be required for 2002/3, with 6 m people dependent on food assistance. This includes 3.3 m persons affected by natural disaster and conflict, 1.2 m returnees, 400,000 IDPs and nearly 350,000 urban poor (see table).

Priorities for geographical and social group targeting have been defined as:

- High altitude mountainous areas, where the sedentary population have lost livestock

- Populations that have lost their sources of agricultural income, such as those previously dependent on irrigation systems that are no longer functioning and groups whose perennial crops have been destroyed.

- Remote mountainous areas where food for work activities will help open up the areas

- IDPs and returnees

- Families that have lost one or more essential earners during the conflict and families that take care of a large number of relatives

- Kuchi people, whose main source of income is still derived from livestock

Programme Activity	Beneficiaries	Estimated cereal requirement (Mtonnes)
Relief to vulnerable population	3,143,000	235,725
Relief contingency reserve		60,000
Assistance to returnees	1,200,000	32,000
Assistance to IDPs	400,000	32,000
Assistance to nomads	200,000	16,000
Assistance to vulnerable urban population	350,000	42,000
Food for education	590,000	50,000
Total	5,883,000	467,725

Northern Shamali plains and Southern Pansheer valley, Parwan and Kapisa provinces

A nutrition survey undertaken in April 2002 by ACF revealed a significant prevalence of malnutrition: 10.5%, including 1.6 % with severe malnutrition (RNIS 38). A food security survey was carried out in the region during June-July 2002 (ACF, 06/02).

The area is comprised of various food economy zones:

- The fertile and densely populated Shamali plains where people used to rely on exports of fresh and dried fruits (mainly grapes) as well as on employment in local factories

- The hilly outskirts of the Shamali plains, mainly rain-fed agriculture with some livestock

- The mountainous, scarcely populated zones, with a mainly pastoralist population.

Sources of income for the population have changed significantly over the past 20 years, as a consequence of both Russian occupation and the civil war. Two major factories which employed thousands of people were destroyed during the Russian occupation. The civil war hampered grape exports and led to the complete destruction of the irrigation systems.

Food and non-food prices were two to six times higher during the war than now. As a consequence, people were obliged to go into debts and sell assets. Almost all households interviewed reported they had contracted debts to pay for food or emigration, and two-third reported to have sold assets.

Although the entire region is suffering from food insecurity, the three most affected areas are:

- the former frontline zone as a result of the destruction of housing and irrigation schemes

- the Shotul valley, which has not yet recovered from herd losses, and has no access to alternative income sources

- the hilly outskirts still suffering from drought

Kabul city

A nutrition survey undertaken in August 2002 by ACF (excluding the rural areas surrounding the centre) showed the highest rate of malnutrition recorded in the city since 1995, 11.7 % acute malnutrition, including 1.6 % severe malnutrition (ACF, 08/02) (see graph). This can be explained, firstly, by a high prevalence of acute diarrhoea. The survey was undertaken during the summer. Secondly, there is widespread poverty in Kabul. A market survey showed that cost of food and non-food items increased by 30% in 2002. Housing costs also rose due to a higher demand. People live in poorer housing, sanitation has deteriorated, and less than half the population have access to safe water.

The survey also showed high numbers of returnees in Kabul City with 18% of the children surveyed being from newly arrived families.

Mortality rates however seemed under control, with a crude mortality rate of 0.21/10000/day and an underfive rate of 0.47/10000/day. The measles vaccination coverage was better than the previous year with 86.3 % of children vaccinated as measured by cards or mothers reports.

A screening exercise in the returnee centre of Pol e Charkhi showed that about 20% of the children had W-H < - 2 Z-scores (ACF, 30/08/02). However, this was difficult to explain, because the malnutrition rate among refugee children in Pakistan was reported to be far below this (RNIS 36/37, RNIS 38). Nevertheless, the results indicate the situation of returnees in Kabul City is still of concern.

Acute malnutrition among 6-59 month olds in Kabul city, Afghanistan

Qaisar and Almar districts, Faryab Province

MSF-B carried out a nutritional survey in July 2002 in two districts of Faryab Province (MSF-B, 07/02). The survey was undertaken just after the wheat harvest, which was reported to be good, and showed a low rate of malnutrition of 6.3 % including 1.3 % with severe malnutrition (in August 2001, the malnutrition rate was estimated at 9%). Faryab Province has high agricultural potential and is prosperous in normal times, but is one of the most drought affected areas. The drought has led to loss of assets and livestock. About 70% of the families reported having a current debt. In addition, many poor families are unable to cultivate in 2002 because of a lack of seeds and tools. About 85% of the interviewed families had access to the general distribution of food carried out at the end of 2001 and early 2002, but only 60% received both of the intended distributions.

