Afghanistan: challenging aid neutrality in war-torn Helmand

by Laura Cesaretti. Laura is Freelance Reporter in Middle East and South Asia, currently based in Kabul, Afghanistan.

Kharim Ahmad, 22, suffered shrapnel wounds on his face and the loss of a leg from fighting in Sangin. He was being treated at the Emergency hospital in Lashkargah on March 25, 2016 (Photo: Paula Bronstein for the Pulitzer Center).

Kharim Ahmad, 22, suffered shrapnel wounds on his face and the loss of a leg from fighting in Sangin. He was being treated at the Emergency hospital in Lashkargah on March 25, 2016 (Photo: Paula Bronstein for the Pulitzer Center).

There is a reason why you can find a cold Guinness in the unstable and alcohol-free Afghan capital Kabul: Globalization. For many, it is a refreshing relief from their daily struggles, which help them to cope with a life full of renunciation. Normally, those people are the humanitarian workers, who have moved to Afghanistan in the name of highest values, career building, or more cynically, the opportunity to have a generous wallet in their pocket. For others, globalization is the process whereby their own culture is weakened and questioned by an unknown outside agenda. “I have a message to send to the world. Please, stop this fight against Afghanistan. We are simple and poor people, the only thing we got is our homes”, says Mahmud.

Mahmud is one of the thousands victims of the fight between the post-2001 governmental forces and the Taliban in Helmand, a troubled province in southern Afghanistan. His brother was killed in a crossfire inside the war-torn district of Marjiah. The wife is still suffering from the many injuries caused by the bullets that crossed her body. But she doesn’t even think about crying. Although she lost a husband and her elder child, she is patiently breastfeeding her younger baby, wrapped in badages in a hospital bed in Lashkargah, the provincial capital.

Emergency NGO Medical Coordinator Luca Radaelli, center, listens in as doctors and nurses make their morning rounds at the Emergency Hospital in Lashkargah, Helmand Province, Afghanistan, Wednesday, August 21, 2013.

Emergency NGO Medical Coordinator Luca Radaelli, center, listens in as doctors and nurses make their morning rounds at the Emergency Hospital in Lashkargah, Helmand Province, Afghanistan, Wednesday, August 21, 2013.

Afghans, especially children, are used to never cry or complain. Many believe this is due to their pride and strong body shape. Most probably it is because mourning is a luxury that they still cannot afford. For decades, international NGOs have been filling this country with aid supplies, humanitarian services, and generous donations. However, the rapid proliferation of these NGOs has also been accompanied by the understanding that their activities on the ground would have been far from neutral. Allegedly international organizations, including non-governmental ones, were accused of aiming to change the behaviour of an entire population. In exchange, they would have provided security and economic development.

Something happened though. An unprecedented number of attacks on NGOs, humanitarian workers, and even international institutions, such as the United Nation, have shown the world that humanitarian inviolability was not to last in Afghanistan. With the rational incontestability of the NGOs purpose challenged, the “machine of aid” was sucked into the sadistic network of war itself. In a conflict where the line between civilians, fighters, criminals and politicians is blurred, they have became simply another actor, struggling between its good and bad side justified by the violence of the environment.

The dramatic use of private securities companies that accompany the humanitarian works in the provinces and the capital is one of the most outstanding evidence of that. Many organizations have also forced their international staff to leave the country, managing the local projects from Europe or other more safe locations. Others have focused their activities in the few districts where security could still be guaranteed. Where welcomed, it was mainly due to the opportunity of high salaries and local economic growth, creating a sickening dependency and the enrichment of certain tribes at the expense of others.

In the name of neutrality: No armed guards, no security cameras and no barbed wire — this is the „Emergency Surgical Center for Civilian War Victims“ in Lashkargah.

In the name of neutrality: No armed guards, no security cameras and no barbed wire — this is the „Emergency Surgical Center for Civilian War Victims“ in Lashkargah.

Emergency, an international medical charity founded in Italy, has helped heal war victims in Afghanistan since 1999, is one of the few, who have followed an opposite trend. As a policy, they refuse to have armed guards, security cameras or barbed wire that covers their medical and accommodation buildings. In the unstable southern province of Helmand, where Mahmud lives, they have located 10 internationals among doctors, nurses and logicians. In their guest house, based in the provincial capital of Lashkargah, even local kids can jump, out of curiosity, over the small walls that surround the building.

It took the organization 17 years, and an abundance of common sense, to gain this trust. When Gino Strada, renowned war surgeon and founder of the NGO, opened the hospital in Panjshir province in 1999, none would have bet that he would manage to run also a hospital in Kabul, the Taliban capital of the, at the time, Islamic Emirate of Afghanistan. Panjshir at that time was the home of the Northern Alliance, the Afghan armed opposition that rejected violently the Taliban’s fundamentalist ruling. Yet, according to Strada, even Ahmad Shah Massoud, head of the movement and famous “Lion of Panjshir”, left his inseparable AK-47 outside the doors of the Emergency hospital.

