Fifteen miles outside Kandahar, a Land Cruiser rolls effortlessly along the blacktop. Rugged mountains, not far off but barely visible through the haze, jut sharply from the otherwise pancake-flat landscape. In the back of the vehicle, Dr. Syeed Mahboob Shah shares a bit of local history with the MSF expats — after all, a well-paved highway is so rare in Afghanistan that it begs for an explanation. “It wasn’t always like this,” says the Afghan physician, smiling under his white baseball cap. “This road was built by the Russians and then destroyed by their own tanks.” Only a few years ago you couldn’t travel on it, because both sides were strewn with vehicles that had been blown up by anti-tank mines. The Afghans, he says with some pride, have since rebuilt it, cleared the mines and removed their metal casualties.
The pace slows sharply when the driver turns right onto a gravel road. Along both shoulders, oblong concrete markers are painted red on one side, white on the other. “Danger — Mines,” a sign advises, “Keep Marked Road.” Soon a tattered white flag beckons in the distance. Mounted on a bamboo staff, it’s emblazoned with the red and black Médecins Sans Frontières logo and marks the entrance of the basic health unit at Zhare Dasht camp for internally displaced people (IDPs). About 40,000 uprooted Afghans make their home in the tents and mud-brick huts of Zhare Dasht, which means “yellow desert” in Pashto. On this day in August 2003, the afternoon temperature hits 111 degrees Fahrenheit. (In winter, it can plummet below zero.) Shade offers some relief, but even indoors it’s impossible to escape the dust that squirms its way into the eyes, nose and mouth. Outside, winds twist the sand into towering dust devils.
Many of Zhare Dasht’s residents are Pashtuns, the ethnic group that spawned the Taliban. Pashtuns make up much of the south and east of Afghanistan, but since the Taliban fell from power in 2001, Pashtuns have become a persecuted minority in the north, harassed and attacked by vengeful Uzbeks, who dominate that area. Those able to escape to the south have sought protection and aid in camps like Zhare Dasht. The camp’s other main group are Kutchis, nomads whose emerald and magenta clothing and beautiful blue-green eyes gleam amid the sea of white, black and khaki favored by Pashtuns. They have not come here to escape war, because the four-year drought has parched the earth and wiped out their herds.
A Kutchi girl in a pretty pink dress and green headscarf carries her little brother into a tent that functions as a supplementary feeding center. Here children are weighed in a basin that hangs from a scale, and those between 70 and 80 percent of their normal weight are given high-protein food supplements. Inside the feeding center, nurse Kathleen Bochsler is just getting used to the challenges of being a woman in Afghanistan. Bochsler and the other female expats have to keep their heads, legs and arms covered whenever they leave their Kandahar compound. Between her sunglasses and sandals, she’s pulled an MSF vest over a blue and white salwar kameez — the loose-fitting cotton pants and tunic worn by locals — and topped the motley outfit with a burgundy headscarf. “This is a fashion crisis,” she joked before leaving for the camp that morning. “It’s more than that,” answered her colleague, Hernan del Valle, the resident wit. “It’s a humanitarian emergency.”
Bochsler, a Canadian who looks younger than her 30 years, is just four weeks into her first mission, but she’s no stranger to delivering health care in difficult places. After graduating with her nursing degree, she worked on a Native reserve in northern Ontario, then in a small rural hospital near the British Columbia–Alaska border, and most recently on a reserve in Manitoba with an unsavory reputation. Although MSF looks for medical workers who have worked in developing countries, it appreciates this kind of Canadian experience, too. “It’s isolated and you’re dealing with not having support services and equipment,” Bochsler says. “Patients may have to be flown out, so there’s a long delay in care. You have to learn how to manage stress, solve problems. I think they liked me for Afghanistan because I was from a violent reserve, so I was security conscious.”
