Afghanistan | Rehabilitation center serves civilians with conflict-related injuries
Irshadullah is one of the countless civilian victims of violence in Afghanistan. As is too often the case, his injury left him with a permanent disability. Humanity & Inclusion was there to help him start over.
In July 2021, Irshadullah was cycling near his home when his left leg was hit by a bullet fired from an armed convoy. His father took him to the regional hospital in Mirwais where his leg was amputated. He was then referred to Humanity & Inclusion’s physical rehabilitation center in Kandahar for physical therapy and an artificial limb.
For a week, Irshadullah was led through physical therapy exercises to strengthen his amputated leg so he would be able to wear an artificial limb. Specialists then took a mold of his leg to make a customized device.
“I’m happy with my artificial leg,” Irshadullah says. "I can go about my daily activities normally and I can walk without difficulty."
Irshadullah can also return to school and help his father with the garden again.
HI's rehabilitation center
Located in Kandahar, Humanity & Inclusion's rehabilitation center treats people with conflict-related injuries, often caused by explosive devices. Survivors of serious accidents, patients with diabetes-related amputations and people with polio are also among those receive physical therapy services. The center is staffed by 52 professionals specializing in physical therapy or psychosocial support work. It is the only rehabilitation center in southern Afghanistan.
Afghanistan | Fazal recovers from mine accident through rehabilitation
Fazal, 18, lost his leg in a mine accident. Humanity & Inclusion is providing him with rehabilitation care.
When he was 16, Fazal worked in a garden in Kandahar, picking pomegranates. One day, the vehicle that Fazal and his co-workers were traveling in on their way to work ran over a mine on the side of the road. The explosion was terrible. Fazal was severely wounded. One of his co-workers was killed and two others were injured.
Fazal spent more than two months in a hospital in Kabul, where he underwent surgery to amputate his leg.
At Humanity & Inclusion’s rehabilitation center in Kandahar, a team of specialists immediately provided him with crutches so that he could get around on his own. Measurements were taken of his amputated leg so he could be fitted with an artificial leg. Fazal worked with experts to complete physical therapy exercises to strengthen his muscles and adapt to walking with the artificial limb.
“Now I can do my daily tasks by myself without the help of a member of my family,” Fazal explains. "I feel hopeful about the future."
Opened in 1996, Humanity & Inclusion’s rehabilitation center in Kandahar treats people injured by explosive weapons. It is the only rehabilitation center in southern Afghanistan. Survivors of other accidents, individuals with diabetes-related amputations and people with polio are among other patients treated by the 52 professionals specialized in physical therapy or psychosocial support at the clinic.
Afghanistan | 100 rehabilitation patients per week
Mohammad Rasool manages Humanity & Inclusion’s programs in Kandahar, Afghanistan, where the organization has been running a rehabilitation center since 1996.
Due to a collapsing economy, drought and consequences following years of war, the humanitarian context has significantly deteriorated. Since U.S. military troops left and the government was overturned in August, people have been flocking to the Kandahar rehabilitation center.
What kinds of people visit the rehabilitation center in Kandahar?
The vast majority of people are victims of the war and of explosive weapons. Last November, I met an 8-year-old girl from Zabul Province, which neighbors Kandahar. A mortar bomb hit her house while she was playing at home with her cousins. She was badly injured in the blast, and she was taken to several hospitals for treatment. Her father and family live on very little income, unable to afford the cost of transportation to Kandahar. After many difficult months, her family finally managed to transport her to Kandahar where she received treatment. Unfortunately, by then, her left leg had to be amputated.
Humanity & Inclusion’s team at the center worked with the young girl for several weeks as she recovered from the operation. We provided rehabilitation sessions to increase her mobility, strength and balance. Finally, when she was ready, measurements were taken and she received a prosthetic leg.
What is the rehabilitation landscape in Afghanistan?
The rehabilitation needs are immense. People come to the center every day, sometimes from very far away. For some families, the journey to the center takes an entire day, as there are only two rehabilitation centers that serve the south of the country. Since August 2021, we have seen a major increase in patient numbers. More people have been able to access the center since the fighting; roadblocks and strict security measures have ended. Now, we receive more than 100 people a week at the Kandahar center.
How strong is the connection between disability and explosive remnants of war?
Based on our data from the center, the majority of the people have acquired disabilities following contact with explosives, landmines and other remnants of war. In Afghanistan, the prevalence of disability is very high: 80% of the Afghan population has some form of disability due to the presence of mines, explosive remnants of war, armed conflicts and limited access to health and nutrition services.
What is the general situation in Afghanistan six months after the Taliban seized power?
