Afghanistan’s Deteriorating Healthcare System

Afghanistan’s healthcare infrastructure is crumbling after its foreign assets were frozen and donor organizations pulled funding after the Taliban takeover. The Taliban is a Pashtun Islamic extremist group that is known for imposing strict religious and conservative rule over their areas of operation including Afghanistan and Pakistan. The organization previously served as the government for southern Afghanistan in 1996-2001 during which the healthcare system had collapsed. The child mortality rate was 2x as high as it was in 2012 and polio was widespread. Safe drinking water and sanitation were also nonexistent.

Over the past two decades, non-governmental organizations (NGOs) have historically provided 75% of the funding and supplies to support the healthcare systems in 31 out of the 34 provinces of Afghanistan. As a result, the Middle Eastern country has seen enormous improvements in the healthcare system. As of 2018, with over 3,000 medical facilities staffed and supplied, about 87% of the population were able to receive services. Maternal and child mortality rates also plummeted and infectious disease treatment programs helped decrease mortality rates.  

International donor support started declining even before the Covid-19 pandemic, and Afghanistan’s Ministry of Health and other public health organizations were barely able to compensate. The economic decline at the onset of the pandemic made medical resources even more scarce. Hospitals began charging payment for supplies such as meals and scalpels previously free to patients, and patients were forced to use their own money to buy surgical equipment. In April 2021, President Biden announced that the United States would withdraw all of their 2,500 troops from the Afghanistan, triggering the entire NATO (North American Treaty Organization) alliance to withdraw a total of 7,000 troops. The process was completed in mid-September. Shortly thereafter, the Taliban rose to power once again in Afghanistan.

 A pile of international notes from the United States, Turkey, and Europe.
A pile of international notes from the United States, Turkey, and Europe. Source: Unsplash

The World Bank then froze $600 million in health care aid funded by the US Agency for International Development, the European Union, and others. The $600 million was part of the Sehatmandi project, a global initiative to increase health facilities in Afghanistan, which was a collaboration with the Afghanistan government. The withdrawal shut down 2000 of the 2800 facilities that the project previously funded, leaving healthcare workers and patients out in the wind. Currently, healthcare workers have not received payment in 6 months and do not know when they will receive payment. Many patients struggle to reach the remaining facilities because the trip there is either unaffordable, geographically dangerous, too far, or the route is lined with Taliban conflict. 

If provided now, donors feared that donations and allocations would be misused by the Taliban to generate income for the militant group instead of for healthcare problems. There is speculation that if the funds are released, wages will never reach workers and medical supplies will be bought then sold to the public at astronomical prices. All entities are waiting on instructions or action from other governments to search for a way to transfer donations in order to circumvent the regime’s administration.  

Healthcare for Children 

A toddler girl biting into her shirt sleeve next to her parent.
A toddler girl biting into her shirt sleeve next to her parent in Afghanistan. Source: Unsplash

Hunger is becoming more widespread as inflation rates climb and supply chains grow unsteady. The Integrated Food Insecurity Phase Classification (IPC) reported that half of Afghans will face acute food insecurity before winter arrives.  

Malnutrition and malnutrition-related illnesses are far more dangerous than any other disease for children. Specific types of malnutrition called acute severe malnutrition and child kwashiorkor, a severe protein deficiency, is prevalent in Afghanistan and are caused by eating too little food or not at all. It can be treated by administering Ready To Use Therapeutic Food (RUTF) and oral hydration therapy. Over 2 million children under 5 years old do not have access to this life saving treatment in Afghanistan. At least half of the children in the country are victims of malnutrition and in light of the food scarcity, mothers unable to produce breastmilk have resorted to feeding infants water mixed with sugar. 

Staffing shortages are also insurmountable. Nurses and doctors fled the country fearing what the Taliban’s takeover could mean for their lives. In the main children’s hospital in Kabul, nurses previously caring for 4 babies now have to care for 24 babies each while hospital staff try to squeeze 3 infants into 1 incubator due to equipment shortages. Current staff are overworked and still have to take up jobs at other institutions to get by. Medicinal needs are also not being met for children and adults. Drug cabinets and storage closets become emptier every day as the influx of patients has depleted the resources faster than can be transported into the country. 

