By Charlene Porter
Washington File Staff Writer

Washington -- Relief organizations indicate that health care is receiving greater attention in Afghanistan now that the danger of widespread famine has been averted and the security situation has improved. The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) say they are increasing their activities and personnel in the country, with financial and logistic support from U.S. government agencies and other international contributors.

The massive international relief campaign that began expanding in September 2001 was initially focused on the prevention of starvation and perhaps millions of deaths. Now, U.S. and international humanitarian officials agree that the intensive effort to move food supplies into the country has prevented the realization of that feared outcome.

International and nongovernmental agencies are now working with the Afghan Ministry of Health to address a public health situation that is currently described as "desperate" by U.N. officials. An October 29 WHO report assessed overall health among Afghan citizens and reported that the population is "highly vulnerable to communicable diseases."

The Afghan Ministry of Health, UNICEF and WHO have begun an immunization program to inoculate about nine million Afghan children against measles, a highly infectious disease especially among poor, malnourished populations.

In a press advisory announcing the vaccination effort, WHO said, "This year, given the current humanitarian crisis, high displacement levels, extreme poverty, cold, prolonged malnutrition and poor access to health services, Afghan children are more at risk than ever before. The sooner they are vaccinated against measles, the better."

Australia, Canada, Italy, Japan, Poland, Sweden, the United States and the United Kingdom are key partners in funding the $8 million campaign against measles, which kills about 35,000 Afghan children each year, according to WHO.

In Kabul alone, 200 inoculation centers opened January 1, and thousands of mothers lined up to have their children vaccinated. "Mothers are very enthusiastic and committed to immunize their children," said WHO Spokesperson Fadela Chaib at a UN briefing in Islamabad January 2.

Inoculation centers will open in other cities and villages across Afghanistan over the next few months. U.S. Agency for International Development (USAID) Administrator Andrew S. Natsios said his agency is now launching a campaign to distribute radios to the Afghan population so they'll be better informed about the vaccination program and other humanitarian aid available to them.

"If we didn't announce it on the radio, they would never know that (the inoculation campaign) was going to take place to get their children immunized," Natsios said at a January 3 press briefing in Washington.

The vaccination campaign was launched the same week that UNICEF and WHO began moving more personnel back into Afghanistan. Expatriate staff of these and other international and nongovernmental agencies quickly evacuated the country in September when security concerns began to mount. In the wake of the Taliban's fall and the installation of an interim administration, WHO now has about 200 international and Afghan staff working in various cities around the country. About 20 UNICEF staff people are expected to be in place within days. Doctors without Borders/Medecins Sans Frontieres, one of the largest nongovernmental organizations specializing in health care, has more than 60 international relief workers in place, working with more than 400 Afghan colleagues.

The U.S. State Department's Bureau of Population, Refugees and Migration (PRM) is also placing priority on the improvement of health care services as it prepares to help refugees return to their country from neighboring Iran and Pakistan. Alan J. Kreczko, acting assistant secretary of state for PRM, said at the January 3 briefing that "basic health care including reproductive health care and maternal-child health care" are among the programs that will be receiving PRM funding in order to support the recovery and reconstruction of Afghanistan.

Given the remoteness of many Afghan regions, and the Taliban-imposed isolation of the country, international relief workers are lacking information on the condition of the population even as this effort begins. Natsios said USAID has asked UNICEF and the NGO community to develop better systems for compiling data on child health and mortality. Such data, he said, is an indicator of the well-being of an overall population. The mortality rate for Afghan children under five is 25 percent, and Natsios said international relief officials believe that rate has remained stable, but they need more data to be sure.

Natsios said at least it appears his worst fear has not come true. "I was afraid ... we'd lose half the kids."