[Before the militants took over in August, foreign donors — largely wealthy Western countries led by the United States — paid for up to 80 percent of all Afghan government expenses. Since then, donors have frozen all funding, as leverage to press the Taliban to meet demands including rights for women, girls and minorities, an inclusive government, and freedom from reprisals and of movement.]
By Susannah George
and Karen
DeYoung
When critical supplies such as
saline solution and dressings ran out, many patients were turned away and told
they would have to purchase such materials themselves.
“It was terrible,” hospital
director Sharifa Noor said of the first time in her 17 years working here that
she had to tell patients she was unable to care for them.
Early this month, a United Nations program gave the hospital a
reprieve, with an influx of supplies and, equally important, cash to pay
the salaries of its staff for the first time in months. Doctors working under
Noor received about $150.
The lifeline was temporary, part of
an experiment cobbled together by U.N. agencies with outside funds to prove to
the international community that money could be distributed in Afghanistan
without falling into the hands of the Taliban.
Before the militants took over in
August, foreign donors — largely wealthy Western countries led by the United
States — paid for up to 80 percent of all Afghan government expenses. Since
then, donors have frozen all funding, as leverage to press the Taliban to meet
demands including rights for women, girls and minorities, an inclusive
government, and freedom from reprisals and of movement.
The Biden administration and allied
governments are debating whether the experimental U.N. program — which targeted
only a portion of Afghanistan’s health-care system — or similar initiatives can
be expanded into other parts of the economy.
“We are also deeply concerned by
the ongoing liquidity shortage, inflation and other economic factors,” Jeffrey
De Laurentis, deputy U.S. ambassador to the United Nations told the U.N.
Security Council last week. “We welcome creative solutions from the
international community to help mitigate” these problems “in a way that limits
undue benefits to the Taliban and sanctioned individuals.”
None of the discussions so far
involves releasing about $10 billion in Afghan government reserves, held
primarily in the United States.
The largest single pot of foreign
money is held by the World Bank’s Afghanistan Reconstruction Trust Fund, whose
cash balance at the end of September stood at more than $1.5 billion. In the
past, it has funded programs as diverse as providing grants for small businesses,
supplying farmers with seeds and financing for short-term agricultural labor,
and building and improving roads and irrigation systems.
Its distributions have now been
frozen by the bank’s member states, none of which recognizes the Taliban
government. The hope at the United Nations is that at least some of those funds
can be released into a new U.N.-administered fund that would go beyond
humanitarian food and medicine aid to Afghanistan to maintain basic services
and pay salaries and wages. The fund is also asking countries with bilateral
development aid programs in Afghanistan to repurpose that money — now also
frozen — and come up with new donations.
Bank voting members are expected to
meet next week to discuss the terms for allowing the release of some funds
while ensuring that their demands are addressed — particularly on girls’ education — and
adequate monitoring is in place.
But international humanitarian and
development agencies are insisting, in increasingly dire terms, that time is
running out and the lives of millions are at risk.
With virtually no money
circulating, the United Nations, the International Committee of the Red Cross
and other major aid operators have warned that more than half of Afghanistan’s
population of 40 million is well on its way to “acute food insufficiency,”
their term for starvation.
“You really have to go there and
meet with people inside Afghanistan . . . to understand the depths of this
crisis,” said Jan Egeland, secretary general of the Norwegian Refugee Council,
one of the largest nongovernmental aid agencies still operating on the ground.
During a recent visit to the
country, Egeland said in an interview, “I asked mothers in tents — how are you
treated now? Are you discriminated against? Are your children in school?”
“They just stared at me and said
‘We have only one concern — not to freeze and starve to death this winter.’”
The absence of cash flow extends
into virtually every part of the Afghan economy.
The public sector “is not first and
foremost bureaucrats,” Egeland said. “There are also 300,000 teachers,
thousands of health workers, water engineers, garbage collectors, electricity
grid engineers,” all of whom are public employees who are not being paid.
International organizations charged
with administering programs and providing services on the ground say they agree
the Taliban must be held to their own pledges.
