The case of health inequity in Afghanistan

In this article, I try to explore health inequities in a war zone. There is no doubt that the damaging effects of war can range from poverty to low education, to poor housing, to physically destroyed neighbourhood, and to weakened social network. Using some news reports and a Youtube video, I explain the impact of the Afghan war on the organizational and cultural health inequity. I describe how distribution of health resources becomes inequitable for the different population of one society, and how culture, in the form of religious beliefs and behaviours, plays part in causing health inequities.

The war in Afghanistan, to me (someone who has experienced it first hand), is a funny one. It is the war of the entire world against an invisible enemy. Forty two developed countries equipped with the most modern war technology are directly involved in it. The rest of the world (even Iran supported the US operation in Afghanistan) indirectly supports it. Majority of Afghans considered the beginning of the war as a military operation to set them free and to give them opportunity. On the other hand, the enemy is invisible and there is no clear battlefield. Some call the insurgents as farmers during the day and fighters at night. When Afghan and international troops drive on a highway, they suddenly hit a roadside bomb. When soldiers walk through a village or a town, a man explodes himself killing many civilians and military soldiers.

Moreover, what is fascinating is the insurgents’ intelligence, and the way they are successfully counterproductive. Besides the international troops’ presence in parts of Afghanistan, the international community give billions of dollars of aids to rebuild the country – mainly those parts that are badly affected by the war. Today, the task is to stop insurgency and such incidents as of 11 September 2001 through providing better education, better health, paved roads, and better living and working conditions for Afghans. Knowing this, the insurgents set fire to and close down schools [5] and health clinics [1,2,3].

Closing down schools and health clinics impacts health inequity in two ways: a fundamental way of taking one’s choice to have access to health care and education, and an inequitable distribution of resources between relatively secure and insecure provinces of Afghanistan. Since the aid money goes to war affected areas, the relatively secure parts of Afghanistan do not receive much attention. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential [6]. The insurgents take away the opportunity from the population to receive health care service and education. On the other hand, the government and the international community allocate more funds to those war ravaged areas to rebuild the school and to rebuild the clinics. In her recent visit to Afghanistan, Hilary Clinton said, “Our message is very clear: We are going to be fighting, we are going to be talking and we are going to be building….”[8]. The message implies that we will be fighting with insurgents, talking with insurgents, and building the insurgent’s villages. This overflow of aids in the provinces (mainly south and east) where insurgents burn down schools deprives relatively secure provinces (mainly north, west and central) from adequate resources.

To study how the war culturally affects health, I give an example from a video on Youtube. The video on Youtube is about children playing ‘the suicide bombing game’ [7]. In the video, three children pretend to be suicide bombers. They bid farewell with their fellows, cover their faces, and walk away. A couple of steps away, the kid bombers throw a handful of dust in the air and lie down on the ground pretending that they are martyred. Hertzman and Power [9] explain the life course development of chronic disease. I can see the life course development of unhealthy (deadly in this case) behaviours and choices in Afghanistan. In addition, I cannot agree more with Dunn et al [10] on the role of place, as Dunn et al puts, ‘the specificity of place – its character, its history, its feelings’. What would one expect from a child, who is raised in a place that smells gun powders, looks destroyed by rockets, feels like a war zone, filled with damaged tanks and AK47s, and produced suicide bombers? I can say that the conflict, the insurgents are convincing the population, with their cultural and religious tools, to make unhealthy (deadly) choices.

In conclusion, I argue that it is commendable to “have a fair opportunity to attain one’s full health potential” but the process of choice making should not be left entirely to individuals. Choice making is also socially constructed. In some context such as Afghanistan where social infrastructures are entirely devastated by the years of war and the people are struggling to survive, the population should be helped with provision of better education and information, and development of their society so that they make healthy choice.

References:

  1. Suspected insurgents burned down health clinic in Kandahar http://www.thememriblog.org/urdupashtu/blog_personal/en/22251.htm
  2. Gunmen torch health clinic in Khost http://www.pajhwok.com/en/2009/07/21/gunmen-torch-health-clinic-khost
  3. Gunmen attack health clinic in Farah http://www.pajhwok.com/en/2008/04/10/gunmen-attack-health-clinic-farah
  4. Staff kidnapped and health clinic reopened http://www.pajhwok.com/en/2007/02/17/health-clinic-reopened-paktia
  5. 651 School closed down in Afghanistan http://www.huffingtonpost.com/2009/01/05/651-afghan-schools-close-_n_155271.html
  6.  Whitehead M. The concepts and principles of equity and health. Copenhagen: World Health Organization, 1990.
  7. Children playing suicide bombing http://www.youtube.com/watch?v=0qx9VVJqcns
  8.  Hilary Clinton’s visit to Afghanistan http://www.bbc.co.uk/news/world-south-asia-15379332
  9.  Hertzman, C., & Power, C. 2005. A life course approach to health and human development. In J. Heymann, C. Hertzman, M. L. Barer, & R. G. Evans (Eds.), Healthier societies: from analysis to action (pp. 83–106). New York: Oxford University Press.
  10.  Dunn JR, Frohlich KL, Ross N, Curtis LJ, Sanmartin C. 2006. Role of geography in inequalities in health and human development. In J Heymann, C Hertzman, ML Barer, and RG Evans (eds) Healthier Societies – From Analysis to Action. Oxford: Oxford Publication.
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