ARLINGTON—Since 2002, child mortality in Afghanistan has been reduced by about 25%, and basic health care services have increased greatly, but there is still more work to be done to increase the health status of the people, according to Afghan officials. “I believe that we have made significant progress in Afghanistan toward building a capable health system,” said Dr. S. M. Amin Fatimie, Minister of Public Health for Afghanistan, at a conference hosted last month by the office of the Assistant Secretary of Defense for Health Affairs in partnership with the National Defense University’s Near East South Asia Center for Strategic Studies. “But we really have a long way to go.”

President Obama announced a new U.S. strategy for Afghanistan this year that will entail sending more U.S. troops there. The conference entitled, “Building Health Security in Contemporary Afghanistan,” was attended by personnel from DoD and other entities to discuss and learn about the health care and security challenges facing the country as they look to the future.

The U.S. military, USAID, and other federal agencies have been working with the Afghanistan government to help address health care issues. “Why are we interested in achieving health security? It is really quite important because health is not just a human welfare kind of issue. It is very important for economic growth for citizens to be productive. They have to be healthy, but also it has very important implications for achieving stability in a country,” said Gloria Steele, USAID, acting assistant administrator for Global Health.

Allowing the People To Choose

Hekmat Karzai, director for the Centre for Conflict and Peace Studies, said that the security situation in Afghanistan has “deteriorated.” This is evident, he said, in the increase in suicide bombings that have increased in the country over the years. There were 21 suicide attacks in 2005, 118 in 2006 , 143 in 2007, and 116 in 2008. “This year we have already had 38 suicide attacks,” he said.

Karzai praised the ministry of health in Afghanistan for bringing down the infant mortality rate and for increasing the access for basic health care for the population, but said that that broad health conditions remain “poor” due to the challenges. “There are so many problems that I think the ministry just has no control over it, particularly the security conditions,” he said.

Infrastructure is also a challenge in providing health services. He said that a woman traveling to a district hospital may end up “losing her life” on the roads before she makes it to the hospital.

Karzai said that there does not seem to be a comprehensive strategy to deal with the overall situation in Afghanistan. “They seem to be very much Kabul focused, but Afghanistan is not Kabul, Kabul is not Afghanistan. Over 80% of the population lives outside of Kabul, and it is in the rural areas where we need to focus,” he said.

He advised that outside donors should consult with the Afghan people when determining what humanitarian projects they bring to the country. He said that outside donors have not always consulted the people in Afghanistan, resulting in projects that the people do not want.

“We’ve had schools that have been built where there is absolutely no need,” he said. “No one was consulted about whether these schools were needed or not.” He added that many countries have their own list of humanitarian projects that they want to accomplish in Afghanistan.

Security for Afghanistan

Andrew Exum, a fellow with the Center for a New American Security, told the conference participants that organizations such as the UN view “security” to mean not just physical security, but economic, health, and food security. He said that it appears that the Obama Administration has adopted an expanded definition of “security” for Afghanistan that goes beyond attaining just physical security. “The way in which not only the military, but also our civilian policymakers are thinking about security, is much more expansive than if you had asked the question in say the 1990s or 1980s,” he said.

Still, Exum said that because of the instability in Afghanistan, the approach that the U.S. will likely take over the coming year will be to focus mostly on the physical security of the population over other types of security. “That is probably not what you want to hear, but unfortunately, I think it is what will have to come first and it is the way the commander and diplomats are thinking about the situation in Afghanistan,” he said.