A hand holding a cluster of large, yellow tablets.
A hand holding a cluster of large, yellow tablets that are basic medications that Afghans need. Source: Unsplash

Women’s Health 

The aid cuts have also decreased access to essential healthcare resources for women and girls, including contraception and family planning. Many women carry out risky pregnancies and are subjected to unsafe reproductive procedures without modern medical equipment. Prenatal and postnatal care for infants is not provided, and postpartum care for new mothers is nonexistent. Despite the labor shortages, a great deal of responsibilities for maternal health clinics are on the backs of midwives. Midwives continue to perform complicated surgeries, dangerous deliveries, and other reproductive procedures.  

Expensive medicines and transportation to clinics for health problems are not feasible for the majority of Afghan women. Beginning in early 2017, extremist groups turned their sights on medical facilities in Afghanistan, which led to increase of attacks on aid workers, doctors, and hospitals. Mounting fear against staying in maternity clinics has also driven many women away from seeking help.  

Covid-19 Pandemic 

The lack of data and accountability in Afghanistan makes it difficult to comprehend the extent to which the virus has contributed to the death rate. Around the world, Covid cases are increasing, and the Afghan population is largely unvaccinated. According to the latest data from the United Nations, only 2.2 million of 39 million individuals have been vaccinated, while 1.8 million doses are waiting to be distributed.  

Public health experts worry that an impending 4th wave of the disease will render the healthcare infrastructure irreparable. Dead bodies line hospital morgues and overflow into the outside corridors as the lack of fuel has stopped ambulances from operating. Many sick patients suffering from Covid don’t bother coming to hospitals, because they know they would not be able to receive medical assistance. Hospitals, private practices, and clinics are resorting to hastily assembling makeshift wards outside hospitals to accommodate Covid patients.  

The healthcare situation in Afghanistan has been worsening for years, and in light of the looming public health disaster, much more support from the international community is needed. The snowball effect of international neglect will continue unless major monetary, political, economic, and healthcare interventions are considered. Nonprofit health organizations such as Doctors Without Borders have been tackling both maternal and child healthcare as well as managing Covid cases in 5 provinces, but people can help by donating to Doctors Without Borders, United Nations Children’s Fund (UNICEF), and increasing awareness for the healthcare crisis in Afghanistan. 

Arab Spring 2.0

The Second Arab Spring has risen, but this time it is much more peaceful, democratic, and youth-centered than the first. Why is this important?

2011 was quite the year for everyone except me. I still attended elementary school, could not ride a bike or swim, and had no idea what I was going to do with my life. Although nothing great happened to me, the world had changed drastically for those in the Middle East, especially the youth. That event, which changed the way many Arabs and Middle Easterners viewed their governments, was called the Arab Spring. Fast forward to 2019, I’m a freshman at The University of Alabama at Birmingham and Middle Easterners are fighting for equality and a democratic style of government. Then and now, human rights violations such as inequality and representation serve as focal points for protest and revolution, allowing for them to stand up for what they believe in and fundamentally change their government.

So, what exactly was the Arab Spring?

Basically, the Arab Spring consisted of many pro-democracy protests that took place in many majority-Muslim countries like Tunisia, Morocco, Syria, Libya, Egypt, and Bahrain. Like many other social movements, the Arab Spring started with a “single act of defiance.”

In December of 2010, a street vendor, Mohammad Bouazizi, from Tunisia set himself on fire to protest the seizing of his vegetable stand by the police due to him not getting a permit. Bouazizi’s sacrifice set aflame the Jasmine Revolution in Tunisia, where the many protestors fighting for more social freedoms caused Tunisia’s authoritarian president for 20+ years, Zine El Abidine Ben Ali, to renounce his position and flee the country. This revolution in Tunisia had caused the country to become more socially democratic and involve the people in its political process due to Tunisia’s first elections occurring in 2011.

Such a great change in government by a country in the Middle East had caused others in the region to also protest, with protests occurring in Egypt, Libya, Syria, and Yemen, although many succeeded and others failed.

Although Bouazizi’s death served as a catalyst for the spreading of pro-democracy fervor, the death of Egypt’s Khaled Said by police officers became another martyr in the fight for democracy. Through his death, an Egyptian Google Executive from Dubai by the name of Wael Ghoneim became a prominent activist, creating a Facebook group called “We Are All Khaled Said,” bringing in thousands of members.

Egypt’s Arab Spring, springing from Said’s death, called for the resignation of Hosni Mubarak, then President of Egypt. After resigning, he was “charged with ordering the deaths of protesters,” of which “more than 800 people were killed.” Once Mubarak stepped down, a former political prisoner by the name of Mohamed Morsy came into power democratically. Although he was chosen by the people, Morsy made it so that no court could overturn his decisions, solidifying him as an autocrat. After many protests and conflicts with the Egyptian military, Morsy “was ousted in a military coup,” leading to the establishment of Abdel Fattah el-Sisi, Egypt’s former military chief, as President through 96% of the vote.