It was in the name of neutrality, not security, that then, as now, Emergency has banned everyone from bringing arms inside their structures. It is also the same reason why the international staff are forbidden from going to areas in Kabul, where the night-life appeals to expats: “We cannot afford that our role could be questioned by the behaviour of a single individual”, explains Luca Radaelli, the country program coordinator.

In Afghanistan, as in other zone of crisis, the idea of purely neutral humanitarian relief has always been difficult to apply, especially when the services were closely associated with cultural and social questions. The realm of “do not harm” policy, to whom all NGOs are inspired to abide by, has been easy contradicted by the social intercourse of foreign entities with the natural development of extremely fragile societies. If this truth concerns certainly any non-governmental nation building effort, it doesn’t spare the basic humanitarian actions, such as medical aid.

The international staff of Emergency based in Lashkargah, Helmand.

The international staff of Emergency based in Lashkargah, Helmand.

Emergency, who have provided medical assistance to over 4 million people, knew that operating under the name of neutrality could cause mistrust, especially when it meant working on both sides of a war. After decades of conflicts, any violated society would have learnt that even good intentions have their price, and will become distrustful toward those, who claim the contrary. There were times when rumours spread regarding Emergency’s activities and the amputations they were carried in their operation rooms. Some believed that this kind of surgical removal aimed to weaken one of the opposite side of the conflict. Others found Emergency’s policy to cure everyone disturbing. Clearly, they were also saving the life of an enemy, allowing him to go in shape in order to kill again.

This and other more difficult events have repeatedly put the organization under severe scrutiny. In 2010, three Italian and six Afghan employees were accused of “terrorism and assassination“, although then released without charges. In 2007, due to their role as facilitator in the release of Daniele Matrogiacomo, an Italian journalist kidnapped with his Afghan colleague Ajmal Naqshbandi (tragically killed then by the kidnappers), their role was extensively investigated by the Afghan authority.

In our work, we keep asking ourselves: will you let your mother be operated here? — Luca Radaelli, Emergency NGO Medical Coordinator, Afghanistan.


Nowadays, however, Emergency is unquestionably the first hospital, where all victims of war are taken in Afghanistan. This is in spite of the availability of other public medical structures, often stationed nearest the location of an attack. In a civilian struggle, where brothers kill each other on the frontlines, their works proved that it is possible to help civilians, government soldiers and Taliban fighters, keeping all of them in nearby beds under the only principle of human care. In a society, which cannot provide adequate formative courses in many of the most basic fields, they found a way to transform almost illiterates into one of the most professional and respected team of health workers in the country.

Emergency has 46 first aid posts (FAPs), all run by a local team and available in the most remote and profoundly unstable areas of the country. “We go only where we are welcome”, explains Luca. In practice, it means never forcing the opening of a clinic according to a top-down organization assessment, but always replying to a demand made by the local communities itself. It is by following this simple rule that they reached otherwise inaccessible districts such as Sangin and Marjiah in Helmand. Those, as other places where their clinics are located, are normally the frontlines of the struggle between government and insurgency forces, inhabited by thousands of victims with war-related injuries.

The staff of the FAPs has to pass through different checkpoints with the risk to be unexpectedly caught in the crossfire with its ambulances, which bring patients to the three main Emergency hospitals, located in the Panjishir valley, Kabul and Lashkargah on a daily basis. In order to guarantee the right hygiene and professional quality standards, actual surgeries and intensive health assistance are provided just inside those structures: “In our work, we keep asking ourselves: will you let your mother be operated here?”, explains Luca. If the answer is yes, it is only thanks to this strict operative model, which takes little inspiration from the new humanitarianism theories, but instead has been developed along years of considerations, humility, and willingness of exposure.

No exceptions!

No exceptions!

Always behaving as a guest, Emergency have received the greatest feeling of openness by the Afghan community. Nevertheless, they never took a step back, when it was time to prove that there were no “weapons” hidden behind the people’s smiles. Even in the conservative Islamic Helmand, the local male staff do not show embarrassment in shaking the hands of their international female colleagues. An important effort, aimed simply to communicate appreciation and respect, not adaptation to others strangers beliefs. Indeed, for the humanitarian realm, this can be translated as a sign of the sacred obligation of hospitality — as a common worldwide certainty embraced by the old Greek western inspired civilization, as well as the historical eastern Afghan society, regardless the doubts that inevitably tie any relationship between host and guest.

In these constant daily actions, Emergency and the Afghan population are proving that something like “universal rights” exists. However these basic rights can only be identified, if a common ground of mutual respect between a foreign NGO and the local community can be found. In that sense, humanitarian assistance implemented in the name of liberal values without the regard for local social inclusion and coherence can no longer be considered as neutral. The balance between “harm and benefit” depends on this effort and on commonly defined ethical rules, rather than high budgets. It might require a deep articulate reform of the international humanitarian aims, but results prove that it is worthwhile.

This entry was posted in Afghanistan, English.

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