Author: karishma
Afghanistan: Medics Under Fire
Afghanistan: Medics Under Fire
LASHKAR GAH: It was 2:08am when the first shells hit the Doctors without Borders (MSF) trauma centre in Kunduz, Afghanistan.
The hospital was brimming with patients and staff when a US gunship unleashed an hour-long attack, killing more than 40 people.
The incident shocked the international aid community.
Medics have always been off-limits in war, protected by international laws.
The United States called the Kunduz attack a “tragic accident”, but many believe that medics are increasingly becoming targets in conflicts.
Can frontline doctors continue to save lives without fearing for their own? Or is this the end of their humanitarian work?
Breaking The Rules Of Engagement
A tiny baby fights for breath. His body goes into shock. He’s just three days old.
“His oxygen is only 50 percent,” says paediatric nurse Samantha Hardeman. “We need another dose of adrenalin.”
As medics crowd around the baby, his fragile body jerks with convulsions.
Suddenly, he goes into cardiac arrest and his body stops moving. His dark brown eyes stare unblinking at the ceiling, and he becomes one of the youngest victims of Afghanistan’s 30-year war.
In this bitter conflict, soldiers and insurgents may be in the firing line but it’s babies like this who are the unwitting casualties.
Three decades of fighting have decimated Afghanistan’s health facilities, and desperately ill babies are paying the ultimate price.
“We have a relatively high mortality rate because the kids are so sick when they come to us,” Hardeman says, as she walks through the neonatal intensive care unit at Boost Hospital in the southern Afghan province of Helmand.
“Sometimes the family can’t get their child to the hospital on time because there’s fighting around them.”
Run by the international medical aid group Doctors Without Borders (MSF) in the dusty provincial capital of Lashkar Gah, Boost Hospital lies just a few kilometres from the frontline separating government forces and the resurgent Taliban.
One of just a handful of health facilities in this part of Afghanistan, Boost Hospital is a vital lifeline for tens of thousands of civilians.
Up to 500 patients come to the hospital every day, the majority of whom are children suffering from acute malnutrition.
It remains one of the main causes of childhood death in the region. In 2015, Boost Hospital admitted almost 2,300 malnourished children – approximately 190 every month.
Baby Hamid* is just six months old, but in his short life he’s been admitted to the hospital three times.
On his most recent visit, Hamid bore the tell-tale signs of malnutrition; his translucent skin stretched over his bones, his round head too large for his frail body.
“The first time I brought him here he was about to die,” says his mother, Sharifa*, from behind her sky-blue burqa. “I took him to the emergency room and doctors put him in an incubator and started oxygen on him. And then he got better. I took him home for a week but he got worse.”
As doctors in the emergency room examine him, Hamid stretches his mouth open to scream, but he is too weak to make a sound. His mother says he is suffering from diarrhoea and a cough, but the staff immediately send him to the hospital’s feeding centre.
“All day I’m scared and crying. Maybe I’ll lose him,” Sharifa says, cradling her baby. “I love my son so much. My heart hurts when he is sick. I can’t even eat anything.”
At the feeding centre, Sharifa and her son are squeezed in beside dozens of other malnourished infants and their mothers. Many have travelled for days, dodging bullets, landmines and checkpoints to reach the hospital.
Demand for care is so overwhelming that often the staff have to cram two or three patients into each bed.
Here, the babies are put on a strict regime of high-calorie formula every few hours, their diet monitored around the clock by medical staff to ensure they gain weight.
“Mother’s milk is the best for a child,” an Afghan doctor tells Sharifa. “When they don’t get that, they’re thin and they have a lot of problems, like a distended stomach and cramps. Breast milk is the only thing that can help the child grow.”
Many of the mothers at the centre have never been to school. Some of them are just teenagers who gave birth after marrying at a young age.
“At home I was giving him cow’s milk and goat’s milk,” admits Sharifa. “But he reacted badly to this.”
The doctors say Hamid has to stay in the feeding centre for at least a week. Without this urgent medical intervention, Hamid and many of the babies here would die.
But the frontline medics working to save their lives, and others like them around the world, are increasingly under threat.