More than half the population is in need of humanitarian assistance. People are really struggling with poverty, displacement, drought, and the ongoing risks associated with improvised explosive devices. The country’s health system is overwhelmed and the economy is collapsing. Many struggle just to get food. With no more cash in circulation, civil servants have not been paid for months and people are unable to buy goods.
How is Humanity & Inclusion responding?
Humanity & Inclusion provides rehabilitation care as the medical system in the country is unable to meet the current demand. As physical therapy services are scarce, we have a national plan to train more than 120 physical therapists over the course of a 3-year curriculum. Humanity & Inclusion also provides psychosocial support to many people experiencing stress and anxiety since there are very few mental health services in the country. We also conduct risk education sessions, as the presence of mines and explosive remnants of war remain a daily threat to the population.
Teams in Kunduz and Herat started providing cash assistance to support families with the lowest income. We will provide between six and nine allowances of $200, targeting 1,600 families. This financial support will enable them to buy food and access basic services like medical care.
Humanity & Inclusion in Afghanistan
Humanity & Inclusion has worked in Afghanistan since 1987 and is active in the five provinces Kandahar, Nimroz, Herat, Kunduz, and Kabul. The organization’s actions include physical rehabilitation, psychosocial support, mine risk education, training of new physical therapists and cash assistance.
Annually, Humanity & Inclusion assists approximately 9,000 survivors of conflict and people with disabilities at the physical rehabilitation center in Kandahar alone. Additionally, mobile teams support thousands of internally displaced people, returnees, and people with disabilities annually.
Currently, Humanity & Inclusion has 370 staff, including 114 women, based in Afghanistan.
Afghanistan | Amid uncertainty, teams provide rehabilitation, mental health support
Mohammad Rasool is base coordinator for Humanity & Inclusion in Afghanistan, managing our work in the Kandahar and Nimroz provinces. There, our teams are providing rehabilitation and psychosocial support. In this interview, Mohammad describes the situation on the ground.
Q: What is it like living in Afghanistan at the moment?
People are still struggling with poverty, displacement, drought, the risk from Improvised Explosive Devices (IEDs) and threat from ISIS. Additionally the country is facing a failing health system and the economy is also on the edge of collapse. So people are highly distressed as they don't know what will happen next in this highly unpredictable situation.
Daily, thousands of people are aiming to leave the country due to protection issues or to seek a better life out of the country. Everywhere in Afghanistan, there is food insecurity and there's a huge need for humanitarian assistance.
Q: What is the level of need for rehabilitation services in Afghanistan?
Even though the conflict is now over, I mean the big conflict between the previous government and the IEA, the battlefields and the districts are still highly contaminated with explosive remnants of war and IEDs. So, of course, the need for physical rehabilitation and risk education, and also for psychosocial support, remains high.
Q: Could you describe how Humanity & Inclusion's teams are supporting people in Afghanistan?
We have several approaches to reach people in need of services, especially rehabilitation, psychosocial support or skill development (which is for income-generating activities).
For instance, we provide support in the rehabilitation center where people are referred to us by other stakeholders including humanitarian partners. And we also have mobile teams. We go to the communities where we deliver the services directly to people. We also refer them for follow-up services to other partners and also to the rehabilitation center if they need further support.
Q: What is the level of injuries at the moment in Afghanistan?
In Kandahar, approximately one-fourth of the people we are seeing in our rehabilitation center are survivors of the conflict. Either they have acquired their injury in the recent conflict in the recent months, or they are the victims of the conflict in the previous years, but they didn't have the opportunity to access the center. We also see people who have injuries from road accidents as well as people who acquired a disability during birth.
Q: Are you able to share the story of a patient that particularly affected you?
I will share one of the story out of a thousand because in our center we are seeing 9,000 patients every year.
One of the people who was referred to us in the recent months was Anisa, an 8-year old girl from Zabul Province (pictured above). A mortar bomb hit her house while she was playing at home with her cousins. She was badly injured and she was taken to several hospitals to treat her.
Unfortunately, her left leg had to be amputated and then she was referred to the rehabilitation center in Kandahar, which is managed by Humanity & Inclusion. Our team at the rehabilitation center worked with her for several weeks to help her recover. She was happy that she could play again with her cousins or go to school.
Q: What are the major challenges you face at the moment?
Certainly, there have been some changes as the new government is not well established yet and the public service remain interrupted. So there are a lot of uncertainties and the new government is trying to introduce new guidelines procedures. Female staff who are working for the public sector, apart from the health sector, are still not able to attend work. We had some challenges related to access for our female staff to our community-based activities. We had a lot of interaction and intensive engagement with new authorities. Finally, we succeeded and access for our female staff was granted.
Q: What do you enjoy the most about your job?
I like visiting my team while they are delivering services to the people we support. I take the opportunity to directly hear from my team and their patients, listening to their feedback, suggestions and challenges that they face in the day to day activities.