Images of Protests in Cairo, Egypt; Tunis, Tunisia; El Beïda, Libye; Sana'a, Yémen; Damas, Syrie; and Karrana, Bahreïn
SCREENVILLE: Iranian Dissidence in Real Life Peril. Source: screenville.blogspot.com, Creative Commons

Was the Arab Spring ultimately successful across the Middle East?

Unfortunately, no.

Although there were some democratic successes in both Tunisia and Egypt through electing leaders democratically, other countries in the Middle East, such as Libya and Yemen resulted in continued conflict and war many years after the Arab Spring.

Libya, though ousting Muammar Gaddafi from his reign, remains in conflict. Libya has essentially been divided through the many militias and political factions that exist today, fighting endlessly to grab power. The situation has been so rampant that many “migrants from sub-Saharan Africa are forced” to dangerously travel to Europe through the Mediterranean, all in an effort to flee human trafficking and violence.

At first, Yemen successfully removed its President of 30 years, Ali Abdullah Saleh. However, instead of a democratic response, an “armed uprising and foreign military intervention” caused Yemen to undergo a brutal civil war. It is through this war that Yemen experienced the worst cholera outbreak, large-scale famines across the country, and the killing of many civilians through bombs and landmines. These issues continue to be present, with no end in sight as to when it will end.

So, the Arab Spring, although deadly, resulted in some Middle Eastern countries to move towards democracy and others toward chaos and autocracy. It’s not like there’s going to be any other event like this soon, right?

Again, no.

In recent news, there have cumulative instances where protesters are fighting for the same issues. However, they “have learned from their mistakes, and are seeking new goals and using new means to achieve real, lasting, regional changes.”

According to the Carnegie Endowment for International Peace, there are three distinct characteristics for this new Arab Spring, otherwise called Arab Spring 2.0:

  1. The protesters do not trust any political leader. They believe that current leaders have not kept to their economic promises and reforms. And as such, many want to start over and introduce new politicians and parties.
  2. The protests are peaceful. Unlike protests from before, many current protests lean pacifist, even through brutal responses from the military. It is through these protests that widespread support is achieved and that countries are willing to listen.
  3. The protesters are rejecting sectarian divisions. In Lebanon, for example, religion and ethnic identity form a crucial part of how the government is formed and how people are treated. These protesters have essentially decided to do away with these divisive tactics and move towards equalizing all in government.
An image of the Peace sign
Peace Logo Wallpapers – Wallpaper Cave. Source: wallpapercave.com, Creative Commons

These characteristics directly coincide with many Algerian protests that began on February of 2019. During a panel discussion hosted by the Brookings Doha Center in partnership with Al Jazeera Centre for Studies, Haoues Taguia, a researcher for the Al Jazeera Centre for Studies, described how Algerians are distancing themselves from being a parallel to the Arab Spring. He noted that these protests are relatively peaceful, combined with the fact that a large portion of the population from “all walks of life” came to participate, legitimizing the movement. Due to a lack of leadership within the movement, these protests will be initially successful, but chaos would ensue in the years to come without a solid and stable leadership structure. During the same event, Shafeeq Garba, a professor of Political Science at Kuwait University, also advised that other civilians of MENA countries should follow Algeria’s example in order to create dialogue for change. He noted that “in the violent alternatives to this, civil wars, everyone loses, and that if these revolutions don’t succeed, they will ultimately lead to failed states.”

Lebanon is another interesting case where protests are fundamentally changing the way that a legitimate government should operate. These protests came to fruition on October 17 due to new taxes on WhatsApp calls, which caused protesters to light “fires on main roads and [block] highways, while banks, schools, and universities closed.” This new tax became the tipping point for those agitated with the Lebanese government and how their politicians are manipulating the wealth and resources that Lebanon contains. Protesters have gone so far as to create a human chain across the country as a form of protest while also involving more and more students into the fray. According to Fatima al-Sheikh, a freshman student protester, many students thought that the sectarian leaders “looked out for [their] interests, even though [the students] knew they were corrupt and oppressive. But now [the students] feel that with our hearts, and we can’t go back from that.” These protests have raged on for more than a month. With elections soon, only time will tell whether or not these protests will ultimately succeed or rather be only one of many protests in the MENA region that result in chaos and a fractured country.