As in many MSF projects, the main responsibility of the expat team here is to assist, train and support the local staff. To be able to do that, the medical team must first understand the cultural context it’s working in. The organization runs hundreds of feeding centers around the world, but the one they have set up in Zhare Dasht is unusual, because the camp is relatively well provisioned by the United Nations. “The problem is, when children are sick, they are given only tea,” says Bertien van Gijssel, the project’s Dutch physician. “You can imagine that if they are given only tea, children can get malnourished.”
Adjusting her headscarf, Bochsler joins Mahboob Shah for a short drive to an area of the camp unimaginatively named Settlement 10. At 6 o’clock that morning, dozens of MSF national staff set up a vaccination center there, and they’ve spent the day inoculating 1,200 people for diphtheria. It’s a disease that neither Bochsler nor van Gijssel had ever seen before — vaccinations have eradicated it from Western countries, and even in developing nations it’s a rare ailment that MSF doesn’t encounter often. There have been about 50 cases in the camp during the past month, however, and MSF has asked the UN’s World Health Organization in Geneva for advice. It’s also relying on the Afghan doctors and nurses, who have experience diagnosing and treating it. Caused by a contagious bacterium that inflames the mouth and throat, the disease can produce a toxin that’s fatal in about 10 percent of cases. “Diphtheria is a little bit endemic in Kandahar,” van Gijssel says, “but the antitoxin has never been in the city itself, so people were always going to Pakistan, or they would die. So the first thing we had to do, together with WHO, was get the antitoxin from Islamabad to Kandahar so we could treat the patients in the hospital. After that, we decided to do a mass vaccination for the whole camp.”
When the expats and the national staff have a good working relationship, they exchange information both ways. Van Gijssel says the Afghan doctors and nurses have taught her not just about diphtheria but also about measles, which Western doctors often learn about from pictures in textbooks, not first-hand observation. She says the local medics are largely well trained, with one big blind spot. “During the Taliban, there were only male doctors, and gynecology and obstetrics were taken out, so they know nothing about menstruation, menopause, spontaneous abortion, delivery. They know nothing about STDs, because they have never examined a woman. But they are very eager to learn about it.” Even in post-Taliban culture, male doctors cannot give females a full examination — they listen to the heart and lungs through clothing, sometimes even through a burqa, the heavy garment that covers the bodies and faces of many Pashtun women. What this means is that doctors have to make guesses, so they tend to overprescribe antibiotics. In other cases, they may underestimate conditions like abdominal pain or gynecological problems because they don’t have enough information.
Near the well at Settlement 10, a barefoot boy approaches the car, his face covered in scabs. “It looks like impetigo,” Bochsler says, “which is very common back home, especially in First Nations communities.” Here, she explains, the only treatment she’s seen is gentian violet, which is ineffective in advanced cases. “When you see it to that degree at home you’d always put them on oral antibiotics.” Here again, delivering health care in Afghanistan means not only having the right drugs but convincing a sometimes reluctant population to use them. Mahboob Shah says that during the diphtheria vaccinations many patients refused the needle. “There are rumors that the vaccine causes infertility.” In other cases, though, Afghans have proven fond of injections, which most believe are superior to oral medication — especially white pills, which are considered useless because they all look the same. The rule of thumb when it comes to tablets, says van Gijssel, is “the bigger the better, and the redder the better.”
Wars, natural disasters and persecution have driven people to flee their home countries since time immemorial. Even the English word refugee is centuries old, first appearing in 1685 and originally referring to the Huguenots who came to England to escape religious persecution. The current legal definition of refugee, however, has been on the books only since 1951, when the Convention Relating to the Status of Refugees was adopted in Geneva and the United Nations High Commissioner for Refugees (UNHCR) was appointed its guardian. Article 1 defines a refugee as “a person who is outside his/her country of nationality or habitual residence; has a well-founded fear of persecution because of his/her race, religion, nationality, membership in a particular social group or political opinion; and is unable or unwilling to avail himself/herself of the protection of that country, or to return there, for fear of persecution.” The 1951 agreement was intended to protect and resettle 1.2 million Europeans who had been uprooted during the Second World War. In 1967, the Protocol Relating to the Status of Refugees widened the geographical scope of refugee law. Today, 145 countries have ratified one or both of these agreements.
