Tuesday, November 6, 2007

Afghanistan From the Lens of a Doctor

(Medical volunteer Northern Afghanistan 30 May – 11 June 2002)

Afghanistan is twice the size of Malaysia. It shares land borders with China 76 km, Iran 936 km, Pakistan 2,430 km, Tajikistan 1,206 km, Turkmenistan 744 km, and Uzbekistan 137 km. Border crossings are literally a donkey ride or long walk away - hence the easy “disappearance” of wanted persons!”

The population is estimated at 21 million with four major ethnic groups: Pashtuns 38%, Tajiks 25%, Hazaras 19%, and Uzbeks 6%. 99% are Muslims (Sunni 84%). Life expectancy is 46 years (Malaysian male 70.3 yrs, female 75.2 yrs). Birth-rate is 41.4 /1,000 (Malaysian 23.5). Each woman has an average of 5.79 children with a high infant mortality of 16 % (Malaysia 0.8% in 2001). One in four Afghani children die before they reach five years. An estimated 50% of children have chronic malnutrition and 10% acute malnutrition. The maternal mortality is 17 per 1000 live births. Literacy rate (aged 15 years and over who can read and write) is estimated to be 31.5% , male: 47.2% female: 15% (1999 est.)

Afghanistan is now reputed to be a major source of hashish and the world's largest illicit opium producer, surpassing Burma.


First screening question: “Are you prepared to be raped, robbed, killed or left behind? There will be no sacrificial ‘Black Hawke’ rescue for stragglers”. If your answer is “yes”, (that includes paying for all travel, lodging, meals and insurance), a seven page questionnaire follows (presumably to exclude the mentally unstable, religiously deranged and those with any delusion of grandeur or death wish).

Warnings abound on the internet e.g. current at 07 May 2002 We strongly advise against travel to Afghanistan. There is a threat from global terrorism, including to humanitarian relief workers. The situation in Afghanistan remains unstable, extremely volatile and dangerous for foreigners”.

One travel information web page had this friendly advice: Those who still insist on travel to Afghanistan (read “suicidal”) …’’


There is an estimated 11 million unexploded ordnances (UXOs) after the 23 years of war (?more after the US versus Taliban contribution?). An estimated 500 or more mine accidents were recorded monthly, about 150 fatal. CIA has an Afghani map for UXOs - colored white (“cleared of mines”) to dark brown (where no angel would dare to tread).

Travel insurance that included repatriation of body was surprisingly cheap, less than a hundred ringgit. Why so cheap? Comment: “They don’t expect you to need a big box. DHL enough-lah” .

A quick check with my life insurance agent(s) : Sorry, your policies do not cover war zones.

A lawyer argues: “How long have you had the policy? More than one year? Most life insurance cover policy holders who commit suicide as long as it is more than one year after they sign up. Volunteers to Afghanistan – it is not reasonable that they should be not be classed in the same category. (Needless to say he is now my lawyer, if ever such need to claim should arise).

No joke – when we were in Mazar i Shariff, we passed the International Orthopedic Hospital. On one of the walls was written in English in bold letters “Do not deal with explosive items. They may kill you.” This came not far after a sign over a shop that reads “the Spare Parts of Abdul”.

The Taliban atrocities

According to the people we spoke to, public executions were carried out in the football field even in the small town of Shebarghan where we were based. Guilty women were buried to their chest and stoned to death. The goal posts were used as hanging gallows for convicted men. Shopkeepers were forced to close their shops to go and watch.

Grown men were not allowed to cut their beards. Those who were thought not to comply would be whipped by the inspectors. The beating could be quite severe. Music was totally banned. The radio only had news and statements. Inspectors would “creep around the flat roof tops” listening for the sound of music. Where this was thought to be heard, they would burst into the house. One engineer had a gun put to his head, and commanded to bring out his player or tape. Fortunately for him, they could not find any.

School was closed to girls and women teachers were forced to stay at home. Boys continued to go to school, but opportunities for leaving the country for university education was curtailed. (Turkey, prior to the late Taliban era, offered scholarship and university places for Afghanis).

The Taliban was notorious for the way they would slaughter men, women, children, dogs and farm animals without exception in the villages they conquered. When asked why they did this, the reply was “They were trained in Pakistan. This is their way of war. They think we Afghanis are not Muslim enough, so killing us is jihad”. This could explain why in some places we saw more graves than houses.


Everyone we met, including the local Governor who was the Mullah and Commander of the Mujahideen, talked about the desire for peace, “How are we to stop war, when a whole generation has grown up and their only skill is fighting. We need help to provide them alternative training and occupation”

Russian tanks stand silhouetted in the desert horizon. Abandoned armory were as many as the graves of the slain marked only by tattered cloth squares tied to bent poles. Expansive fields of ripening wheat were interspersed with desert and destroyed ruins, with people harvesting and grazing their sheep and goats. Here and there in the corner of the fields are graves, with large stones neatly arranged on them, with sometimes white and sometimes green flags.


Most toilets are P.Ls (pit latrine) where nose holding is highly recommended. Taxi drivers and locals know where cleaner ones are. Whenever team members come back from the toilets and exclaim ecstatically “so clean” it is relative to the degree of smell and the amounts of visible deposits. MBKS (local council) standards should not be implied.

Our P.L in Gosh Tepa clinic had a little curtain, that flaps happily in the wind, fixed up only for us. There was no roof or door. We did think of putting up a white flag every time someone went in, but did not get round to it. This was a good thing, in restrospect. We learned that the Talibans used to use a white flag for their flag unlike the present tricolor green, red and black Afghani flag.

The lack of a door, the type you can lock, or at least attempt to keep closed, is universal. The ability to whistle or sing badly may help to keep people at bay. It is interesting to watch the sunset over the hills as one goes about one’s business of (trying to) emptying yesterday’s meals. You really need cooperative sphincters.

Sleeping arrangements a.k.a place to lay your head

For the twelve days, one had to get used to sleeping in a room with nine erstwhile strangers, to all the noises each make before they fall asleep, as they sleep (dog-tired) and when they awake. Dawn is very early at 4:30 am, so all get (woken) up by then.

With only one pit toilet and one bathroom (water carried in little pails from the well up the hill) between us, major adjustments to our daily ablutions had to be made. I fell back to my three-minute houseman bath. Plus an extra minute for getting in and out of the salwa kameez – the XXL trousers, which is held up by string, must be properly secured if you do not wish to lose it in public.

All had to bathe with less than 2- 3 liters of well water each, brushing teeth with precious bottled water (rationed to 3 litres/day as each 1.5 l bottle cost US$ 0.53). We were thankful for the cloudy water fetched from the pond, with its happy tadpoles, strained, (hopefully, before boiling) for chyar (tea).

It was a blessing to be forced to live simply, apart from the clutter that defines us, binds us but also blinds us.

Once one is prepared to lose it all, everything else is gain.

- July 2002