Afghanistan's Long Road To Recovery: Navigating A War-Torn Nation's Past And Future

Afghanistan has been ravaged by war for over four decades. The country has been the site of numerous conflicts, including the Soviet-Afghan War, the Afghan Civil War, and the US-led Afghanistan War. The Soviet invasion of Afghanistan in 1979 marked a significant event in the Cold War, as it was the only time the Soviet Union invaded a country outside the Eastern Bloc. This intervention sought to suppress the Afghan Civil War and establish a socialist government aligned with Moscow.

The US-led Afghanistan War, which began in 2001, resulted in the deaths of an estimated minimum of 160,000 people and lasted nearly two decades. During this period, the US and its allies ousted the Taliban from power, but the country continued to face challenges in establishing a stable and secure environment. The conflict in Afghanistan has led to a dire humanitarian crisis, with 95% of families facing acute food insecurity and a lack of essential health facilities, medications, and vaccinations. The impact of these conflicts has been devastating, with millions of Afghans displaced and seeking refuge in neighbouring countries.

The impact on cancer care and the healthcare system

Afghanistan has been a hotspot for military conflict for four decades, and the resultant political turmoil has had a devastating impact on the healthcare sector, leading to an ongoing humanitarian crisis. The country's healthcare system is on the brink of collapse, with 95% of families suffering from acute food insecurity and a severe scarcity of essential health facilities, medications, and vaccinations. The lack of a cancer care infrastructure has meant that many Afghans seek treatment in neighbouring countries like Pakistan.

The conflict in Afghanistan has impaired the development of its health infrastructure, and the displacement of millions has placed a substantial burden on host countries' healthcare systems. A significant proportion of Afghan patients present with advanced cancers, which are significantly cheaper and easier to treat if detected early.

It is imperative that all stakeholders invest in developing a robust national cancer screening and awareness programme, which is currently lacking in Afghanistan. Funding cancer care for refugees has historically been neglected, with resources and funding directed towards more acute treatments. The funding deficit is compounded by the misconception that all types of cancer have poor prognoses.

Several commentators have advocated using national cancer registries to achieve better surveillance and allow forecasting of crises so that aid from international organisations can be requested beforehand. Public awareness, including information on when and where to seek help, should be made available to help detect and treat early-stage cancer, which is less costly and carries a better prognosis.

In addition to increasing funding for secondary and tertiary care, primary prevention and cancer surveillance strategies incorporating mobile health clinics and civil society organisations should be considered. Afghanistan can also benefit from initiatives aimed at improving cancer control in the Muslim world, such as the Programme of Action for Cancer Therapy, a collaborative effort between the International Atomic Energy Agency, the Organisation of Islamic Cooperation, and the Islamic Development Bank.

Over forty years of conflict has decimated Afghanistan's health infrastructure, and there is minimal data on the burden of disease or resource allocation in the country. The lack of a cancer surveillance programme, the cost of treatment, and the lack of knowledge about cancer treatments lead to significant delays in patients seeking medical attention and presenting with advanced disease. The situation is exacerbated by ongoing conflict and insecurity, financial hardship, and limited access to follow-up or definitive treatment.

The rise of the Taliban and its consequences

Afghanistan has been ravaged by war for decades, with the country suffering from conflict since the Soviet invasion in 1979. The Taliban, a predominantly Pashtun Islamic fundamentalist group, rose to power in the early 1990s, promising to impose stability and rule of law after years of conflict between rival mujahideen groups.

The Taliban's first stint in power lasted from 1996 to 2001, during which they imposed a harsh interpretation of Islamic law, or Sharia. They banned women from working and receiving an education, and enforced strict rules on dress and behaviour, including requiring women to wear the head-to-toe burqa and banning music and television. The Taliban also committed massacres and conducted a policy of scorched earth, burning vast areas of fertile land and destroying homes.

The Taliban's first stint in power ended in 2001, when they were overthrown by US-led forces following the 9/11 attacks. However, the Taliban regrouped and waged an insurgency against the US-backed government in Kabul. In 2021, the Taliban returned to power, nearly 20 years after their initial ouster.

Since retaking power, the Taliban have imposed harsh restrictions on women and girls, limiting their access to education and employment and restricting their freedom of movement. The Taliban have also cracked down on press freedoms, restricted freedom of expression, and committed human rights abuses, including public executions and corporal punishment.

The Taliban's rule has had devastating consequences for Afghanistan's economy, which was already weak before they took power. The country has experienced mass unemployment, a collapse of the housing market, and increased rates of malnutrition. The Taliban's takeover has also disrupted the delivery of humanitarian aid, exacerbating the humanitarian crisis in the country.

The Taliban's return to power has also raised concerns about the group's ties to terrorist organisations, particularly al-Qaeda. The Taliban provided a safe haven for al-Qaeda before their initial ouster in 2001, and there are fears that they could once again provide a base for terrorist groups to launch international attacks.