None of the convention’s 19 original signatories could have anticipated how the world’s refugee situation would evolve in the decades to come. As 2003 opened, there were about 10.4 million refugees worldwide, approximately the same number as in 1982, though far fewer than the peak of almost 17.8 million in 1992. UNHCR works to ensure that these refugees receive official status, which entitles them to protection and assistance. If and when circumstances permit, the organization helps them return home and rebuild their lives, but in the meantime one of its roles is to set up and administer camps where refugees can receive shelter, food and medical aid. It’s an enormous task that is increasingly subcontracted to government organizations, private companies and international aid agencies like Médecins Sans Frontières. MSF cut its teeth in refugee camps in the late 1970s and early 1980s, and it now brings decades of experience to delivering health care in these environments.
In the months following the US-led attack on the Taliban that began in October 2001, hundreds of thousands of Afghans scattered, some to other parts of the country, others to neighboring Iran and Pakistan. Decades of conflict and years of drought had already pulled the rug out from under Afghanistan, the world’s leading exporter of refugees, but this crisis was unprecedented. A little perspective: At the beginning of 2002, there were about 12 million refugees worldwide. Of these, more than 3.8 million — almost a third — were Afghans. Another 1.3 million Afghans were internally displaced. When you consider that the country’s population is about 28 million, about that of New York and New Jersey, these numbers are staggering. Between March and November 2002, more than 1.8 million Afghan refugees returned to their country, the largest homecoming in history, and hundreds of thousands have since followed. But millions more are still living in camps both inside and outside Afghanistan, completely reliant on aid agencies.
While the rights of refugees are enshrined in international law, internally displaced people — who may number 25 million worldwide — inhabit a gray area. They are, strictly speaking, the responsibility of their own governments. But because governments often lack the resources or the political will to look after these people, UNHCR has stretched its mandate to include millions of them, including those at Zhare Dasht. Indeed, the Afghan situation is a prime example of how the distinction is in some ways a mere technicality. Within a couple of hours’ drive from Zhare Dasht is a network of other camps — one in Spin Boldak, on the Afghan side of the border, and several others near the town of Chaman, Pakistan. Whether refugees or IDPs, the Afghan families in these camps face the same medical predicament that comes from cramped conditions, exposure to a harsh climate, inadequate water and sanitation, and despair.
In several of these camps, and in many others around the world, MSF provides basic health care for months or years and intervenes in acute emergencies, such as outbreaks of disease. A refugee camp provides ideal conditions for all manner of pestilence. One of the most rampant is measles, which kills almost a million people each year in developing countries, most of them children. Although its most familiar symptom is a distinctive skin rash, measles is a respiratory infection that is caused by an airborne virus transmitted the same way as the common cold — through coughing and sneezing. In an overcrowded refugee camp, where people may already be weakened by inadequate nutrition, measles outbreaks can be swift and deadly. Measles vaccination is priority number one when setting up shop in a refugee camp, and MSF tries to make sure that all the children between the ages of 6 months and 15 years are immunized. These campaigns may also include a vitamin A distribution, since a deficiency of this nutrient can increase the measles mortality rate.
Cholera is another disease that is easily prevented and treated in developed countries. Among refugees and displaced people, however, it can lead to an agonizing death. Caused by a bacteria, Vibrio cholerae, cholera is usually transmitted when infected feces comes into contact with the mouth, often with the help of flies, contaminated water, unwashed hands or improvised latrines. Many infected people have no symptoms, but the unfortunate ones suffer vomiting and copious diarrhea — discharging up to a quart of fluid an hour in severe cases. Some patients are so weakened that they have to use a “cholera bed,” a stretcher with a strategically positioned hole, placed over a bucket. Left untreated, cholera can be fatal in up to 50 percent of cases, but a simple course of rehydration, either orally or intravenously, can bring a quick turnabout. Other diarrheal diseases, including those caused by Shigella or E. coli bacteria, cause even more deaths among displaced people.