Q: Do you have any message for our supporters here in the U.S.?
Of course, I have a message: The people of Afghanistan really need the support from the international community now more than ever. So please, please don't forget Afghanistan in this difficult time.
Afghanistan | Humanity & Inclusion resumes humanitarian activities
After more than 30 years of war, humanitarian needs in Afghanistan are immense. Humanity & Inclusion is steadily resuming its activities in four provinces: Herat, Kunduz, Kandahar and Nimroz.
Julio C. Ortiz-Arguedas, Humanity & Inclusion’s Country Director in Afghanistan, shares more information on the organization’s history in the country and how it has been impacted by the recent regime change:
Most of Humanity & Inclusion's activities with people in Afghanistan have resumed after a few days' interruption. Humanitarian needs are immense in a country devastated by decades of conflict and one of the most contaminated by explosive remnants of war and landmines in the world. Today, 80% of the Afghan population has some form of disability due to the presence of mines and explosive remnants of war, armed conflicts and limited access to health and nutrition services.
The rehabilitation center in Kandahar is the major activity of Humanity & Inclusion in Afghanistan. Humanity & Inclusion set up this center in 1996 and has been supporting it since. At the center we have a total of 53 staff working to support people for rehabilitation and psychosocial aid.
Support inclusive aid in Afghanistan
We were able to gradually resume activities. Since the Taliban took control of Kandahar on August 13, the rehabilitation center has served 240 men and 180 women, distributed 200 walking aids and fitted 50 beneficiaries with orthotics or prosthetics. These numbers represent a 50% increase over the average in the previous months: the end of the fighting, of the roadblocks and the increased security have allowed more people to access the center.
However, the Kandahar Mobile Team—comprising 15 members—could not yet return to the countryside, so it was deployed in the center and, in that same week, was able to accommodate 117 people.
People are coming every day at the center, sometimes from very far away—we had families who made a one-day trip to come to get treatment—as it is the only rehabilitation center for the south of the country.
Images: A glimpse at daily activities at the Kandahar rehabilitation center, including physical rehabilitation and manufacturing of artificial limbs and braces. Copyright: HI
Afghanistan | Assistance continues as country faces third wave of Covid-19
As the security situation in Afghanistan worsens, the country is also battling its third wave of Covid-19. Humanity & Inclusion has adapted its activities in Afghanistan to continue providing critical care, as well as resources to prevent the spread of Covid-19.
Since 2020, more than 144,000 people have been infected with the coronavirus in Afghanistan. And that number could be higher, given that many people do not have access to health centers. Herat, Kabul, Nangarhar, Daikundi and Ghazni appear to be the worst-affected provinces.
Humanity & Inclusion’s Covid-19 response in Afghanistan includes:
Raising awareness
Humanity & Inclusion provides the local population, particularly people with disabilities, internally displaced people, and host communities, with information on the risk of infection with Covid-19 and how to protect themselves by social distancing and wearing a mask. These awareness-raising activities are particularly important in a country where rumors and misinformation about the pandemic continue to circulate, such as drinking or washing your face with Coca-Cola or drinking black tea as a cure for Covid-19. Teams have conveyed key messages through radio broadcasts and door-to-door outreach to raise awareness.
Rehabilitation care
Humanity & Inclusion has continued to provide physical therapy to patients in need at the Kandahar rehabilitation center, and its mobile teams have made at-homes visits in camps for internally displaced people, particularly in Herat and Kandahar provinces. In 2020, more than 17,000 people participated in rehabilitation sessions. So far this year, the organization has trained 120 physical therapists.
Psychosocial assistance
The pandemic has left many people feeling depressed, with many facing job loss or other challenges exacerbated by Covid-19 and its restrictions. Humanity & Inclusion’s teams provided psychosocial support to people who needed it, and set up a hotline. The organization also distributed “leisure” kits containing items like beads or sewing and knitting equipment, as well as games, puzzles and books children to enjoy. Teams have trained medical center personnel in psychosocial first aid.
Humanity & Inclusion continued to provide psychosocial support to people psychologically affected by the conflict or other traumatic events, including Afghan refugees previously living in Pakistan who have been sent back to Afghanistan. In 2020, Humanity & Inclusion provided psychosocial support to nearly 6,000 people in Afghanistan.
Hygiene kits
The organization distributed protection and hygiene kits containing soap, hand sanitizer and other items to people unable to afford those products. Humanity & Inclusion plans to distribute 200 kits containing clothes, blankets and more to people with disabilities, widows and internally displaced people.
Referrals
Humanity & Inclusion also referred people in need of other services such as health care and protection to other organizations able to offer them appropriate support.
