The human cost of conflict, northern Afghanistan
I’m in Belgrade now and delighted to be back in Europe again – though there is much to lament about leaving Asia, I’m relishing the quiet roads and the voluptuous curves motorists make around me. It is a strange, unfamiliar world, without the constant threat of death.
I’m not publishing my usual update because this month has involved very little cycling – I’ve been busy instead visiting projects associated with the health of marginalised people in the Caucasus. I usually don’t blog about these topics – the aim is to write a book with the running theme of ‘edges’ which will combine a travelogue (crossing Asia by bicycle) with reporting on marginalised people and their helpers that I met along the way – remote, physically marginalized communities, and the figurative edges of the human world too, those isolated for social, economic or cultural reasons.
So far I have visited fourteen projects around the subject of marginalised people in Asia – the focus has ranged from patients with communicable disease (TB, HIV, Hepatitis), deforming disease such as leprosy, mental illness, children with disability, economic migrants, the homeless, sex workers, victims of domestic violence, terrorist attacks and natural disasters, refugees, nomadic tribes, drug users, remote communities, slum dwellers, ex-prisoners and members of the LGBT community.
With home virtually around the corner, my thoughts have veered to plans for The New Life. In the short term I will be starting a new blog with practical advice and articles relevant to cycle touring, and I will be rejoining my profession (part-time). I’ll also get cracking on that book, though realistically it’s about three years from publication.
The concept of Slow Journalism is an interesting one, though perhaps just a rebranding of what’s been performed for decades, and the bicycle with its unprotected view proved a great way to immerse myself in the landscape and context of people’s lives. “You can’t write about people unless you know what’s on their mantlepiece.” Journalist and mental health campaigner Marjorie Wallace said recently on Radio Four. Over the last six years I’ve slept in the homes of people in more than fifty countries, as well as countless churches, mosques, hospitals, schools, police stations and army barracks. I have shared the fusty air and mosquitoes of a barn with a snortsome, cheesed-off buffalo. Along the way I didn’t see many mantelpieces, but I do see Marjorie’s point.
This is a piece from Afghanistan
The human cost of conflict, northern Afghanistan
The frail, garbled song of a city waking up drifts through my hotel window. As the emerging sun restores colour to the domes of the Blue Mosque in the Afghan city of Mazar-e-sharif, a man splays a piece of cardboard onto the pavement below, a makeshift mat, and begins to pray. Next to him a tough gang of street kids fight over the fruits of begging, and a scattering of women wander about on early errands, most draped in blue burqas; rippled and shaped by the desert wind.
It’s the trucks though which hold my gaze, as they drag their long shadows up and down the square of road that encloses the Blue Mosque. Gangs of men sit in the open-topped backs, slung with silvery-worn assault rifles, legs draped casually over the side, their shemaghs wrapped around their heads and faces, leaving just a slit for the eyes. One of these wraith-like men per car attends to a mounted machine gun that makes my heart race. Some may be police, and some paid militias loyal to the provincial governor, at least I hope so. When the Taliban attack, they have done so in a similar disguise.
Mazar-e-sharif, Afghanistan’s fourth largest city, has long been considered a place of relative safety, attested by 14 years of calm following the driving out of the Taliban by the Northern Alliance in 2001, but this summer two attacks rocked such confidences, and darkened headlines. There was the murder of nine workers from a Czech NGO in their beds on the outskirts of the city, and the attack in April on the Secretary General’s office in daylight leaving scores dead, though the numbers are disputed. Witness accounts of fatalities are often at odds with numbers revealed on Afghan news, the government keen to promote a picture of stability in a country struggling to prevent Taliban inroads in the North, now that international military support has largely pulled out.
The population of Mazar-e-sharif is on the up as those affected by the spreading violence are drawn from villages to these safer streets controlled by a famously wealthy, ethnically-Tajik governor, Atta Muhammad Nur, known as ‘the teacher’, a former commander in the Mujahidin, a man skilled in the art of war. Though he has the monopoly on violence, he is widely respected for keeping order, and the Taliban at bay.
Sitting in an eating house scoffing the city’s famous ice cream, fluffy-moustached students practice their English with me; assuming that I’m a soldier. I exchange facebook pages with one who goes on a liking frenzy of my posts on his smartphone. Above us a TV set hums and throws out images from battlegrounds in some distant or perhaps not-so-faraway province.