Despite the squalor of a refugee camp, life and love go on as before. Some of the 100 to 120 daily visitors to the basic health unit at Zhare Dasht have broken bones or lacerations suffered in minor mishaps; many have respiratory problems or irritated eyes, both largely due to the unmerciful dust. Diarrheal diseases are common, especially in the summer, when the heat allows the bacteria to flourish around the pumps and jerry cans that carry the camp’s water supply. Many patients show up with headaches, body pains and other complaints that have a psychosomatic cause, not unusual in a population that has endured years of stress and hardship. The vast majority are treated on the spot or given medication from the camp’s pharmacy. The basic health unit also has a nursing station for dressing wounds and performing simple diagnostic tests, a vaccination area for children under two and women of childbearing age, and a tent where pregnant women can visit a midwife. There are two consulting doctors — one for men, another for women. Health care, like virtually all activities in Afghanistan, is strictly segregated by sex. Perhaps five or six patients each day are sick enough to have to endure the one-hour drive to Mir Wais Hospital.
On January 8, 2002, in a second-floor ward of Mir Wais Hospital in Kandahar, seven men were crowded into a single room. Nursing three-week-old wounds that had never been properly treated and living on bread, oranges and cookies smuggled in by bribed staff, they were no doubt in considerable agony. One of the seven, apparently unable to endure his hospital stay any longer, shaved his beard to disguise his appearance and tried to make a hasty exit. When he was quickly surrounded by Afghan soldiers, the patient held a grenade to his chest, pulled the pin and checked out for good.
Like his six colleagues, the dead man was an al-Qaeda fighter, one of several who had been dropped off at Mir Wais in December after being wounded in battles with the Americans or their Afghan allies. A few had already escaped from the hospital without being captured, and two others were lured out by a ruse and promptly arrested. Eventually six remained, holed up with some 120 other patients, refusing to surrender even to the Red Cross and vowing they would use their pistols and grenades if their enemies tried to take them alive. Before dawn on January 28, Afghan and US special forces, weary of the siege, surrounded the hospital. After hours of maneuvering, they attacked, lobbing several grenades into the building and then storming the ward. In the firefight that ensued, the last of the al-Qaeda patients were mowed down by assault rifles, some while hiding under their beds.
Nineteen months later, nurse Mohammed Yaqub walks along a freshly painted corridor at Mir Wais, which has been rehabilitated with the help of MSF. One of the most experienced of the national staff on this project, Yaqub has seen many expats come and go as teams have been evacuated and recalled. He’s even outlasted the Taliban. His tidy black beard was much longer during their reign, of course — he could have been lashed or jailed for trimming it. “Those were very difficult years,” he says, with decided understatement.
MSF is supporting the infectious diseases ward in the renovated hospital, which has become suddenly busy in the wake of the diphtheria outbreak at Zhare Dasht. Because of limited space, patients recovering from the disease are sheltered outside in large tents, where small electric fans are outmatched by the stifling heat. The fact that diphtheria patients are here at all is something MSF had to fight for, says Kathleen Bochsler. When the first reports of diphtheria came in from the camp, the Afghan ministry of public health and the WHO asked MSF to stop referring the patients to Kandahar. “They said it was putting the city at risk for diphtheria, and they didn’t want them at the hospital. They said they’d build a little hospital at the camp and we could treat them there. Well, in theory, that’s wonderful. But if there’s an emergency, like an anaphylactic reaction, they’re an hour away from Mir Wais. If it’s anaphylaxis, they’ll be dead.”
