Afghanistan: ‘For Patients to Feel Safe and to Be Safe’

Country Representative Michiel Hofman explains why the independence of aid in a war is in the best interest of the patient.

In 2009, there were many people talking about a post-conflict environment, and that seems to have changed in 2010. It’s most because [it’s] all around you now. Last year in the south and in the east, there was a lot of fighting going on, but here in Kabul and other areas in Afghanistan, it was very safe to go around. And since nobody actually went to the south and the east, it was very easy to convince yourself that it was post-conflict. At this moment there’s fighting everywhere. You can’t drive out of Kabul anymore, all the provinces that were considered safe before, there have been bombings, kidnaps and other security incidents. So at this moment, nobody can deny that there is a war going on. Unfortunately, this has not led to a different approach to providing aid, and that is my biggest concern at the moment. In a war, aid has to be provided independently. You cannot continue to rely on development assistance to provide essential services, because inevitably these kind of services that are connected to government or military or any other party in the conflict will be targeted by other parties in the conflict. So at a certain point, it doesn’t actually deliver assistance. It becomes too dangerous to use these services. And that is why it’s so important that when there’s a conflict going on that the essential services are delivered independently and independent means not connected to government, military or any of the warring parties involved in the war.

There is a lot of assistance that is connected to the government or to military or to development organizations that are supporting the government activities and of course there’s nothing wrong with that in itself in a country where there is no conflict going on. But when there is a lot of fighting, which means that this government which is supported by these development activities is becoming a target of other fighters, these kind of services become very dangerous for people to use. They can be a hospital or a school or anything else that is part of a government building and this government is under attack. So this school or hospital that is based in the same building will also be attacked because it’s part of this government structure. And then the response is often to put more armed people around these structures to protect this assistance, but that doesn’t work, because the more military you put around it – and people can’t see the difference between a private security company, a military, a police – it’s all people with guns. And where there’s people with guns around, there’s other people with guns that will attack that place. That’s the way a war works. So the only place for people to get whatever they need – it can be healthcare, it can be food – is places where there are no guns. Because only then they can be sure that they will not be attacked when they are trying to get this assistance. And that is the nature of any conflict in the world. So for us it’s very simple – a hospital in a conflict zone needs to have a no weapons, not because Médecins Sans Frontières doesn’t like weapons, not because Médecins Sans Frontières wants to stop the war, but very simply that if there are weapons in this hospital, this hospital becomes a target for other people with weapons, and then it’s not a safe place for patients to go. And that was what was happening in Helmand when I arrived there: it was full of development workers who had armed protection, private security companies making all kinds of services in this hospital.

The only thing missing was patients, because patients were afraid to go inside. Now, a hospital without patients is not a hospital, and the only way to fix that was to get rid of all the weapons in the compound so that people would feel safe again to go there if they were sick. It’s very difficult to know the reasons why people come or do not come to the hospital. There’s many different reasons. Sometimes they do not come because they don’t trust the doctors, sometimes they don’t come because the medicines are not available, but also sometimes they don’t come because they’re afraid to go there. Since we started working in Helmand, we’ve seen all kinds of patients coming from different regions and sometimes we manage to ask them: ‘So why did you not come here before?’ Some of them actually answer that I was afraid to go to this hospital because there were too many military people inside so I was afraid to go inside.’ Or sometimes people say, ‘I prefer to go to this hospital because in my village, there’s only a clinic that belongs to the military, and I’m afraid to go inside because then my family will get threats from the opposition groups if I go to this military compound.’ So from these stories from patients, we do get the impression that it does make a difference to make sure that all the military stay away from the hospitals, and probably also from the clinics, because wherever there is weapons, there is fighting and there is war, and people know that. They have been in Afghanistan in a state of war for twenty or thirty years, so the people that have lived here have seen that, they know what it means. They know that if it’s a place with many guns, it is a dangerous place to go. And they feel much safer if they are sure that at least when they are sick, that they don’t have to live with all these guns when they are in the hospital. So this is very important for the patients in the hospital for them to be safe and for them to feel safe.