AFGHANISTAN: Interview with UNICEF special representative

© UNICEF


ISLAMABAD, 8 Nov 2001 (IRIN) - With winter rapidly approaching, the United Nations Children's Fund (UNICEF) has warned of an estimated 100,000 children dying in Afghanistan, in addition to the 300,000 already dying every year, if sufficient assistance is not received before crucial routes in the north of the country are blocked by heavy snowfall.

In an interview with IRIN, UNICEF Special Representative Nigel Fisher said half of the child population in Afghanistan was already chronically malnourished, and that there could be a "very serious situation" if crucial amounts of aid was not transported to the needy in the next few weeks.

QUESTION: How did UNICEF estimate that 100,000 children could die this winter? What is this figure based on?

ANSWER: Basically, we have done it on the basis of what we already knew with regard to prior mortality rates, and what we know about the prevalence of acute malnutrition based on a number of surveys that primarily NGOs have done, and we came out with the fact that over and above pre-11 September estimates, 100,000 extra children could die as a worst-case scenario if the minimal amount of assistance is not received by them.

The main causes of death are diarrhoea, measles and pneumonia, all compounded by the fact that most kids have malnutrition. So you add these to the cold, lack of clothes and shelter, and it adds up to a very serious situation.

Q: In which parts of Afghanistan are the most malnourished children?

A: We are talking about at least 25 percent of the population being at high risk, and they are all over. But the most serious places are where the food deficit is, which is in the north and northeast, including that whole corridor from Badakhshan right through to Mazar into Herat and the central highlands, Bamian. So it's quite a big area. But even in the south and southwest, there are around 300,000 IDPs [internally displaced persons], and people are at high risk.

Q: Are there reports of visible severe malnutrition?

A: There are two kinds of malnutrition in Afghanistan. Up to half of the child population is chronically malnourished. That means, since birth, they have not been getting sufficient nutrition. So chronic malnutrition shows up in the form of stunting, which means children are a little shorter than he or she should be for their age. But in addition there is severe malnutrition in about 12 percent of the child population, so there is evidence of both, and children are more vulnerable to both types of malnutrition.

Q: Is malnutrition worse in children than it is among adults in Afghanistan?

A: We don't have statistics for that, but there are vitamin deficiencies, especially in women, there are deficiencies. Some 70 to 80 percent of women in Afghanistan have anaemia and are deficient in many of the minerals, especially vitamin A, but it doesn't show up chronically. They are thin and smaller, and they have to feed their children and breast-feed, so women are [at] pretty high risk too.

Q: Some experts would argue that carrying out surveys on just children would not be a good reflection of malnutrition all over Afghanistan, as food is channelled towards children by their parents. What is your view on this?

A: Well, we would have to check the feeding patterns, but mostly in the subcontinent you find that men eat first. We stick with what we know in terms of children's malnutrition, and look at the facts: 20 years of war, several years of drought and displacement and destruction of livelihoods of families then.

I would also say entire families are badly off, and looking at malnutrition of children would be a good indicator. Half of the entire population is malnourished; it means they haven't got enough food, which means the family as a whole doesn't have enough food.

Q: What are your concerns about diseases spreading among children over the next few months?

A: Disease and malnutrition feed each other; diseases in sanitation, diseases of dirty water show up in diarrhoea, worm infestations, for example. Obviously, if a child is eating and is worm-infested, then the child is not feeding him or herself properly. Increasing a normal vitamin A level is important and does help to reduce mortality, and increases resistance to the diarrhoea and respiratory infections. For a young child in the winter, with the dust and cold and no protection, they are going to catch colds etc.

If you add all these things up, the child just doesn't develop resistance, and two of these diseases feed on each other. A child with diarrhoea also has high respiratory problems, so they feed on each other. Often on the medical record it will say that a child died of diarrhoea, but it is in fact a combination of these diseases made worse by a chronic lack of nutrition. A sick child is just unable to recover.

Q: Moving on to the polio campaign, UNICEF has started the second round of immunisation against polio. How many children are you hoping to cover, given the military situation?