Mortality rates were reported to be high, with a crude mortality rate of 1.5/10000/day and an under five mortality rate of 4/10000/day. Measles vaccination coverage was 87.7% according to the card or the mother’s statement.

Pastoralists

There are estimated to be about two million pastoralists in Afghanistan. They have been severely affected by drought and war, and have lost significant portions of their herds. Livelihoods have changed significantly, depending on what assets remain and coping mechanisms. If they still possess livestock or are able to find other income activities in their previous grazing areas, they have remained there. In other cases, they have moved nearer to cities to find casual labour, or if coping strategies have been exhausted, they become reliant on charity or begging in cities, villages or IDP camps (AFSU/VAM, 08/02). The conclusions of the survey undertaken by AFSU/VAM provides numerous recommendations regarding interventions, which could benefit the different Kuchi groups and those interested are encouraged to read the full document (AFSU/VAM, 08/02).

Micro-nutrient deficiencies

Several outbreaks of scurvy were observed last winter. Various studies show that diets were deficient in fresh or dried fruits and vegetables during winter. In two villages of Ghor Province, a survey undertaken by WHO revealed that although wild green leaves, plants, and fruits are eaten during spring and summer months, there is little access to vitamin C-rich foods during the winter due to poor availability in the market. Also, growing vegetables is not widely practised, and not feasible during winter. A few farmers who have returned from Iran have introduced tuber and vegetable cultivation. Others prefer to cultivate the main wheat crop instead of vegetables due to scarce resources (land, water and time) (WHO, 05/02).

In the Shamali plain, the ACF food security survey reported that only 25% of the population could afford to buy fresh vegetables or fruits during winter, and indeed only 8% had sufficient dry vegetables for winter. The majority of families experienced a gap in fruit and vegetables supply: 17% experienced a three month gap, 17% a six month gap and 33% a nine month gap (ACF, 06/02). MOPH/UNICEF intends to begin an emergency vitamin C distribution from November in the North, North-East and in other isolated areas (MOPH/UNICEF, 09/02).

Iodine deficiency

Most of the population does not have access to iodized salt (MOPH/UNICEF, 09/02). Several surveys have reported high goitre prevalence and low iodized salt consumption (see table).

Goitre prevalence and iodized salt consumption (MOPH/UNICEF, 09/02)

Survey	Goitre prevalence (%)	Percentage of house-holds consuming iodized salt
Bagdhis, UNICEF, 03/02	-	2.4
Jawjzan, GOAL, 05/02	10.3 %	3.1
Kabul, ACF, 08/02	5.4 %	5.9
Panshir district, ACF, 08/02	63.7 %	1.0

Reports of paralysis

In the North and West of the country cases of acute paralysis, sometimes leading to death, have been reported. These are thought to be either poliomyelitis, or due to the consumption of badly prepared wild foods (MOPH/UNICEF, 09/02). An investigation into similar cases in the west of the country had suggested that these may be attributable to cyanide exposure resulting from improper cooking of a wild plant which is eaten only at the time of high food scarcity. This plant is a starchy white tuber referred to as tartran (ENN, 31/08/02).

Refugees in Pakistan

Before repatriation, refugees living in urban areas of Pakistan constituted about 50% of the refugee population. About 75 % of refugees who have returned to Afghanistan are from this group. Consequently the percentage of refugees in Pakistan still living in urban areas is now only about 27%, while the percentages for those living in long-term refugee settlements, and those settled in the new camps in the frontier region now represent 63 and 10%, respectively (UNHCR, 10/09/02).

The crude mortality and under five mortality rates of refugees in NWFP remains low, 0.2/10000/day and 0.5/10000/day respectively (UNHCR, 06/02).

Overall Returnees, particularly when resettling in Kabul, experience poor living conditions and their nutritional status is troubling (category II). The situation may worsen further this wintertime. The overall population, particularly in remote areas, is still at high risk of micro-nutrient deficiencies.

Recommendations and priorities

From the ACF survey in Shamali plains

· Develop short term labour intensive work projects to enable people to re-capitalize

· Short-term strategies

- Fortify food aid with micro-nutrients
- Implement targeted vitamin C distribution

· Mid and long term strategies

- Encourage the production and consumption of vegetables and tubers

- Encourage the preservation of fruits, vegetables, and other suitable wild foods for consumption during the lean season

· Carefully monitor the situation of the returnees, particularly in cities
· Strengthen programmes targeted the returnees, particularly in cities, with a special focus on:

- Proper housing and sanitation conditions
- Fuel access during winter time
- Food access through food distribution and income generating activities