The Future of Disability Work in Afghanistan

Laura Krefting and Douglas Krefting*
Consultants, Comprehensive Disabled Afghans Program
Afghanistan

Abstract The people of Afghanistan have experienced 23 years of conflict, a harsh political regime and recently 3 years of severe drought. The effects of this on the lives of people with disabilities and their families have been devastating. This short article outlines the writers' current understanding of the general situation as of October 2001, the services for disabled people at that time, and presents some ideas for the future. Critical to the future is the formation of and provision of financial resources for a National Coordination Committee for Disability. A guiding framework of including disability within the general development of Afghanistan will be critical to the rapid and geographically widespread approach to prevention of disability and provision of assistance to families and disabled people in need.

Introduction
The people of Afghanistan have been subjected to more than 23 years of continuous conflict. This conflict started in 1978 when Russia invaded Afghanistan to prop up a failing communist government. Ten years later Russia left and centuries old inter-tribal rivalries, that had been suppressed while they fought a united war against the Russians, surfaced once again. This internal conflict, fueled by neighboring governments and extremists, carried on at varying levels of intensity until the Taliban began their rise to power in the mid-1990's. The Taliban were united by strong religious beliefs and, with the help of the foreign fighters who had helped defeat the Russians, quickly rose to power over most of Afghanistan. Some of the groups who opposed the Taliban, who were also supported externally, still control some parts of Afghanistan.

The effects of conflict have recently been greatly intensified by more than 3 years of severe drought. The net result is that several millions of people are now dependent on humanitarian aid for their survival-aid that cannot be delivered effectively while the punishment of the Taliban and the hunt for Osama Bin Laden and his cohorts continues. Afghanistan is a harsh place to live in the best of times and now that the limited transportation infrastructure has been destroyed once again, water and food are in short supply everywhere, and the borders of the surrounding countries are closed, fleeing to a safer place becomes impossible. In situations like this survival becomes difficult. If you are disabled, each day can present a life and death situation. Furthermore, the incidence of disability will increase significantly not only due to obvious conflict related injuries but also due to poor nutrition and closure of the few health facilities that have once been operating. These effects are particularly noticeable among the very young and the elderly. From one perspective, the increase in disability now occurring in Afghanistan can be attributed to the people who attacked the World Trade Towers in New York on 11 September 2001.

The needs of this increasing number of disabled will certainly not be met in the near future. The Taliban government in Afghanistan was always more interested in establishing and maintaining a fundamentalist Islamic religious atmosphere than it is in the development of systematic ways to help the people. The impact of this attitude was increased by the reluctance of the government to hire qualified people and the reluctance of qualified people to be associated with the Taliban. External agencies and NGOs were also reluctant to cooperate with this type of regime. The net effect of this is a country with very few services of any kind, including transportation and communication infrastructure, postal service, radio, television, health care, education, etc. This situation made working with disabled people very difficult and has minimized the establishing of local NGOs and greatly inhibited the entry of interested international NGOs into Afghanistan.

Status of Disabled People
During the extended period of conflict, a few organizations (UN agencies and NGOs) working in very adverse conditions, established programs to provide assistance for disabled people and their families. At first most of the effort was directed at providing assistance for people with physical disabilities that were the result of the conflict, primarily land-mine victims, both military and civilian. However, other programs were also developed to provide assistance for other disabled people, most notably for those with visual and hearing impairments. In the early 1990's, the Swedish Committee for Afghanistan and the International Labor Organization started to work at the community level to develop Community-based Rehabilitation (CBR) programs. In 1991, these latter programs were combined by the United Nations Operational Program Support (UNOPS)and the United Nations Development Program(UNDP) into what is now known as the Comprehensive Disabled Afghans Program (CDAP). The following table1 summarizes the work of the 17 agencies that were working in disability in Afghanistan up until 11 September 2001.

1 Based partly on information from the unpublished CDAP, Terminal Report prepared by Peter Coleridge, October 2001.

2 CDAP is developed, supported, and managed by the United Nations Operational Program Support (UNOPS) unit working through the United Nations Development Program (UNDP).

In spite of the small number of organizations, limited resources and difficult operating conditions, collectively these organizations provided training to hundreds of physiotherapists and assistants, orthotic technicians, special education resource persons, and community workers. Through their efforts, tens of thousands of disabled Afghans survived and led productive lives. In this work, CDAP often acted in a leadership and co-ordination role. Not only did they provide direct service to tens of thousands of people, they also assisted to establish national level organizations. It is expected that CDAP will continue to provide the essential support and leadership once some measure of normalcy returns to Afghanistan.