Besides, the antitoxin used to treat diphtheria can’t be given in extreme heat; the temperature must be below 95 degrees, and at Zhare Dasht the mercury can reach 120. “At least at the hospital, we have fans and water coolers,” Bochsler says. At Mir Wais, the 48-hour antitoxin treatment can be given inside the infectious diseases ward, and only then are the patients moved to the recovery tent, where they spend a week on antibiotics. So MSF did what it usually does in these situations: it refused to work on terms it found unacceptable. “We said to the WHO and the ministry of public health, unless you can replicate what we’re doing in the city, we are not going to support your building a little hospital in the camp, and we said if they didn’t meet certain criteria we wouldn’t send our patients there. That made us very unpopular. However, after we put that all in writing and submitted it, they changed their mind.” As a rookie, Bochsler admits to being surprised that MSF won this argument. “I’m still trying to get my head around the fact that if we don’t agree with something here, we don’t do it.”
Above the walls of the MSF compound in Kandahar, you can occasionally glimpse a kite flitting about in the dry wind. It’s a triumphant gesture: before the Taliban was ousted from this area, kite-flying was outlawed, along with such other vices as music, public laughter and white shoes. The bans are gone now, but there’s still a Taliban presence in and around Kandahar, says Mattias Ohlson as he sits in the inadequate shade a dozen yards from the compound’s bunker. The 31-year-old Swede is on his third mission with MSF and, as the project coordinator, it’s his job to keep on top of security. The UN and coalition forces are supposed to advise NGOs about any potential dangers, but they don’t always keep pace with the word on the street, Ohlson says. “We also send the local staff to the bazaar to talk to taxi drivers and things like that.”
Having a close relationship with community leaders and the general population isn’t just important for security. “For me, that is one of the reasons to work with MSF,” says Bertien van Gijssel. “To go into cultures where no one else goes and see the daily lives of people, to do the work that you love and have a little adventure. And also to see what is really going on in these countries, because you hear a lot, especially from Afghanistan, and it’s quite interesting to see how people really live.” That’s been almost impossible in Kandahar, though, where the MSF team is under virtual house arrest. “Many times we are invited to the homes of national staff, but we can’t go because they live on narrow streets and we can’t park the cars there. We are not allowed to walk around the streets — we’re always getting into the car inside our compound, and getting out in the compound of another NGO. We’ve been shopping only once or twice, always accompanied by national staff. At a certain point, you want to go out into the streets and see what’s happening or ride a bicycle. You really feel quite locked up.”
Van Gijssel was pleased to finally get a peek under the burqas when she was invited to a local wedding. “Of course, the men had to go with the men, and the women had to go to a female party. Then you suddenly see all these women who are totally dressed up — they come in with their burqas, then they take them off and dress up in very nice clothes and start dancing all night long, really enjoying themselves. No scarves, with makeup on. It was amazing. It’s such a strange situation, because the men never see the women like this. Unfortunately, we had a curfew and the party was just getting started when we had to go.”
By Kandahar standards, the MSF compound, which includes both office and living quarters, is more than comfortable. There’s cold running water, a fridge with a few cans of Heineken, some maple syrup for the Canadians. The television gets CNN and the BBC, and there’s a video-disc player to screen pirated movies purchased in Pakistan. There’s a CD player, too, though music is still hard to find in Afghanistan. (“You can get CDs in Herat now,” says Hernan del Valle. “It’s the first stage of reconstruction. The second stage is McDonald’s. After that comes health care.”) An old man even tends a small garden, where Ohlson hopes to plant some vegetables to enliven the menu. The withered pomegranate trees don’t inspire confidence, but locals boast that Kandahar still produces grapes “sweet enough to make men cry.”
