Safety Fears Put Rural Health at Risk

International health officials are calling for more doctors to be sent to deal with acute rural health problems, but there are few medics willing to risk their lives by traveling to isolated parts of the country.

Joyce Smith, a Kabul-based World Health Organisation, WHO, representative, recently visited Peshawar's Afghan University to encourage medical students to move to rural Afghanistan upon completing their studies.

"The main purpose in my coming here was to help the Afghan women, particularly those living in villages or in areas far from cities," said Smith.

"I wanted to talk to the medical students and teachers to encourage them to work with WHO in these parts."

Dr Hayatullah Jawad, an Afghan University lecturer, supported the WHO initiative, but added a note of caution.

"It would be very useful for doctors to go to the areas they originally come from, because no one knows those places better. We agree that we must help the people once we are satisfied it is safe to do so."

No one knows for sure just how bad the health situation is in Afghanistan. Nearly a quarter century of war has ravaged the country and its people, and the few statistics gathered by international organisations make for grim reading.

A 1996 issue of the UN Human Development Report placed Afghanistan 169th in its league table of 175 developing countries. In subsequent years, it was felt that too little was known about the country to include it at all.

Seventy per cent of the population is malnourished. One woman dies approximately every 30 minutes from pregnancy-related causes - that's 1,700 for every 100,000 live births.

Half of Afghan children are stunted in height and one in four will die before their fifth birthday. Diarrhoea and respiratory infections account for 41 per cent of child deaths. Another 21 per cent will die from illnesses that could have been prevented, as only 32 per cent have been vaccinated against childhood diseases.

The facts are not lost on Shafiqa Akbar, a female student at the Afghan University medical school. "We and our families agree with the idea of working in the villages because we know the people and they are facing huge problems. If everyone is working in the cities, who will help rural people?" she asked.

But while the students are enthusiastic, their teachers are more pragmatic. Rafullah Seediqi, a medical faculty lecturer, said, "I believe rural conditions must be improved. But if it is not safe, we cannot agree that our students should work there," he said.

Despite the displacement of vast numbers of rural dwellers through conflict and devastating drought, most Afghans continue to live in the countryside. The cities are home to just a quarter of the population.

Only 12 per cent of Afghans reside in Kabul, yet it has nearly half of all hospital beds in the country. And while there is one doctor for every thousand residents in the capital, there is only one doctor per 100,000 people for those living in the central province of Bamyan.

WHO recently took part in a health mission to the country, and has recommended a 200 million US dollar investment to bring about more comprehensive medical coverage to the area over the next two and a half years.

It is estimated that around 1,000 new clinics will be required, as well as the upgrading of all existing facilities, to improve access to essential health services.

However, with better facilities and a higher standard of living offered in the municipalities, may prove difficult for WHO to persuade doctors and nurses to devote their careers to rural communities.

As with the country's other pressing needs, an extended period of stability may be necessary before medical staff can be expected to relocate to the more remote parts of the country.

Zarlashta Awreen is an Afghan University journalism student who participated in the IWPR course in Peshawar.