Arab Spring 2.0 may only seem like a relatively new phenomenon for the MENA region now, due to the rippling effects the first Arab Spring had and still has to this day in countries like Yemen and Libya. However, rising protests against a corrupt and unfair government have spawned all over the world, from Latin America (my recent post concerning Chile’s protests) to the Middle East. Since many of these protests have been led by students it just really comes to show how concerned many college-aged people are about whether or not their respective government will be able to fairly implement policies that benefit the entire nation rather than just the ruling class. In terms of Lebanon and Algeria, both countries are fighting to revamp their respective governments. By fighting to create fair elections that emphasize the importance of the people and not just the ruling elitist class, protesters in the MENA region symbolize the importance of human rights values such as equality in a government through democratic and fair elections.

Digital Citizenship: The Good, The Bad, & The Role of the Internet

Picture of hand in a web of technological devices
Communication Internet, by Pixabay, Creative Commons

In the early history of democracies, political voting was inherently simple: it was the communication of approval or disapproval of policies, platforms, and so on. Dissention was normal, but the partisan politics we are familiar with today were almost nonexistent. Issues that one politician had with another’s proposal were addressed in a direct, timely manner. In terms of the general public, everyone was essentially getting the same information via the same means – the printed press. This meant everyone was getting the same information at the same time; there may have been differences in interpretations, but everyone was reading the same headline as their neighbor. Today, we have thousands of media vying for our attention on many topics, especially politics. Whether from CNN, MSNBC, NPR, or Fox News, we are bombarded with information on Facebook, Twitter, Instagram, and other social media.

So, how did we abruptly shift from getting news from the same medium to getting news from every angle? The answer is simple: The Internet. The Internet completely transformed how we receive and access all media of information, including political information; politicians can directly speak to voters who then participate in the political arena without leaving their home. Technological advancements in communication play an important role in influencing electoral behavior, easing the accessibility of political information. The Internet makes it easier to find out a candidate’s platform, what they want to work for, and their history. By using the internet in this way, people are engaging in what is now known as “digital citizenship.” A “digital citizen” is one who engages in democratic affairs in conventional ways by using an unconventional medium such as their laptop or smartphone.

The media’s role in elections and politics has grown exponentially since the 1960s. Prior to television, presidential candidates relied on the radio, think of President Franklin D. Roosevelt’s fireside chats, and other interpersonal means to communicate with voters: caucuses, party conventions, town halls, and so on. As technology progressed and television became widely accessible, reliance on interpersonal connections diminished and reliance upon the media grew. Power transitioned from party leaders and bosses to the candidates – as they were able to take control of their campaign, so long as their actions were worthy enough to make headlines. This transfer of power once benefitted only the candidates; however, now the power resides with the media: for they decide what suits their audiences, and who America sees.

This transfer of power greatly impacts our political processes. When politicians are their own bosses, they are able to disregard societal “norms” and use populist rhetoric to enhance their performance in the political realm. Kellener asserts President Trump is the “master of media spectacle”; using populism to make headlines and instill fear into voters more susceptible to fear- and anger-based messaging, he was able to “use the disturbing underside of American politics to mobilize his supporters”.

Picture of various social media icons
Online Internet Icon, Pixaby, Creative Commons

The Good

ISTE.org layers the ‘digital’ components onto the definition of a conventional good citizen:

A good citizen… A good digital citizen…
Advocates for equal human rights for all Advocates for equal digital rights for all
Treats others with respect Seeks to understand all perspectives

Does not steal or damage others’ property

Respects digital privacy, intellectual property, and other rights of people online
Communicates clearly, respectfully, and with empathy Communicates and acts with empathy for others’ humanity via digital channels
Speaks honestly and does not repeat unsubstantiated rumors Applies critical thinking to all online sources, including fake news or advertisements
Works to make the world a better place Leverages technology to advocate for and advance social causes
Protects self and others from harm Is mindful of physical, emotional, and mental health while using digital tools
Teams up with others on community projects Leverages digital tools to collaborate with others
Projects a positive self-image Understands the permanence of the digital world and proactively manages digital identity

All of the characteristics of a “good digital citizen” may be applied to participating in democracy via the Internet. If everyone had access to the internet, more people would be able to register to vote as well as discussing and engaging in the political arena. If we seek to understand more perspectives, we could combat the political “bubbles” that we either choose to live in or are placed into by Facebook filtering your newsfeed depending on your online habits. If we used technology to advocate for social causes such as voter disenfranchisement, we could get more people engaged with our democracy.

