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Amid Death, A Model for Hope

In Afghanistan, a general can look like an angel of mercy.

In Afghanistan’s cities, it might as well be the 19th century; in the countryside, even earlier—at least, in terms of medical care. Hundreds of thousands of Afghan women, children, and infants will die unnecessarily this year. The death of so many seems anachronistic because, while epidemic and starvation are quite possible in this country, they will not, in fact, be the principal cause. The real culprit will be the lack of modern medicine, and that is perhaps the greatest tragedy. A sick infant dies of exposure in a mountain province with no electricity and no clinic; a woman bleeds to death in the back of a pushcart, 70 kilometers from the nearest hospital. The youngest Afghans die from cholera, diarrhea, dysentery, malaria, pneumonia, polio, and tuberculosis—opportunistic diseases that often follow chronic undernourishment. Thousands die at birth. Political instability is the handmaiden to the crisis.

Yet in the midst of what many call the worst health crisis for women and children in recent memory, a hero has emerged in the form of a former Afghan general. And in this country where men rule absolutely, the surprise is that this general is a woman and a former army surgeon. Sohaila Sediq, a Pashtun, is one of two female ministers in President Hamid Karzai’s cabinet, and the only female general ever to serve in the Afghan army. She earned a reputation as chief of surgery for Kabul’s Wazir Akbar Khan military hospital for saving the lives of soldiers and civilians during the rocket attacks of the ’90s. When the Taliban took over the city in 1996, they prohibited all women from working, and ordered Dr. Sediq to leave the hospital. Within months, the regime realized it had lost the country’s best surgeon and asked her to return to the 400-bed hospital, where she treated soldiers on both sides of the conflict, earning the respect of Taliban and tribal leaders alike.

General Sohaila, as she is known, began her work for President Karzai in early 2002, and her appointment as minister of public health has, by many measures, been providential for the women and children of Afghanistan. Dr. Sediq’s ministry is small and streamlined, and contains only eight deputies and general directors, most with no government training.

The department’s second in charge, Deputy Minister Ferozuddin Feroz, was also a military surgeon, but unlike his boss, he fought the war as part of the mujahideen resistance. Dr. Feroz is matter-of-fact when he relates his experience in the field: “I learned medicine from doing.” He describes Dr. Sediq in respectful terms. “Her Excellency the Minister is a very decisive person because, after all, she is a military general,” he says. “But she also seeks out advice. There is a lot of give-and-take between her and her senior staff—she is not afraid to make a decision.”

Accolades have also come from such independent sources as Ron O’Connor, who has been working in Afghanistan for 30 years and is now CEO of Management Sciences for Health (MSH), one of the largest U.S.-backed nongovernmental organizations, or NGOs, assisting Afghanistan’s reconstruction. The minister, he says, is “a forceful woman, deeply committed to improving public health.”

That is vital, because the true dimensions of Afghanistan’s crisis, as revealed through epidemiology, are enormous. The Lancet has tracked child survival in the developing world for many years. According to a study published last year, 250,000 Afghan children under five years old died in 2000.1 Afghanistan ranked fourth in child mortality. It is no surprise that among the top ten countries listed in the study, nearly all are currently or have recently been at war.

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Afghanistan; Copyright © 2004 Acumen Sciences, LLC, All Rights Reserved.

Afghan women suffer almost as much as Afghan children. Seventy thousand new cases of tuberculosis are expected next year, and of those, about 70% will be in women, double the worldwide incidence.2 Overcrowding and malnutrition contribute to markedly low body weight in women of childbearing age in Kabul. Tradition compounds the health problems—Afghan women are often confined to small, poorly ventilated sections of the house that are filled with smoke. The country’s socioreligious underpinnings discourage adequate health care for most women, and prenatal and neonatal care is nearly absent; as a consequence, the death rate for women is among the highest in the world. The life expectancy for Afghan women is 44, but if present conditions prevail, a female born today will live to only 36.3

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1  Black, R.E. et al. (June 28, 2003) Where and why are 10 million children dying every year? The Lancet 361:2226–34.

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2  World Health Organization (n.d.) who Report 2001: Global tuberculosis control. Published online.

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3  World Health Organization (2003). Selected health indicators for this country: Afghanistan, Online. >>

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