A: It is the same plan as last time; that was 5.5 million children under the age of five, and in the last round in September, we are very impressed with the data that shows five million children were reached. It is a massive social mobilisation process, with 30,000 volunteers around the country who go door to door. We have discussed it with the Taliban and the Northern Alliance, and we are going for the same goal, and most of the volunteers are in place.

The cold chain and stores are in place, and the vaccine was sent in recently. We had first reports from 6 November that mobilisation and vaccination had started, so we are hopeful that a significant amount of children will be covered over the three days. Of course, we are facing additional difficulties. There has been population movement since 7 October, but we are still expecting a high coverage rate.

Q: But has the bombing not stopped you from going ahead with this, particularly as we hear that military action has intensified?

A: We are not asking children to go to centres to receive the polio drops. It is a door-to-door campaign, so I would say the bombing is going to have localised and time-bound effects, so that if a bomb lands in the neighbourhood in the night, we can go along there in the morning. We are hoping the bombing would not have that much effect.

Q: Has there been a reduction in volunteers? They must be scared to come out of their homes to carry out this work?

A: The reports coming out of Afghanistan from our people are that volunteers are still coming up, and in very large numbers. It's interesting, because we ask why that is, and we get the response that this is creating interest, because it is a chance for ordinary people to do something useful in desperate times, as it gives a feeling of self-worth.

Q: How about the problem of child soldiers in Afghanistan? How are you going to tackle that?

A: We are trying to work with a number of NGOs. We need to document cases. We have lots of hearsay, but nothing concrete. In terms of what we can do to try and stop this, we are monitoring, and bringing it to the attention of the concerned parties is the best we can do. It has been a long tradition. We hope that they would point out their international obligations. Afghanistan has signed some of the conventions on the rights of the child and so on in the past.

We point out that they need to demobilise, which presents another challenge, because agencies like us and our NGO partners need to look at if there are halfway houses, centres where such young people can at least get a square meal a day? Often the cost of hiring a child is just one square meal a day. But it is necessary that we keep on emphasising that there is no excuse for exploiting children under any circumstances.

Q: What problems has UNICEF encountered in getting aid into Afghanistan?

A: Number one is just getting quantities in due to insecurity. You are about to send in a convoy, and you get word not to send it, because there is bombing or the road is insecure. We have been able to get in something like 43 convoys into Afghanistan in the last month, but we still need to get more in.

The second is that it is difficult to distribute, depending on where the bombing is taking place. We don't want to have aid sitting in warehouses in case we lose control, so we like to distribute straight away. We have to get some assurance that there are partners on the ground before we send aid in, and that slows down the process yet again.

I would say the pipeline is a little slow. For example, we have a pledge from the US of 250,000 blankets, but in fact the blankets are now being produced, so that will take another month before we get the blankets, and of course the old question of funding. We get commitment from donors, but it is often several weeks before it is translated into money, and we have to place orders and so on.

So there are a combination of factors. But we still have 50 staff in Afghanistan, and we know that NGO partners have a lot more staff in place, but you may find that staff are moving around due to the air strikes. However, we are communicating with our people from day to day.

Q: UNICEF recently sent some convoys into Herat. What reports are you getting from the camps for the internally displaced there?

A: The people are still there, but we have had confirmation that [Taliban] military hardware has been put into the camps, increasing risks for the IDPs and those distributing aid. But otherwise I was on the [Afghan] border 10 days ago when we had a convoy going in, and it was held up at the last minute because of security, but went through two days later.

Q: How confident are you that the international community will get aid to the vulnerable before winter blocks off crucial routes?

A: I think now it is only inevitable that there will be huge shortages before winter sets in. We can get blankets and children's clothes in now, which will last all winter. Our major constraint is distribution - can we distribute aid? We have a major operation with our partners to make sure we can map fairly precisely, right down to district level, whether the people in need can be reached in the next four to six weeks. I think the challenge for WFP [World Food Programme] is even more huge: they have to keep pumping in tonnes and tonnes of food. We have to work out how we can guarantee security for convoys with the authorities on the ground. That is an ongoing discussion in the humanitarian community: how close do we get to the military or how far do we stay away in terms of sharing information.



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