Being a “good” digital citizen transcends holding personal values – it includes the pursuit of equality for all. We are lucky enough to live in a country where digital citizenship is accessible for most, but we are doing no justice by those who cannot access it by not utilizing this new form of citizenship.

 

The Bad

The era of digital citizenship is a result of the rapid spread in access to the Internet. If you have access to the Internet in America, you have the opportunity to register to vote (given that you meet the proper requirements set by your state), to research political platforms and to engage with others to discuss politics. Political participation (not exclusive to voting) has increased – people are engaging more in more discussions on every form of media; however, these discussions may not always be beneficial or productive. Kurst says, due to our emotionally charged atmosphere in the US, it is very easy (and very typical) for conversations surrounding politics escalate to attacks on opposing values. It is easy to rely strictly on what you are told from your favorite news source or directly from a politician and regurgitate the rhetoric, but it is vital to our unity as a society to fact check your information, and respectfully listen to the “other side.”

In today’s political climate, virtually everything is politicized – including our social media. We live in our “red bubbles” or “blue bubbles” and disassociate from anyone who may be on the other side. Thompson argues this is normal; we seek homogeneity in our marriages, workplaces, neighborhoods, and peer groups. However, when it comes to politics and the Internet, we are allowed to pretend like those without similar interests do not exist. When we ostracize a group of people and those people feel as though they are not being represented, we see members of the Republican party proclaiming they are the “silent majority,” which was a galvanizing force behind their voter turnout in 2016. By devaluing another side’s beliefs, we are dehumanizing those who hold them. This causes anger, frustration, and retaliation – all of which that may take place in the digital or physical realms. We cannot abandon our fellow Americans simply because we disagree; we have to realize the differences we have are much less than the commonalities we share.

The polarization of the two parties in America today discredits many media outlets. 47% of conservatives said they get their news exclusively from Fox News; while liberals get theirs from a more diverse set of news. Conservatives and liberals alike see anything that does not reflect their values as “biased”, in fact, members of society gravitate to information that reaffirms their beliefs and intentionally avoid information that contradicts said beliefs, according to Drs. Rouhana and Bar-Tal. This creates a biased interpretation of the news – information that is consistent with already-held beliefs are interpreted as fact and support for whichever side of the argument the reader/viewer ascribes to. As a result, Americans question the validity of news sources that contradict that of their personal beliefs. The crossroads of political polarization and declining trust in our media outlets is where fake news exists. Truth has become a relative term and is often manipulated by an ideology, not fact.

How can we fix the political polarization tearing at the social fabric of American society? Establishing trust “across the aisle” seems like a hopeless cause in today’s America. When asked how to “pop” the political bubbles we live in, Gerson claims, “[the] cause is not hopeless, because the power of words to shape the human spirit is undeniable. These can be words that belittle, diminish and deceive. Or they can ring down the ages about human dignity. They can also allow us, for a moment, to enter the experiences of others and widen, just a bit, the aperture of our understanding. On the success of this calling much else depends.”  The solution to diminishing this polarization is to listen – listen and realize the other person you are disagreeing with possess the same humanity you do, and this humanity should be respected.

@ symbol with American symbols
News Internet, by Max Pixel, Creative Commons

Digital Citizenship and Human Rights

Marginalized populations have always struggled to get their voices heard. Without active engagement in democracy, minorities struggle to achieve full citizenship. The Internet and digital citizenship have worked together to diminish this obstacle faced by minorities. Social movements such as Black Lives Matter, #MeToo, and even the Arab Spring began and spread with the assistance of the Internet. Digital citizenship is linked to creating online communities to which people who struggle “fitting in” with their physical environment can find a home.

Using the Internet, citizens are easily mobilized on issues that concern them, whether domestic or international. They are able to pressure politicians to take actions against human rights violations and assist organizations doing field work where an injustice is present. For example, we are able to donate financially to the organizations making an effort to abolish the attacks on the LGBTQ+ community currently taking place in Chechnya, Russia. By being aware of it and all the other injustices taking place, we are able to assist in the resistance and make a difference in a way we could not have 10 years ago thanks to the Internet.

There are those who choose to not engage in politics in any shape or form, and there are those who use the Internet exclusively for political reasons. Wherever you fall within that spectrum, it is easy to agree that the polarization we have in America today is an issue that needs proper attention. It starts at the individual level: listening to what others who are different have to say, diversifying your news sources, and being open to disagreement. We must break out of our “bubbles” and not allow the influence of the Internet to shape our values for us.