I seek out the regional hospital, part funded by Germany, Sweden and Japan, which hides behind a tumult of fruit vendors. There is the usual collection of labs and wards, with the addition of a centre for the treatment of opium addicts, signal of yet another problem lumbering beneath Afghanistan’s turbid surface. Burqa-clad women sit in clumps on the steps by the entrance, be-turbaned men stand apart by the doors. Mazar-e-sharif homes a great variety of peoples, and the city’s roots are inscribed in the multiplicity of hats, skin tones and faces, in the emerald and café-au-lait and blackish eyes.
Dr Rallimullah is a bushy-browed kind-eyed orthopaedic surgeon, Indian and Afghan-trained, who I meet in one of the hospital’s offices.
‘Medical schools here can be a joke’ he says, mirthlessly. ‘Doctors come out with virtually no clinical experience, under-skilled, trained inadequately in one specialty by teachers of another. The difference between a teacher and a student is one night’s reading, I’m serious! Information is passed on like water is passed between hands, and after enough hands, there’s no water left.’
Dr Rallimullah believes the healthcare system is not much better than it was 50 years ago, when he boasts of how specialists indulged in open heart and even brain surgery. These days, he says, a so-called Chest Surgeon is someone who can insert a chest tube, which most junior doctors can manage in the West. In today’s Afghanistan, the doctors themselves are often the blood donors.
Dr Rullimullah has been invited for training in the UK, in Newcastle and Belfast, but even with references, his medical license and referral letters in abundance, a UK visa is far from a given when you hold an Afghan passport, and he seems reticent about discussing his chances. Go online here, I’m told, and the Afghan IP address will trigger a barrage of advertisements from the Australian government instructing Afghans not to make the journey, with the phrase ‘No Way. Do not make Australia home’. Who then, I wonder, will train the next generation of doctors if in-country education is scant and Afghans are ordered against venturing abroad to learn?
I push open a door stickered with a no guns sign and join the swinging tail of a ward round which sweeps volubly through the orthopaedic department. On any given day around 70% of the patients here are victims of road traffic accidents, but the peril of the region’s hectic highways is old news. It’s the 20% here by actions of an insurgent Taliban which is the fraction growing the fastest. But it’s not just targeted attacks I’m told: violence is infectious. Family feuds can be settled using guns, and Dr Rallimullah recounts stories of wedding party massacres, insisting this was never the case before, even five years ago.
We stop by the bed of an 11 year old boy. As we crowd round his face distorts into a mask of unchildlike fear; his mother, a small lady in a white veil, reaches for his hand. I sense some deep psychological trauma, and wait to hear a story I’m already guessing at.
Marjan had been at the bazaar in the northern town of Maimana with his mother to buy new sandals when a woman in a burqa detonated a bomb in a pressure cooker. The blast wave threw him into a nearby canal, where he was found with a head injury and broken femur. He was rushed to a private clinic with no expert orthopedic surgeon, but where external fixators were poorly applied in order to adjoin the ends of fractured bone. Dr Rallimullah holds up an x-ray film for me to examine ‘totally unnecessary’ he grumbles, pointing to the misaligned pins. When the bones failed to unite he was taken by his mother to a mullah who proclaimed the boy to be cursed, and responsible for his own pain and disability. Months later Marjan arrived in Mazar-e-sharif, via the Red Crescent, where he awaits further surgery and psychiatric evaluation. At night he wakes, screaming and tearing at his bedclothes.
I offer his mother a seat, but she refuses, opting instead to crouch on her hams on the floor, gazing up at me past the vacant seat and speaking through a white veil drawn half over her face. Before the bomb blast, she says, her husband had become addicted to opium and left her to look after their six children alone. Now, after her son’s injury, her other children go to school for only half the time, the other half they are forced to work, stitching together clothes to raise two dollars a day for food. I see then the ripple effect of violence, of how in time, deprived of education, these ripples may create ripples of their own.
But for now, her main concern is her son. ‘He’s not normal’ she tells me, in hushed tones, sending her words to the hospital floor. ‘He screams and talks to himself. I pray his leg will heal, but I worry most about his mind.’
On the way out Dr Rallimullah turns to a female doctor in the corridor: ‘Be orange!’ he says to her in passing, and she smiles back. I ask him why. ‘Last week two of our specialists argued about whose responsibility a patient should be.’ He says. I nod, thinking of how often a similar debate plays out in hospitals across the UK. He goes on: ‘I said to them: it is the patient that matters, do not let the patient get stuck in the middle of your arguments. If one of us is white and the other is red, then we must both become orange’ adding wistfully ‘I hope for this attitude too, for the people of Afghanistan’.
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