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, gHumanitarian and Medical Aidh, 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-kaifs 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 wouldnft 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 countryfs 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.
Now, let me mention some facts on Afghanistan which are not widely known. The area of Afghanistan is twice as large as that of Japan. The countryfs population is approximately 20 million. The majority of its land is dominated by the Hindu Khush Mountains that are 6,000 to 7,000 meters high. Obviously, it takes us quite a long time to cover numerous valleys spread across the mountainous area. For example, it could take us a whole week on a horseback to travel from our clinic to a patientfs home in a remote village. As you can imagine from this example, it takes a lot of time to accomplish anything over there. Regions and districts are physically divided by these massive mountains, keeping them isolated from one another. In each region and district, different ethnic groups live together, leading self-sufficient lives.
In Afghanistan, there is a proverb that says, gOne can live without money, but not without snow.h 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.
Most Afghans are devout Muslims. Mosques can be seen everywhere in villages and towns throughout the country. Islam is not only their belief but it is also their way of life. It provides the basis for their ethics, cultures and traditions. People belong to local communities as well as mosques and have moral obligations toward one another.
The huge gap between the rich and the poor is also a big problem in Afghanistan. For example, wealthy Afghans can easily fly to London, Tokyo or New York to seek better medical treatment, while poor Afghans are dying, being unable to afford medicines that cost only a few dollars. With this example, you may understand why simply bringing advanced medical equipment and facilities wouldnft solve the problems there. The big challenge we face in Afghanistan is how to benefit the maximum number of people with the minimum amount of money. That is why it is very important for us to identify the real local needs and come up with proper arrangements so what we do will truly benefit the deprived people.
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. Thatfs where I started. Those who visited me at the hospital during those days were shocked to see the situation.
Peshawar-kai Head Office (Japan) has been very active in fund-raising and continued to provide financial assistance to my medical activities for all these years. Without their support, I wouldnft have been able to extend my medical services to benefit a growing number of patients.
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.
This tradition made my medical work especially difficult because the early signs of leprosy appear on the patientfs 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.
No matter how inconvenient this custom may be, however, one has to be very careful not to make a mistake here. Many foreign workers often react wrongly in this kind of situation.
In 1979, 100,000-strong former Soviet troops invaded Afghanistan. During my first three years in Peshawar, from 1984 through 1986, the Afghan civil war was fought most fiercely. Peshawar is a border city and is also called, gthe city of Pashtunsh. They are the largest ethnic group in the region. A half of the 16 million Pashtuns live on the Pakistan side and the other half on the Afghan side. They are the majority group on both sides. They freely travel back and forth between the two countries. The civil war, which followed the Soviet invasion, generated six million Afghan refugees and half of them flooded into Peshawar and its surrounding areas. Reportedly, at least two million people, including 600,000 combatants, have been killed during the civil war. Our medical activities, of course, were greatly affected by this war.
Around this time, we ran a small-scale mobile clinic at refugee camps for a while and decided to change the way we operated our medical activities. Most Afghan villages with a high incidence of leprosy are located deep in the mountains. Where leprosy is common, many other infectious diseases such as typhoid fever, malaria, dysentery and tuberculosis are often found too. To make things worse, patients inflicted with these diseases are very poor and have no access to medical services. In such areas, it is very difficult to tell local people that we came to their village only to treat leprosy, but other diseases. Consequently, we decided to establish a model case of medical care specifically for rural areas in Afghanistan where no medical services are available.
Statistics of Afghanistan are often unreliable. When we launched this new project, we had no idea about the demography of our target areas or what diseases were common there.
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 2,400km-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 countryfs highest mountain, and local men came up to me and said, gWelcome from France.h 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.
What was more interesting to me on that day was that, once I told them that I was Japanese, their attitude toward me completely changed. They began acting very friendly toward me. I later learned why. The country name of Japan in their mind was associated with the Russo-Japanese War that occurred a century ago. They also knew about Hiroshima and Nagasaki. Everywhere I went, no matter how deep in the mountains, villagers knew these things. I believe their respect toward Japan comes from the fact that they too have experienced misery through the western domination and that they have been deprived of peaceful life by that.
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 gteachersh 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.
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.
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 Organizationfs 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.
In some areas of Afghanistan, we have seen people walk for several kilometres just to get water, sometimes spending a whole day. Villagersf main property is livestock, but they had to sell their cattle to survive. They say 90% of whole livestock in Afghanistan was lost in year 2000. Vast farmland has turned into a desert. The number of internally displaced people and refugees rapidly increased. The countryfs agriculture has been seriously damaged by the drought. In the areas that surround our clinic, residents started evacuating their home villages.
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.
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.
However, people cannot survive only on drinking water. Our next challenge was to obtain water for farming. Afghans have a traditional irrigation system called gkarezh which brings underground-water to cultivated land.
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.
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.
We intentionally avoided a costly, modern method.Inlet from the Kunar River: This is a copy of Japanfs classic goblique damh 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 Japanfs traditional water gate: Water flows over the wooden plates and the volume of water will be control here manually.
We tend to think we could do better if we had more. However, the more you possess, the more despondent you become. In Japan, people say we are facing a serious recession.
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.
I consider myself fortunate to be able to discover this truth and speak about it, while the whole world seems to be confused by the campaign of the war on terror. There is no doubt that my experience in Afghanistan helps me see things more clearly. To me, it is time we seriously contemplated and found out what is truly needed for mankind and what is not. Whatfs taking place in Afghanistan today is teaching us a lot about this. 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.