On this day, Ohlson says, the team is worried about a doctor and a nurse coming to Kandahar from the MSF project in Chaman, Pakistan, about two hours to the southeast. Part of a notorious smuggling route that stretches from Iran to India, the road from the Pakistani border to Kandahar may be the most dangerous in Afghanistan. Not long ago, it wasn’t unusual to encounter dozens of checkpoints along the 60-mile road, each manned by Kalashnikov-toting warlords demanding a toll. These days it’s more likely to be patrolled by American soldiers flushing out the Taliban, many members of which have escaped to Pakistan, but who return occasionally to stir up trouble, and this is their favorite route. Less than three weeks ago, US aircraft attacked an area nearby, killing 24 Taliban fighters. With Afghanistan’s independence-day celebrations coming next week, Ohlson is worried there may be another incident.
While the MSF medical team travels in a clearly marked Land Cruiser, red crosses and other humanitarian logos no longer offer protection in this region. In fact, NGOs may as well paint targets on their vehicles these days. In Chaman, the MSF team travels in unmarked vans and flies no flag over its compound. No aid worker had been killed in Afghanistan since 1998, but everything changed on March 27, 2003, when Ricardo Munguía, a Salvadoran water engineer with the International Committee of the Red Cross, was stopped with his convoy by armed Taliban in Uruzgan province. According to a witness, the gunmen first poured gasoline on the vehicles and set them alight. Then they called their mullah on a satellite phone to ask for instructions. The reply: “Kill the foreigner.” The gunmen pumped 20 bullets into Munguía. (To add a cruelly ironic twist, the mullah who ordered Munguía’s execution uses an artificial leg provided by the Red Cross.) The compound where Munguía lived is a two-minute drive from the MSF house, and the team often goes there for a party or a dip in what might be the only decent swimming pool in Kandahar.
Several more attacks on aid workers followed. On the very day Ohlson described his security concerns, two members of the Afghan Red Crescent Society were shot by gunmen who fled on motorcycles — a Taliban trademark — in Ghazni province to the north. Three weeks later, five workers with the Danish Committee for Aid to Afghan Refugees were stopped by nine armed men, dragged from their vehicle and tied up. The attackers berated the men for working with an aid organization, then murdered four of them; the fifth miraculously survived. “It’s a difficult situation to be in,” says Ohlson. “You have to be constantly alert to what is happening in your area and spend lots of time drinking chai with different people, who become part of your security network. There is a great deal of uncertainty, and you don’t know what tomorrow will bring.”
It’s little wonder that the MSF compound has a bunker, complete with food, bottled water, a small stove, a VHF radio connection and a satellite phone. David Croft, the logistician on the Kandahar project, is even planning an improvement. “I’m thinking of putting a pickax in there so we can tunnel out if the shit really hits the fan.” He and van Gijssel got to try out the bunker just days after arriving. “It was quite good fun in hindsight,” Croft says, “though at the time it was a bit scary. Bertien and I showed up in this project and were greeted by just the national staff, who’d been holding it together for three months when the previous expats had been pulled out. Usually you go into a project and you’ve got three or four expats who take you under their wing. Well, Bertien is second mission and I’m first mission, both of us new to Afghanistan, and neither of us had a clue what was going on. We had a ball when we first came here and didn’t really see the big issue about security. We respected it, but we hadn’t seen anything yet. Then one day I was sitting in the administration office and a bomb went off down the road at an NGO house — a small grenade or something was thrown over the fence. That was all very exciting.”
The next night, it got even more exciting. “We were up in the office doing some e-mailing and bang — something went off with such a blast. I’ve traveled in a lot of dodgy countries before and I’ve heard explosions, but nothing that big, that close. It didn’t blow any windows out, which was surprising because these windows are about as strong as wet cornflakes. Bertien was already down the steps on her way to the bunker. I dove for the switches and started turning off lights, because I’d seen in a movie once where someone did that. I was just running around, not sure what the hell I was doing. We were totally unprepared, no shoes on, nothing. I got the computer and the mini-M [satellite phone] and jumped into the bunker. We phoned the country management team in Herat and they were quite cool, they really calmed us down. Then we smoked a dozen cigarettes each, and it was all pretty good.”