The current political situation in Afghanistan highlights and intensifies the major difficulty faced by disabled people everywhere. Not only are the lives of disabled people placed in great jeopardy because of their vulnerability, the services that are intended to decrease their vulnerability are severely affected. Under current conditions, external assistance has been eliminated and local assistance is only being maintained at a minimal level. These conditions will increase the probability of change towards more severe disabilities among those with mild to moderate disabilities, and, more significantly, they will decrease the probability of survival of people with moderate to severe disabilities.

The Political Future
While it is too early to be sure about the outcome of the current conflict in Afghanistan, there is evidence that when it ends, the situation will be dramatically changed. The nature of governance will probably change to a more representative format that is less oppressive than the current regime and more open to accepting external ideas and assistance. The expected changes in the nature of governance will make it easier for increased activities of non-governmental organizations (NGOs). The effect of these changes could create new opportunities in three areas.

• The first opportunity could be resulted from the creation of a more autonomous governance format in local communities and at the provincial or regional level. This autonomy is needed to accommodate the significant cultural and tribal differences that exist among the different ethnic groups in Afghanistan.
• The second opportunity could come from an increase in openness to development concepts and ideas at all levels, provided these concepts and ideas pay attention to Islamic thinking. This openness could result in the creation of new institutions within the governance system and new non-governmental organizations (NGOs) to assist with the reconstruction and development of Afghanistan.
• The third and final change, of which there are already indications, will be the provision of increased funding by the international community for this important work.

Hope for Disabled People
The reality of the re-development of Afghanistan will require a large input of resources necessary to ensure survival of those who do not have sufficient food and shelter. This relief work will be the major immediate priority because of the large number of people who are in this situation due to the severe drought and being displaced by war. The next priority will be returning these displaced people to their homes as quickly as possible and ensuring that they have sufficient resources to survive and be reintegrated into the new political reality that will prevail in Afghanistan. At the same time, enormous efforts will be necessary to replace the basic national infrastructure; this includes everything from communications and transportation systems to schools to medical services and government facilities. Normally, in situations like this, few people think about the needs of disabled people, and even when they do, their needs will be given a low priority.

Hope for disabled people in Afghanistan can rise out of the expected changes as noted above by working to ensure their inclusion. However, for many disabled people this hope will come too late. These people, because of their vulnerability, and the indifference of the international community to this vulnerability, will probably not survive this critical period. This tragic outcome could also give rise to hope if the international disability community will use these needless deaths as a rallying point to work for assurance of the inclusion of the needs of all vulnerable people, especially those with disabilities, in emergency relief, reconstruction, and development planning.

Inclusion of people with disabilities in emergency relief, reconstruction, and development planning should start with the careful development of an action framework. This action framework should be designed to provide inclusion and service activities for disabled people that are:

• Sustainable: Affordable in the long term within the economic reality of the country as a whole.
• Efficient: Minimum use of resources (human, material, and financial) when implementing activities to meet objectives.
• Effective: Maximum impact of activities in terms of meeting objectives.
• Measurable: Inputs (resources) and outputs (benefits) identifiable for monitoring that provides indications of sustainability, effectiveness, and efficiency.

The development of the disability action framework should focus first on the community, then on specialized agencies for each of the major types of disabilities that will be necessary to support the community work. Developing this multi focus approach will require careful coordination and planning of the activities that will have to be implemented to ensure inclusion of disabled people in national, regional, and local development. Initially activities should be implemented in the following four major sectors.

In conclusion, it is important to note that CDAP are already working in each of the above noted four areas and could continue to be the lead agency until the government is ready to assume this responsibility. However, there is a need for a more refined vision to guide their activities in the existing changed situation. Development of objectives, activities, and expected outcomes in each of the above four areas will provide this refined focus.

* About the authors:
Laura and Douglas Krefting are independent consultants who have worked in Afghanistan intermittently for CDAP for the past 3 years. While the opinions expressed in this article are the authors, they wish to acknowledge the significant contributions of Farooq Wardak, the National Program Manager and Peter Coleridge ex-Chief Technical Adviser for the UNOPS/UNDP Comprehensive Disabled Afghans Program (CDAP), Islamabad, Pakistan.

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Asia & Pacific Journal on Disability, Vol. 4, No. 2, December 2001, pp 35-42 The Future of Disability Work in Afghanistan