There have been at least 2,400 strikes against hospitals, health workers and patients in the past three years, according to the International Committee for the Red Cross.
In Afghanistan alone, there is an incident every three days.
One of the most devastating strikes occurred in October 2015, when a MSF hospital in Kunduz, northern Afghanistan, was obliterated.
More than 40 people, including medical staff, were killed when the US military dropped more than 200 shells on the facility.
Survivors described scenes of horror: patients in the intensive care unit burnt in their beds, medics dismembered by a hail of bullets as they tried to flee the hovering AC-130 gunship.
“I heard my friends shouting,” said Dr Esmatullah Esmat, an Afghan surgeon who was working in the centre at the time of the attack. “They were saying ‘Please help us’… But there was no one to help them.”
The attack sent shockwaves through the international aid community. Health workers are supposed to be protected by all sides in warzones, but aid workers fear that governments and fighters are no longer respecting international laws.
An internal investigation by the US military found that its aircrew attacked the hospital, believing it was another building that had been overrun by the Taliban. Investigators blamed a series of human, technical and procedural failures for the bombing.
“It was absolutely not a deliberate attack. It was a mistake,” Brigadier General Charles Cleveland, a spokesman for the US military in Afghanistan, told Al Jazeera.
The investigation found 16 servicemen culpable. They were given administrative punishments ranging from letters of reprimand to retraining. No one has been charged with a crime.
Frustrated by the lack of criminal charges, MSF has demanded an independent investigation into the incident. The organisation said it repeatedly shared the GPS coordinates of its hospital with the Taliban, the Afghan Army and the US military before the attack.
“War still has rules,” says Canadian nurse Samantha Hardeman. “These are innocent people who are not part of what’s going on, and they should never be brought into it.”
Hardeman says the attack in Kunduz devastated the MSF community and she’s worried that these attacks may make medics less willing to work on the frontline.
“There’s some people who, because of Kunduz or because these kinds of attacks are happening more, are probably less likely to come to a place where the perception is that it’s more high-risk,” she says.
For babies like Hamid, the work of these frontline medics means the difference between life and death. After five days in the hospital and a regimented feeding schedule, he is out of danger for now. Nurses say he has gained 200 grammes and will soon be able to go home.
“I’m happy because my baby is getting better,” says his mother. “When he gets bigger, I want him to study and be a doctor.”
Editor’s note: Hamid and his mother’s name have been changed to protect their identity.
India: Born To Fight
India: Born To Fight
KASHMIR: The most militarised zone in the world isn’t in Iraq or Syria. It’s in Indian-administered Kashmir, a region racked by a separatist insurgency for almost 30 years.
More than 600,000 soldiers are stationed here, accused by activists of decades of murder, torture, rape and other abuses. But Kashmir may have reached its tipping point. The government’s violent crackdown on unarmed protesters has fuelled unrest in recent months.
Separatist leaders are now warning that the government’s iron-fisted rule is radicalising Kashmir’s young men. 101 East asks: Is India’s hardline policy in Kashmir creating a new generation of fighters?
Ifra Shakour’s Eyes
There are some things about October 31, 2016, that Ifra Shakour says she will never forget. And then there are the hours that she was unconscious.
She remembers hunching over school books, cramming for her eighth-grade exams. She recalls hearing bursts of tear gas shells coming from the local market. And she definitely remembers that feeling of dread when she realised that her little brother wasn’t home.
“I asked my mother what was happening outside,” the 14-year-old said.
“I didn’t know what was going on. I closed my books and went out.”
Ifra only made it to her front gate. The last thing she saw were two uniformed policemen running towards her.
“When I saw them, I got scared. That’s why I ran,” she told Al Jazeera.
“They caught me by my hair and dragged me. And then they beat me with their baton on my arm. But still they weren’t satisfied so they shot me with a pellet gun.”
This pump action shotgun has been the weapon of choice for security forces in Indian-administered Kashmir for years. It’s classified as “non-lethal”, used to maim rather than kill its victims.
Each cartridge carries lead pellets the size and shape of mustard seeds. With the pull of a trigger, the gun sprays hundreds of these tiny balls indiscriminately into the air.
Ifra said the policemen shot her at point-blank range.