Eventually the whole story emerged. The blast turned out to be from an old Chinese-made 107-mm rocket that had misfired — only the fuel exploded, not the business end. Croft believes it was ignited by someone trying to send a warning to the governor, who lives a stone’s throw from the MSF house. “So that whole big blast that showered gravel and sand into our compound two doors down was actually nothing more than the fuel going off. I’d hate to see the warhead.”
On October 4, 2003, the attacks came to the doorstep of the Zhare Dasht basic health unit. Four armed men, most likely Taliban, entered the outskirts of the camp and rounded up six members of a mine-clearing NGO. They were about to execute them on the spot when one of the agency’s drivers started his truck and tried to escape. The gunmen, distracted from their task, turned to shoot at the vehicle, and the deminers ran for their lives. They all managed to escape, though one was shot in the leg. The MSF driver heard the shooting and grabbed the radio to warn other vehicles to stay away. “Kathleen and I were almost in the camp at the moment it happened,” van Gijssel remembers, “and we had to turn back without any information — that was quite frightening. We had only heard that there was a car coming toward us, and they said, ‘You have to leave, it’s not safe, there’s shooting, the Taliban is here.’ There is only one road in and out of the camp, so you just have to hope that nothing is going to happen.”
After the incident, MSF had no choice but to stop its work at Zhare Dasht. “Suspending medical activities is, of course, always a very difficult decision to make,” says Ohlson. “In this case, ten thousand families in the camp depend on the health care, and more than two hundred people visit the clinics every day.” While the expats stayed in Kandahar, local staff, some of whom live in the camp, set up a triage and ambulance system. “They worked really hard for long hours, treating some of the people and sending the seriously ill ones to the hospital or a clinic closer to the city. We had seven minivans shuttling back and forth.”
Within two weeks, Ohlson convinced the governor to provide more checkpoints around the camp and the team returned. By December, however, the situation had deteriorated further, and MSF once again withdrew to Kandahar and confined its work to Mir Wais Hospital.
It was in the northwestern province of Badghis, ironically one of the safer places in Afghanistan, that MSF’s luck ran out on June 2, 2004. A Land Cruiser carrying five staff was ambushed by gunmen, believed to be Taliban fighters. Whether words were exchanged or warning was given, no one is ever likely to know, as the team never checked in by radio after setting off around 3 p.m. Later that afternoon the car was discovered — it had been shredded by gunfire, and shrapnel indicated a grenade had exploded. It was a heinous murder of five unarmed aid workers: Belgian project coordinator Hélène de Beir, Dutch logistician Willem Kwint, Norwegian doctor Egil Tynaes, their Afghan translator Fasil Ahmad and their driver Besmillah. Just weeks before the slaying, while de Beir was taking a break in Italy, she told a friend, “I am exhausted, physically and emotionally.” The friend asked why she was going back. “Because I have to,” the 30-year-old replied. “It’s what makes me happy.”
The next day, MSF suspended its work in Afghanistan. The murderers have never been identified, and during the next five years the organization had no choice but to watch from the sidelines as the health of the country deteriorated. MSF teams continued to work in northwestern Pakistan, operating an ambulance service for victims of the tribal fighting in the Taliban-controlled region. February 1, 2009, was supposed to be a day off for ambulance workers Riaz Ahmad and Nasar Ali, but when they heard that dozens of civilians had been killed in clashes that day, they arrived in the town of Mingora to take a shift in the ambulance. They drove about 12 miles north to Charbagh, the center of the violence, and although their vehicle was clearly marked, they were fired on, and Ahmad and Ali were killed. As result, MSF was forced to leave Pakistan, too.
The group made a tentative return to Afghanistan in October 2009, opening a project at Ahmed Shah Baba, a hospital between Kabul and Jalalabad where MSF had worked before their withdrawal from the country. Some 300 miles to the southeast, thousands of Afghans were still living in the camps for displaced people on both sides of the border with Pakistan. Their medical needs were as great as ever, perhaps more so, but there were no MSF teams in the yellow desert.