“But even if the Taliban in all
corners of the country said yes to all our demands tomorrow,” Egeland said,
“the crisis would be so deep that too many people will perish this winter
unless there is a real change in policy from the Western countries on these
fundamental issues” affecting a functioning economy.
[Across
Kabul, evidence of Afghanistan’s fast-unraveling economy under the Taliban is
everywhere]
With Washington immersed in
political arguments over responsibility for the Taliban takeover, the chaos of
the U.S. withdrawal in August, and ongoing efforts to evacuate U.S. citizens
and at-risk Afghans, the internal collapse has drawn little notice.
“Members of the international
community have focused understandably on helping those Afghans who want to
leave,” Deborah Lyons, the U.N.’s special representative for Afghanistan, told
the U.N. Security Council earlier this month. “But our attention must now turn
to the vastly greater number of Afghans who remain in the country but face in
the short term a most dire future.”
Afghanistan’s gross domestic
product has already contracted 40 percent and fuel and food prices have
skyrocketed. “Cash is severely limited. Traders cannot get credit,” and Afghans
“can’t access their savings,” Lyons said. “An entire complex social and
economic system,” including substantial public works the international
community paid for in the first place “is shutting down,” she said, primarily
because financial sanctions “have paralyzed the banking system.”
Dominik Stillhart, operations
director the International Committee of the Red Cross, said that with little to
no banking services available in Afghanistan, and sanctions largely prohibiting
the entry of dollars into the country, organizations such as his have
increasingly turned to informal systems, including hawala, in which money is
deposited, usually in dollars, and then doled out in local currency, for a fee,
by traders in Afghanistan.
The world has stepped up donations
for direct humanitarian aid, almost completely funding a $606 million U.N.
emergency fund to pay for food, medicine and shelter materials trucked and
flown into the country.
But while “humanitarian aid is part
of the solution,” Stillhart said, “it was never meant to replace a functioning
economy and public service delivery”
The health-care payment program
spearheaded by the U.N. Development Program — which oversees and supports a
network of 25,000 health-care workers in 2,200 primary-care clinics and small
hospitals around the country — proved that money could flow into Afghanistan,
Kanni Wignaraja, assistant UNDP administrator and regional director for Asia
and the Pacific, said during a visit to Kabul this month.
The program used one of the few
commercial banks still open to send direct payments to health-care workers via
cellphones — and delivered cash in person to those with no phone or account.
Lists of workers every sector supported by international payments through the
previous government remain intact and could be used to expand the experiment to
teachers and other public sector employees, Wignaraja said.
“It’s clear that we have to avoid
money going in through the de facto authorities. They know that. We know that.
It can be managed,” she said. “These are the basic things that we take for
granted . . . schools, basic health clinics,
the electricity grid, sanitation. These are not projects. These are nationwide
systems.”
The health-care distributions were
“all done under this very short time frame,” during October and November, “but
it showed end to end it works,” Wignaraja said, noting that the Taliban did not
interfere.
While the UNDP program covered
small clinics — some of which had already shut down — larger hospitals in Afghanistan are
funded through the ICRC, which was not part of the UNDP experiment. Among them
is Jumhuriat Hospital, one of the biggest in Kabul.
There, director Mohammadullah
Alishungi said this week that if he cannot start paying salaries in the next
month, he may lose up to half his employees by the end of the year. “Without
staff, we cannot function,” he said, estimated that roughly 30 have already
left, many fleeing the country.
Marghlai Muhammadi, a nurse in the
hospital’s emergency room, spoke with passion of her work. But with no income,
she said, she will be forced to leave in the coming weeks and find a way to
support her family.
Compounding the problem, as
supplies run low and doctors and nurses look to flee, large hospitals in cities
like Kabul are seeing spikes in patients as health-care and other systems
collapse around the country and Afghans travel long distances for treatment.
“We receive more and more people in
very critical conditions,” Mohibullah Barakzai, the emergency room’s chief
doctor said. But “by the time they get here, we can’t help them.”
DeYoung reported from Washington.