Shafiqa watches closely over her six-month-old niece. Lying on a bundle of fabric, Maryam’s legs jut out, thin and pale. When they arrived at hospital two weeks ago, she could hardly breathe. Her body was swollen with malnutrition, her lips and fingers were blue.
There are 24 children being treated at Mofleh pediatric hospital’s malnutrition ward on the outskirts of Herat in western Afghanistan. Mothers and aunts lean next to hospital beds, some rocking tiny babies back and forth.
The worst drought in a decade, prolonged conflict and poverty have pushed families across Afghanistan to the brink. About 13.5 million people are severely food insecure — 6 million more than in 2017. This means they are surviving, for the time being, on less than one meal a day.
“That’s the highest number of any country in the world except Yemen,” UN Deputy Special Representative in Afghanistan Toby Lanzer said.
An estimated 3.6 million people are one step from famine. Flash flooding in many areas has compounded the misery families are facing.
As US and Afghan Taliban peace talks continue, and the prospect of US troops withdrawing looms, the UN’s appeal to donors — which set a target of US$612 million for this year — is only 11 percent funded.
Without donor support, Afghanistan would face “a humanitarian tragedy beyond what one could describe,” Afghanistan’s UNICEF representative Adele Khodr said.
The nation could fall apart, she said.
“It will become a chaotic situation that can generate insecurity not only for here but maybe elsewhere,” Khodr said.
Outside Mofleh hospital, tents stretch into the distance. It is one of several areas where families who fled the drought have sought shelter. Some sleep in white tents handed out by the UN, others have propped up flimsy pieces of cloth on sticks.
Critics say the response to the drought was slow and failed to support people to stay in their home areas. Alarm bells were first rung by several agencies on the ground, including World Vision, in autumn 2017, but it was not until April last year that the Afghan government declared a drought.
About 260,000 people were forced to leave their homes across northern and western Afghanistan. New arrivals, whose presence in Herat is politically sensitive, are scattered across several sites, making it harder for agencies to provide services.
Access to drought-affected areas, where millions more remain, is hampered by insecurity and lack of funding.
Rahima Lakzai and her family left their village in the Muqur District of Badghis Province four months ago. Almost all of their animals had wasted away. There was no money for transport; for eight days, they traveled with two donkeys across the rugged terrain that leads to Herat.
Sitting in a small mobile health clinic run by World Vision, Lakzai, 22, cradles her youngest daughter, Rakima, who is 11 months old, who is wrapped in a red cardigan, a matching scarf tied under her chin.
A measurement of her arm circumference — just 11.2cm — indicates that she has developed severe acute malnutrition.
Rahima is given peanut paste to feed to her daughter and asked to come back in a week’s time.
She said through an interpreter that the family still have not been given a proper tent to sleep in and can barely afford food for their two children.
Her husband will do any daily labor he can, she said, but there is little work available.
Torpikae, 35, from Badghis Province, lost all 50 of her sheep and three cows in the drought before she fled with her family.
“Only a few people remain,” she said.
She has received cash handouts, but debt to neighbors means she is not able to keep everything she receives.
“Half we give to those [neighbors] we borrowed from,” she said.
Like Rahima’s family, Torpikae’s husband goes out to look for work in the city.
“Mostly he is jobless,” she said.
Herat is one of Afghanistan’s most prosperous and safe cities, but competition for daily labor, which pays up to US$5 a day, is tough. Food is abundant in markets, but numerous families — both locals and people who have fled the drought — cannot afford it.
Shafiqa is from Herat Province’s Shindand District, an area that has been racked by violence.
Maryam’s mother died two days after giving birth, leaving her in Shafiqa’s care. The family has no stable source of income, because Shafiqa’s husband is not well enough to work.
Before bringing Maryam to hospital, she depended on neighbors for handouts, she said.
“I went from house to house to ask for milk,” she said.
The effects of malnutrition for children aged two and under are irreversible, says Shakib Popal, a doctor with World Vision Afghanistan, which supports the hospital’s malnutrition ward. “The brain of the child will be affected and all the consequences will remain for a lifetime.”
Babies often need to stay in the ward for 45 days, but mothers struggle to say away from their families for so long, Popal said.
“I am begging them to discharge me,” said the woman whose baby is next to Shafiqa.
Her three-month-old still has swollen legs, but she has eight other children at home.
Families who have been displaced face the greatest barriers to healthcare. On top of discrimination against new arrivals, many are often too preoccupied with finding shelter and food to go for checkups.
It was six weeks before Torpikae was given a proper tent. In other areas of Herat, and across eight other provinces, flash flooding has swept away the shelters used by displaced families.
“Some 15,000 families, many of them already affected by the drought, were hit by flash floods, and WFP [the UN’s World Food Programme] and partners are responding to cover their immediate food and other needs,” said Zlatan Milisic, WFP country director in Afghanistan.
Lanzer said that acknowledging and responding to slow onset natural disasters such as droughts typically takes time.
Whether the response was slow is difficult to judge, and irrelevant, Lanzer said.
“It’s a bit like counting the number of dead people after an earthquake. It doesn’t matter. We deal with the survivors,” he said.
“For the past nine months we’ve been doing everything we can with woefully limited resources to do as much as possible,” he said, adding that 5.4 million people were reached with food aid last year.
While conditions for displaced families are dire, there are millions more who remain in drought-affected areas.
The effects of the drought are expected to wane. However, land degradation — driven by decades of conflict, overuse of natural resources and climate change — means the full benefits of recent rains are not felt. Instead, the risk of flash floods is heightened.
“When forests and rangelands are degraded, topsoil erodes. Any loss of plants and the soil they hold in place means that when rains come, the land doesn’t benefit as much as it should,” said Rajendra Aryal, the UN Food and Agriculture Organization’s representative in Afghanistan, which is working with the Afghan Ministry of Agriculture, Irrigation and Livestock to restore forests and rangelands.
Over the past decade and a half, droughts have become more frequent and more serious. It is likely this trend will continue, creating food crises, prompting large numbers of people to flee their homes and increasing the risk that water conflict will exacerbate existing ethnic tensions.
Many of those who have fled to Herat do not want to return home.
“Even if this year is a good year [for rains], we do not have resources there,” Rahima said.
Shafiqa will stay in the hospital for another two weeks before she goes back to her children in Shindand.
“I have heard from others that the government is going to make peace with the Taliban,” she said. “I hope peace comes to my district.”
Shafiqa said her children are used to the fighting.
“We have a shelter underground we go to. Once, we were in it for a whole night. When they hear the firing sound, they just come and stick to me,” she said.
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