The International Committee of the Red Cross, which has been in Afghanistan since 1987, generally runs toward disaster and conflict, not away from them.
Najmudin Helal is just one symbol of the ICRC’s ability to transform lives broken by war in Afghanistan. In 1988, he arrived at the ICRC’s newly opened orthopedic center in Kabul for treatment after having lost both his legs to a landmine years before.
In the three decades since, Afghanistan has been convulsed by a string of wars and chronic insecurity; relief workers have been targeted by killings and kidnappings; and Mr. Helal became the director of the Kabul center.
Today, however, the ICRC’s capacity is diminishing, as new levels of insecurity prompt the organization’s most significant downsizing here in a generation. A Taliban insurgency is encroaching upon Kabul; an emergent Islamic State franchise is conducting attacks; and militias are fragmenting, all blurring the lines for relief workers between what is safe and what is not.
For years, the organization found security for its workers in its visibility to the Afghan public. The more varied and broadly distributed its services, the more assured the ICRC workers were that the public welcomed them.
“Our security is not guaranteed by high blast walls, or by armed people,” says Monica Zanarelli, the ICRC head of delegation in Kabul. “Our security concept is all around what we deliver, in terms of services, the relevance of it, and the acceptance we get in return.”
But the loss of seven ICRC staff in three incidents in 2017 – including the inexplicable gunning down of a Spanish physiotherapist by one of her own patients inside the ICRC orthopedic center in Mazar-e-Sharif – led the organization to announce in October that it would “drastically reduce” its work, especially in northern Afghanistan.
Balancing risk and need
That decision illustrates the increasing challenge of balancing the risk of relief work in Afghanistan against the vast scale of the need, even for a humanitarian player that has become an organic part of Afghanistan’s health infrastructure.
“Emotionally we were very, very sad that something like that happened. We were all shocked,” Helal says of the murder of Lorena Enebral Perez by a polio patient she had been helping last September. The ICRC has closed two offices, scaled down the Mazar-e-Sharif orthopedic center, and stopped work in less-secure rural areas. As it assesses its previous assumptions that higher visibility meant more safety, no new security paradigm has presented itself other than to hunker down for now and hope the situation improves.
The Kabul center – one of seven ICRC orthopedic centers nationwide – also closed for a week immediately after the shooting.
“We could see how the people were suffering. People were coming to the gate and asking, ‘When will you open?’ and ‘How it can be?’ ” recalls Helal.
“I am telling you not as an ICRC worker, but on behalf of the disabled population of the country, that what they get at ICRC centers around the country is unique,” adds Helal. “It’s always positive, they are very happy.”
The numbers indicate how, in Afghanistan’s vast field of disability and rehabilitation, the ICRC accounts for roughly 50 percent of activities, which include micro-loans, job placement, food distribution, and even home-schooling, to maximize chances of social integration for those with life-altering war injuries and diseases.
Thousands of artificial limbs each year
The ICRC annually produces more than 19,000 artificial legs and arms and other prosthetic devices in Afghanistan, and registers more than 10,000 new patients each year, for a total of about 160,000 across the country.
In the past, that has served as vital for ICRC workers’ security, because Afghans knew of and respected ICRC efforts to help them in even the most remote areas.
If “our acceptance is not recognized for what we do, that’s where we become weak. We are a soft target like any other humanitarian actor in this country,” says Ms. Zanarelli.
This accounts for the surprise at being targeted by a patient, she says, “in a place where we thought our acceptance was at the maximum possible. Of course we are vulnerable in those situations…. We have still to be accessible to people, otherwise we are not relevant anymore.”
Security measures have been stepped up, with metal detection wands and pat-down checks at ICRC facilities. But they are of limited value when so many patients have metal inside them already. At the same time, the military and political situation fluctuates daily.
On top of that, relief agencies on the ground during the past two years, especially, have also seen lines blur as militias in northern Afghanistan have fragmented, says Zanarelli: “There are more gray zones than there were in the past, gray zones for everyone, in the sense of, ‘Who is in charge of what?’ ”
Seeking a 'responsible withdrawal'
Still, the ICRC is working on what it calls a “responsible withdrawal” from where it is pulling back, handing over part of the workload to the local Afghan Red Crescent, for example, and other relief agencies, so the majority of ICRC beneficiaries will not be affected.
That is important because many of the cases the ICRC takes on – such as the 27,000 patients registered at the orthopedic center in Mazar-e-Sharif, which the ICRC is looking for others to take over – require years of commitment.
The ICRC decision to reduce its footprint was especially tough for an organization that, for example, was the only relief agency that kept working in Kigali during Rwanda’s 1994 genocide. It kept a hospital open, despite horrific carnage that left 800,000 dead in 100 days.
But the ICRC has also shut down before, as it closed its 23-year-old operations in Iraq after its Baghdad headquarters was bombed in 2003. In Afghanistan in 2013, the ICRC also shut down its office in Jalalabad after a suicide bomb attack, and trimmed operations in the east of the country, gradually moving back from 2015.
The latest attacks saw one ICRC staff member abducted in Kunduz province in December 2016 and held for four weeks. In February 2017, six ICRC Afghan staff were killed when their convoy was ambushed, and two abducted and held for four months, released just days before the killing of the physiotherapist.
Alarm for other relief agencies
The ICRC decision served as an alarm for other humanitarian agencies such as the Norwegian Refugee Council (NRC), which also has a large footprint in Afghanistan and provides emergency response with shelter, food, and water.
The attacks on the ICRC were “really unfortunate; cumulatively I think they had to make that decision to scale down, particularly in northern Afghanistan,” says William Carter, the NRC country director in Kabul.
“In some ways it means that we need to do a little bit more, to help stem some quite important gaps up there,” says Mr. Carter. “It’s a high-risk area, so we definitely don’t think we are invulnerable…. If the ICRC can’t work, it’s one of the standard-bearers of humanitarian organizations, so it’s pressure on us and scrutiny to look at whether it’s worth it…whether we feel our staff is safe enough.”
The ICRC may be a bellwether for other relief agencies, but it is also “in its DNA” say one former European staffer, to one day expand again in Afghanistan, where needs are so great.
Helal doesn’t doubt it, as he looks at the transformation of his own life by the ICRC – and those of so many other Afghan amputees.
“When I see a patient come to us crawling, and leaving us by walking, it gives me energy,” says Helal.