South Lebanon
New York -- Years of war, bad government, corruption and poverty have left Afghanistan with the highest infant mortality rate in the world, according to UNICEF. More than one out of every five children are dead by the time they are five.
The statistics are frightening. More than 60% of all child deaths and disabilities are due to respiratory and intestinal infections, and of such vaccine preventable deaths as measles. Diarrhea kills tens of thousands of children every year. Many also die from severance of breast-feeding before time. An estimated 7.5 million children and adults are at risk from hunger and malnutrition, the latter affecting children's growth in particular.
Some cities, such as Jalalabad, the largest city in eastern Afghanistan located at the junction of the Kabul and Kunar rivers, are high risk areas for polio due in large part to the massive and continuous population movements from and into polio infected areas. In South Asia in 2000, over 40 percent of the confirmed cases of polio occurred in Pakistan and Afghanistan.
Afghanistan is also one of the most heavily mined nations in the world and has one of the highest proportions of disabled people as a result. It is a well-known fact that children are landmines’ most vulnerable victims as they play, go back and forth to school, tend animals or scavenge.
To control the spread of disease, UNICEF and the Department of Public Health in Nangarhar have launched the “Women Courtyard” initiative, aimed at providing local women with information about polio and other vaccine-preventable diseases, as well as such related issues as hygiene and water-borne illnesses. While this is an important initiative, certain popular traditions may well constitute a barrier to its successful conclusion. One such tradition is that babies not leave their homes before the 40th day after birth, a tradition which prevents many newborns from being vaccinated in good time.
To make matters worse, deadly attacks have targeted schools and impeded access to critical health care. According to Daniel Toole, the UNICEF Director for South Asia, “We have had attacks on villages and on schools by both anti-government elements as well as by coalition forces and international troops that have hit civilians”.
Not a single child growing up in Afghanistan today has known peace in his/her lifetime. Deteriorated mental health is one of the consequences of a permanent state of war. A UNICEF study has found that the majority of children under 16 years of age in Kabul suffer from psychological trauma resulting in serious mental health problems including psychiatric disorders and post-traumatic stress syndrome.
Children in Afghanistan are exposed not only to violence related to acts of war but also to violence resulting from accidents, beatings by close relatives or neighbors or seeing close relatives being beaten or executed. As a recent study published in the Lancet has pointed out, “In Afghan children’s lives, everyday violence matters just as much as militarized violence in the recollection of traumatic experiences.”
Daniel Toole, the UNESCO executive, remarked recently at a press briefing in Geneva, “Afghanistan today is without doubt the most dangerous place to be born,” a sad commentary on that beleaguered country.
Cesar Chelala, MD, PhD, is an international public health consultant. He has written extensively on child health issues.
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