In addition to Covid-19 related activities, Humanity & Inclusion has continued to assist victims of the conflict in Afghanistan by providing them with rehabilitation sessions, psychosocial support and mine risk education, along with assistance to conflict victims.
Global response to Covid-19
Humanity & Inclusion teams around the world have been responding to the Covid-19 pandemic since March 2020. Donors helped launch more than 170 Covid-19 projects in dozens of countries to protect and care for the people that others overlook. Between March and August 2020, staff have reached 2.2 million people with care and aid to keep Covid-19 at bay.
World Refugee Day | More and more people are forcibly displaced from home
More than 80 million people in the world are living forcibly displaced from their homes, according to the latest data from the UNHCR, the United Nations refugee agency. That number has doubled over the last decade, skyrocketing in the last few years.
Violent conflicts, human rights violations, weather-related disasters and food insecurity are among key factors forcing people to flee their homes.
Among the 80 million people currently displaced, 45.7 million are displaced inside their home country. Humanitarian law differentiates between these individuals, who are referred to as internally displaced people, and refugees, who flee their home and cross a border to seek refuge in another country.
More than two-thirds of all refugees come from just five countries:
- Syria: 6.6 million
- Venezuela: 3.7 million
- Afghanistan: 2.7 million
- South Sudan: 2.3 million
- Myanmar: 1 million
39% of all refugees are hosted in Turkey, Colombia, Pakistan, Uganda or Germany.
More and more people are displaced for years. For example, the Kakuma Refugee Camp in Kenya was established in 1992 and has grown akin to a small city. With more an 180,000 people living there, it is one of the world’s largest refugee camps. The camp is home to refugees from Sudan, Uganda, Eritrea, Rwanda, Uganda, Ethiopia, Somalia and the Democratic Republic of the Congo.
Humanity & Inclusion works alongside people living in the camp and nearby host communities to provide physical rehabilitation services and assistive devices such as wheelchairs and crutches, and improve the living conditions of for refugees, in particular those with disabilities, by ensuring equal access to services, raising awareness of discrimination and building the capacity of staff working with refugees to assess needs.
Displacement of people with disabilities
Approximately 15% of the 80 million people displaced worldwide are living with a disability. Globally, an estimated 12 million people with disabilities have been forcibly displaced from their homes by conflict and persecution.
Forced displacement disproportionately affects people with disabilities, who are often at higher risk of violence, exploitation and abuse, and face barriers to basic services, education and employment.
Having left behind their homes and belongings, many displaced people—including those with disabilities—depend on humanitarian organizations like Humanity & Inclusion to access health care, food, water, shelter and other necessities.
Header image: A man carries his daughter, who is wearing leg braces, through a refugee settlement in Lebanon. They are Syrian refugees. Copyright: Kate Holt/HI, 2021
Inline image: An occupational therapist helps a boy with prosthetic legs use a walker during a rehabilitation session at the Kakuma Refugee Camp in Kenya. Copyright: Patrick Meinhardt/HI, 2019
Afghanistan | Mahnaz is back on her feet again
When she was 4, Mahnaz lost the use of her legs. Since meeting the Humanity & Inclusion team, this determined little girl is getting back on her feet again.
As a toddler, Mahnaz loved playing games with her friends, but that changed when her health quickly deteriorated. Soon, she couldn’t stand or use her arms. At an age when most children are exploring the world around them, Mahnaz found herself unable to walk.
Mahnaz, her parents, and her six siblings have always lived in extreme poverty. Her father is a laborer, who is away most of the time, working in Afghanistan’s Ghur province to provide for his family. Despite their difficult situation, Mahnaz's parents tried to help their daughter using traditional treatments, but nothing worked. They lost hope in ever finding a solution.
Nine months ago, when Humanity & Inclusion’s mobile team in the Herat region offered to treat 9-year-old Mahnaz, they accepted with low expectations.
"When Humanity & Inclusion started her treatment, we didn't think she would get any better because all the traditional treatments had failed,” Mahnaz’s mother explains. “We didn't believe in it anymore.”
Since people in Herat have almost no access to health care, Humanity & Inclusion’s mobile teams provide at-home services to vulnerable individuals, including people with disabilities.
Mahnaz's life has changed immensely. Mahnaz does regular rehabilitation exercises to strengthen her muscles and improve her balance. Humanity & Inclusion has given her leg braces and a walking frame. Equipped and determined, Mahnaz is learning to walk again.
The girl's mother can’t believe the progress Mahnaz has made. “Mahnaz has started to improve,” she says. “She can stand up and do a few steps with her braces. She is walking better, and we think it’s going to work! We're so happy!”
Mahnaz dreams of running and even playing soccer. Once she is self-reliant, her family wants to enroll her in school.