“After I was hit I couldn’t see anything. Blood was coming out of my eyes,” she said.
“All I could think about was seeing again so I can study, go out with friends, teachers, my family and neighbours. I used to pray to God to make me see again so I can be a doctor.”
Protests triggered by the death of Burhan Wani
The shooting of Ifra came during the worst protests Indian-administered Kashmir has seen in six years. They were triggered by the killing of Burhan Wani, a young rebel commander who had joined an underground network of separatist guerillas.
Wani was an icon and a social media star with thousands of online followers. His death sent shockwaves through India’s only Muslim-majority state. Angry protesters flooded the streets, throwing rocks at security forces and demanding independence.
The subsequent crackdown by the government was swift and violent. Hospitals struggled to cope with the dead and injured. Some had been severely beaten, others suffered pellet wounds.
Ophthalmologists in Srinagar’s Shri Maharaja Hari Singh Hospital said they operated day and night, treating at least 1,000 patients with pellets lodged in their eyes.
Some, like Ifra, were completely blind.
“She was screaming,” said her aunt, Rubeena Banu. “There was blood coming out of her eyes, her ears, her nose. I was so stressed. I couldn’t look at her. I thought she would die.”
Ifra had three pellets in her right eye and two in her left.
“She had gone out to bring her brother home because there was firing and fighting going on,” Banu told Al Jazeera. “What did she do wrong? She didn’t have a rock or a gun in her hand. She had just gone to get her brother.”
‘No rule of law here’
The Indian government has resisted increasing pressure to ban the use of pellet guns against protesters and civilians.
“Banning it would take us straight to using bullets, so it’s the lesser evil,” said Naeem Akhtar, a senior minister in the state government.
“Use of disproportionate force is a problem, crowd control is a problem,” he admitted. “We want to create an atmosphere where we should not use it. It should be the last resort because it’s not for human beings.”
But activists and political leaders have accused the government of being disingenuous. For decades, human rights lawyers have been recording a catalogue of complaints against security forces, including cases of extrajudicial killings, torture in custody and rape. They believe abuses in Kashmir are systemic.
“There is absolutely no democracy here, there is no rule of law here, there is no accountability here,” said Umar Farooq, a separatist leader and the religious head of Kashmiri Muslims.
“Every time [there is a protest] the reaction is brute force. Kill the Kashmiris, maim them, blind them.”
Akhtar, the government minister, said the state takes these allegations seriously and is committed to protecting civilians in this 30-year conflict.
“The government is looking into specific cases of it and wherever we find that there has actually been an established case of disproportionate use of force, we will certainly take action,” he told Al Jazeera.
“They will be investigated, compensated.”
But when pressed about when these investigations will take place, he said: “I can’t put a time frame on that … I don’t know.”
Al Jazeera also requested interviews with the police, the military and the federal government, but none agreed to be interviewed.
Ifra’s family does not hold any hope that her case will be investigated. They have not lodged a complaint with the police.
“If we complain, who knows? Maybe they’ll pick up my little nephew and put him in jail,” said Ifra’s aunt, Rubeena. “That’s why we’re scared and we won’t complain.
“Today, this happened to my niece. Another day, it will happen to someone else, and someone else the day after that. That’s why we say we want an independent Kashmir.”
Ifra has had three surgeries to restore her vision, but her sight is still limited. Her relatives say she has stopped studying and barely eats. She spends most of her days sitting alone in the courtyard outside her home.
“My friend used to come to see me every morning, but now she doesn’t come,” she said. “I don’t know what has happened. She’s busy studying and going to school. She’ll graduate, but what will I do?”
Drugged Up Pakistan
Drugged Up Pakistan
KARACHI: With over six million drug users, the United Nations says Pakistan is one of the world’s most addicted countries.
It is a key link in a major drug trafficking route from neighboring Afghanistan to foreign nations, but increasingly its own people are becoming hooked to heroin and cannabis. Addiction is now crossing class and age boundaries, destroying countless lives.
Poorly funded law enforcement agencies and the public heath system is failing to manage the crisis, while billions of dollars worth of narcotics continues to flow in and out of the country.
Karishma Vyas looks at whether Pakistan can kick its drug habit.
