AS BOMBS FALL ON AFGHANISTAN, DOCTORS WITHOUT BORDERS AWAITS TAJIK WINTER
A EurasiaNet Q&A : 10/09/01

While Americans hastily acquaint themselves with the plight of Afghan refugees, humanitarian workers in neighboring Tajikistan are carrying on their usual busy schedule. Tajikistan has insisted that it will coordinate humanitarian aid and perhaps provide access for relief workers. But the country can hardly provide succor for ill Afghanis; a food deficit and drought have left it in a permanent public health crisis. Medecins Sans Frontieres-Doctors Without Borders, which has worked in Tajikistan since the early ‘90s, knows how political and religious hostility has worsened this crisis. The group has harshly criticized the U.S.-led strikes on Afghanistan that began Sunday, reportedly dismissing the American shipments of food as "propaganda."

Whatever its political position, the group knows how political belligerence can worsen public health. In Tajikistan, the group’s doctors work in the Karetegin valley, which they say has received little government support because "it is a historical stronghold of Islamic opposition." Its teams deliver medicine to five clinics around the valley and train midwives and gynecologists in good reproductive health practice. MSF also supports 17 psychiatric facilities and runs a mental health program in Dushanbe; Tajikistan’s psychiatrists have seen depressing levels of somatic and psychiatric-related deaths since the civil war ended in 1997. Penny Harrison, who heads the organization’s Dushanbe mission, talked with EurasiaNet before the U.S. bombing began.

EurasiaNet: Can you describe how things have changed for your mission since terrorists attacked the United States on September 11?

Harrison: We have revised all our security and contingency planning. [However,] our health projects in Tajikistan continue as normal in all locations - Dushanbe, Rasht/Karategin Valley and Khojent. Like many other agencies we have been planning our contingencies and monitoring for changes in the region. Meanwhile, it is very important that MSF and other organizations here continue to advocate for the needs of vulnerable communities in Tajikistan. Parts of this community are already suffering due to the food deficit, exacerbated by drought conditions. Access to health care, essential drugs and safe birthing practices is critical.

EurasiaNet: What are your most urgent supply and personnel needs? Are you having any trouble with supplies getting through?

Harrison: Overall we have a good working relationship with the Ministry of Foreign Affairs. In Tajikistan all our projects can continue without any resource problems. For support to the MSF Afghan projects, we hope that we continue to have full access, via Gorno Badakshan, to northeast Afghanistan, where MSF still has expatriates present in Faizabad. The pipeline for the MSF projects in the northern and southern areas in Afghanistan is supported through existing bases in Pakistan and Turkmenistan.

EurasiaNet: How would you design a relief program to help border refugees? Would their health be more likely to improve if they concentrated onto one island [in the Panjay river, which runs along the Tajik-Afghan border]?

Harrison: The contingencies MSF and other agencies are prepared for include the unlikely possibility of refugees crossing to Tajikistan as well as support for internally displaced people should they move closer to the border. This covers all basic needs, health, water, sanitation, shelter, heating and cooking material. Our main concern is ensuring basic needs can be met in the pending harsh winter conditions.

The question of the islands is difficult as their status is unclear under international law. For now basic health needs are being met by Merlin and food support by ACTED and WFP. Should there be a further influx, MSF would probably be asked to assess – along with other agencies – the changed situation. The emphasis would be to ensure that basic needs are met and the health situation does not deteriorate.

EurasiaNet: How do you go about making requests of the government? Do you deal more with Russian officers, Tajik officers, or neither?

Harrison: As a registered organization here, all our requests for visas and permits are conducted through the Tajik authorities, Ministry of Foreign Affairs and Ministry of Security. Should we work on the border areas, then the Russian Border Forces would also be included in discussion regarding access. MSF values the independence and impartiality of action, and it is imperative this is understood at all levels of government and other authorities in the country.

EurasiaNet: How should Westerners understand the scope and urgency of the humanitarian crisis at the Afghan-Tajik border? How can the Tajik government admit refugees without exposing itself unduly to terrorist incursions?

Harrison: MSF is not present in the border areas, so I cannot directly answer the question. However, with support from the UNHCR, internationally accepted screening mechanisms for new arrivals as refugees would be installed. UNHCR must also ensure appropriate conditions, protection and basic needs. The Tajik government is a signatory to the [U.N’s 1951 Geneva Refugee Convention], and so is obliged to fulfill its responsibilities.

EurasiaNet: If you could sit down with the presidents of the US and Tajikistan and give them an appeal, what would you say?

Harrison: [I would] explain the present humanitarian needs in Tajikistan and the importance of continued international support for projects like MSF’s. The [Tajik] peace agreement is still young and many aspects of the transition from crisis to normalcy need ongoing international support. For Afghanistan, I’d explain the present vulnerability of the population, the acute humanitarian needs already being addressed, and our concern with the approach of winter. To the Tajik authorities we state our commitment to continue all our normal operations, also to react to changing needs within the country.

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Posted October 9, 2001 © Eurasianet
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