CWS Afghanistan refugee health project saves lives, teaches health care
Female Community Health Supervisors
Female Community Health Supervisors at Khaki refugee camp in Pakistan discuss nutrition with an Afghan mother and provide nutritional supplements for her children. Photo: Mohammad Arshad, CWS Pakistan/Afghanistan December 12, 2007
Hi-res photos to accompany this story are available at: www.churchworldservice.org/media/hires.html
NEW YORK CITY -- As time runs out for three million Afghan refugees to stay legally in Pakistan, Church World Service and its nearly 30-year-old Pakistan/Afghanistan Community Health Project are working to prepare the refugees to take care of their own health upon return to Afghanistan, a country with one of the world's worst health records.
CWS Pakistan/Afghanistan Program staff Dennis Joseph and Wajahat Latif described their work in meetings Dec. 3-7 with governmental and nongovernmental bodies in New York and Washington, D.C.
Since 1978, successive conflicts have displaced millions of Afghans within Afghanistan and to neighboring countries, including Pakistan. Now Pakistan is pressing all Afghan refugees, most of whom live in camps, to return home by 2009. Many face return to rural areas of Afghanistan that lack even the most basic health services.
The United Nations refugee agency UNHCR projects 1.6 million will return from Pakistan to Afghanistan by the deadline, said Mr. Joseph, associate director of operations for CWS Pakistan/Afghanistan.
Dennis Joseph Dennis Joseph Wajahat Latif Wajahat Latif Photos: Carol Fouke-Mpoyo
"We have a window to talk with Afghan refugee men and women before repatriation, when it will become harder especially to talk about health, especially HIV/AIDS and family planning," he said. "We are telling people, 'This is the time to absorb information.'"
Intensive community education will be complemented by enhanced training of medical, paramedical and other project staff ? many of whom are Afghan refugees themselves ? as well as Community Health Committees, and Male and Female Community Health Workers, who together carry out the CWS work.
The CWS project currently serves over 57,000 Afghan refugees through three Basic Health Units in three camps in Pakistan's Mansehra District (North West Frontier Province). CWS is concerned that these communities not lose their substantial improvements in health, including effective control of tuberculosis, malaria, and leishmaniasis; a dramatic decline in maternal and infant mortality at childbirth, and high rates of vaccination against preventable diseases.
CWS has carried out its work in a context that is highly conservative socially, and highly volatile in terms of politics, economics, and security, noted Mr. Latif, the CWS Pakistan/Afghanistan senior program advisor, thanks to long-term, effective relationship building with civic and religious leaders.
"We've gained religious leaders' confidence over the years," Mr. Joseph said. "Their support has enabled us to work with local communities," even on more sensitive issues like family planning and HIV/AIDS education.
"When a refugee child is born, the parents come straightaway for vaccinations," he said. "Religious leaders even participate in the annual World AIDS Day walk each December 1 in Mansehra District."
CWS also has built Afghan men's support for women to receive ? and provide ? health services. Afghans' cultural and religious norms forbid women to be examined by males. To bolster the work of its female medical and paramedical staff, CWS has recruited, trained, and deployed hundreds of Female Community Health Workers to assist in safe, normal childbirth at home and to recognize complications that require referral to a hospital.
The general population in Pakistan suffers a maternal mortality rate of 500 per 100,000 live births and an infant mortality rate of 57 per 1,000 live births, according to the World Health Organization's 2006 Annual Health Report. Among Afghan communities in Pakistan where CWS works, those numbers dropped to 122.69 and 5.52, respectively, in 2006, according to CWS project data.
To further equip Female Community Health Workers for repatriation, "in 2008 and 2009, they will be receiving additional training for care of common ailments," Mr. Joseph said.
The CWS Pakistan/Afghanistan Community Health Project already works in eastern Afghanistan's Nangarhar Province, where it serves roughly 200,000 internally displaced persons, returnees, and local residents through six Basic Health Units. These are the only health services available in the province. Church World Service is looking to strengthen that work and expand into an additional province in 2008, Mr. Joseph said.
In Afghanistan in the general population, 1,900 women die in childbirth for every 100,000 live births, and 60 of every 1,000 newborns die, according to the World Health Organization?s 2006 Annual Health Report. According to CWS project data, those numbers dropped to 860 and 5.2, respectively, in 2006 in communities CWS serves.
Medical staff of the CWS Pakistan/Afghanistan Community Health Project Medical staff of the CWS Pakistan/Afghanistan Community Health Project in Mansehra District in Pakistan gather in advance of World AIDS Day 2006 observances at the Khaki Basic Health Unit, which serves just over 20,000 Afghan refugees. Photo: Mohammad Arshad, CWS Pakistan/Afghanistan
CWS also offers preventive services to local Pakistanis in Mansehra district, and additional services are provided to those displaced by the 2005 earthquake. As Afghan refugees leave, CWS will be expanding its work with Pakistani communities. CWS is participating in the new "Refugee-Affected Host Areas" initiative, a collaborative effort of the Government of Pakistan, UNHCR, UNDP and nongovernmental organizations. The initiative is examining the ways in which the infrastructure and knowledge developed through refugee assistance programs can be utilized for the benefit of local Pakistanis, in areas such as water and sanitation, health and education.
"We don't want to lose the human and technical resources we have developed over the years in Pakistan," Mr. Joseph said.
Mr. Latif added, "Pakistan's rural areas are a vast field for nongovernmental organizations to do health work. In both Pakistan and Afghanistan, the governments' ability to deliver humanitarian assistance in remote areas is diminishing. Organizations like Church World Service with a strong community base need to kick into high gear. Otherwise, the people out there will be left high and dry."
Afghans also are being forced back to Afghanistan from Iran, and Mr. Joseph said, "We are looking at ways to assist them with unmet basic needs."
Mr. Joseph and Mr. Latif met with a number of groups while in the United States, including a "Population and Family Health Departmental Seminar" at the Columbia University Mailman School of Public Health; the U.S. Permanent Mission to the United Nations; UNAIDS; members of Refugee Council USA and InterAction; the U.S. State Department; members of Congress; and the Reproductive Health Working Group of USAID, the U.S. State Department, the Centers for Disease Control and nongovernmental organizations.
Read more on CWS work in Afghanistan.
Media Contact:
Lesley Crosson, CWS/New York, 212-870-2676; lcrosson@churchworldservice.org Jan Dragin, 781-925-1526; jdragin@gis.net