Pakistan’s Deadly Addiction
The United Nations Office on Drugs and Crime estimates that Pakistan has 6.7 million drug users. More than four million of them are addicts, amongst the highest number for any country in the world.
Abuse of cannabis and heroin is so rife that experts say it is cheaper to buy narcotics in Pakistan than food. It costs just 50 cents to get a high.
“The way you place an order with Pizza Hut for pizza, it’s even easier than that to place an order for drugs,” says Dr Mohammad Tariq Khan, who has been researching narcotics in Pakistan for more than 20 years.
Pakistan’s government and law enforcement blames the crisis on the endless flow of narcotics from neighbouring Afghanistan.
The war-torn country is the source of at least 75 percent of the world’s heroin, according to the UNODC, and much of it is trafficked through Pakistan on its way to lucrative foreign markets. Of the 150 tonnes of heroin that enters Pakistan each year, 44 tonnes is consumed locally.
The human cost of this flood of drugs making its way through Pakistan is extreme. On a sweltering Sunday inside a suburban bungalow in Karachi, 14-year-old Mohammad Shehzad is fighting an internal battle.
Shehzad started using hashish when he was nine. When he began detox three months ago, the withdrawal would send him into fits of rage.
Shehzad is living in Karachi’s only drug rehabilitation centre for children. It is run by the Alleviate Addiction Suffering Trust, a private NGO that cares for up to 25 boys at a time.
He says he is committed to staying clean, but his neighborhood is so rife with drug abuse that he has already relapsed several times.
“I tried twice at home to leave drugs but I couldn’t leave it,” he says, sitting on the roof of the drug rehabilitation centre. “I want to go to all those people whom I have hurt, people whose hearts I’ve broken. I want to ask for their forgiveness.”
Most, like Shehzad, are hooked on hashish or glue. But increasingly the staff is seeing children addicted to heroin.
“I can’t even count how many people do drugs in this city,” says Aftab Alam, 21, a former heroin addict who is now an outreach worker with the Trust. “There are so many addicts now. Their lives are destroyed, there are so many who have died.”
REPORTER’S BLOG
“If you don’t talk to me today, I’m going to slit my wrists.”
It was my third visit to the children’s drug rehabilitation centre in Karachi and 14-year-old drug addict, ‘Tariq’ (not his real name), would not let me leave until we talked.
I was interviewing some of the boys in a quiet room to find out about their addiction. Tariq wanted to know why I had not chosen him; why he was not special enough.
It was an emotionally charged atmosphere inside the centre run by the Alleviate Addiction Suffering Trust. Dozens of boys, some as young as eight, were fighting withdrawal and emotional turmoil after giving up their addiction to cannabis, glue, heroin or methamphetamines.
Many fled physical and sexual abuse at home only to be victimised again on the rough streets of Pakistan. One boy had been sold by his parents to a fish monger who sexually abused him for years. Another child told me his father would pass out, exhausted after beating him.
Many of these children used drugs to suppress their trauma, but now in rehab and stone sober, they had no way to escape their past.
My first day at the centre was overwhelming. About 20 boys were undergoing three months of live-in rehabilitation. Some were still in the initial throws of detox, while others were just beginning to rebuild their lives.
But the boys were not the meek victims of drug abuse I had expected. They were tough and rowdy, running circles around me and the staff with practical jokes and silly stories. Some of them drew pictures of colourful houses and gardens for me.
They could also be unpredictable, playing foosball one minute and collapsing into desperate sobs the next. Some of them would secretly disappear to scratch their arms until they bled. Other boys had violent outbursts, physically attacking the staff and other children over small disputes.
I didn’t know how to begin to tell their stories as a filmmaker, or how to do it without harming them. So when Tariq, the 14-year-old hashish addict, threatened to slit his wrists, I was terrified.
The staff at the centre were remarkable at navigating these emotional minefields. Counsellor Shehla Mazardar told me a boy once stood in front of her with a knife to his own throat, threatening to kill himself if she moved.
From the beginning she told me to be kind but firm. With her endless patience and calm, Mazardar had earned their respect. Many of the boys treated her as an older sister, someone to poke fun at but ultimately to be obeyed.