The Soviet invasion and its aftermath

The Soviet invasion of Afghanistan began on Christmas Eve 1979, with the Soviets air-dropping elite troops into principal Afghan cities and taking control of Kabul and large portions of the country. The invasion was triggered by the internal power struggle within the Afghan communist government, which had overthrown the centrist government of President Mohammed Daoud Khan in 1978. The new government, led by the Marxist-Leninist People’s Democratic Party of Afghanistan (PDPA), was divided into two factions—the People’s (Khalq) Party and the Banner (Parcham) Party—and lacked popular support. The PDPA government's extensive land and social reforms were bitterly opposed by the devoutly Muslim and anti-communist population, leading to insurgencies among both tribal and urban groups, collectively known as the mujahideen. The Soviets invaded Afghanistan to prop up the faltering PDPA government, now headed by Babrak Karmal of the Parcham faction, and to prevent the country from turning to the United States for help.

The Soviet invasion triggered a brutal nine-year civil war in Afghanistan. The Soviets dealt harshly with the mujahideen rebels, levelling villages and using aerial bombing to deny them safe havens. The mujahideen employed guerrilla tactics, attacking and then disappearing into the mountains. They were supported by various foreign powers, including the United States, Pakistan, China, Iran, and the Arab states of the Persian Gulf, making the war a proxy conflict between the US and the Soviet Union. The war resulted in massive casualties, with an estimated one million civilians killed, along with 90,000 mujahideen fighters, 18,000 Afghan troops, and 14,500-15,000 Soviet soldiers. Millions more Afghans fled the country as refugees.

The war in Afghanistan became a quagmire for the Soviet Union, causing significant financial and reputational damage and contributing to its eventual collapse. The Soviets struggled to suppress the mujahideen rebellion, which was able to neutralize Soviet air power with US-supplied Stinger missiles. By the mid-1980s, the Soviet military presence had increased to around 100,000-115,000 troops, but they were unable to defeat the mujahideen. In 1988, the Soviet leader Mikhail Gorbachev announced the withdrawal of Soviet troops, which was completed on February 15, 1989. Afghanistan returned to a non-aligned status, but the civil war continued, leading to the rise of the Taliban and the establishment of an Islamic fundamentalist regime.

The impact of foreign military intervention

Afghanistan has been a hotspot for military conflict for over four decades. The country has been subjected to foreign military intervention by the Soviet Union and the United States, which have had a detrimental impact on the country.

The Soviet invasion of Afghanistan began in December 1979, when the Soviet Union sent thousands of troops to assume military and political control of Kabul and large portions of the country. This marked the only time the Soviet Union invaded a country outside the Eastern Bloc and was met with worldwide condemnation. The invasion was an attempt by Moscow to subdue the Afghan civil war and maintain a friendly and socialist government on its border.

The United States responded to the Soviet invasion by supplying non-lethal aid to Afghan mujahideen, or Islamic insurgents. The conflict escalated into a brutal, decade-long war that resulted in millions of deaths and billions of dollars spent. The Soviet Union eventually withdrew in 1989, leaving behind a shattered country that eventually fell under the control of the Taliban, an Islamic fundamentalist group.

Following the September 11, 2001, terrorist attacks on the United States, the US military, with British support, invaded Afghanistan in pursuit of the War on Terror. This foreign military intervention ousted the Taliban regime, which had harbored al-Qaeda leaders accused of planning the attacks. The invasion was justified under the "Just War" theory, which states that there must be a just cause for war and that it should be declared by a legitimate authority.

The US-led invasion of Afghanistan resulted in significant civilian casualties and collateral damage. Drone strikes and targeted killings by US forces led to thousands of civilian deaths and fueled support for the Taliban. The intervention also had limited success in achieving its stated goals, as al-Qaeda and the Taliban continued to pose a significant threat.

In 2020, the United States signed an agreement with the Taliban to withdraw its troops from Afghanistan by May 2021. However, the Taliban swiftly regained control of the country, leading to a humanitarian and military crisis. The US withdrawal was criticized for abandoning Afghan allies and failing to follow established evacuation procedures.

The human cost of war, including refugee crises and casualties

The human cost of the war in Afghanistan has been devastating, with a significant impact on the lives of civilians. The conflict has resulted in a massive loss of life, widespread displacement, and a range of social, economic, and health issues.

Since 2001, about 243,000 people have been killed in the Afghanistan-Pakistan war zone, with civilian deaths accounting for more than 70,000 of those killed. The number of civilians killed by US-led airstrikes in Afghanistan increased by 330% from the last year of the Obama administration to the last full year of recorded data under the Trump administration. Additionally, the war has left at least half of Afghanistan's population living in poverty, with 92% facing food insecurity and 3 million children at risk of acute malnutrition. The war has also taken an invisible toll, with two-thirds of Afghans suffering from mental health issues, according to a 2009 report by the Afghan Ministry of Public Health.

The war in Afghanistan has also contributed to the global refugee crisis. Afghanistan is among the top five countries with the most refugees, with an estimated 2.7 million people forced to flee the country to Iran, Pakistan, or Europe. This has placed a strain on the resources of host countries and communities. The total number of refugees and internally displaced persons from the US-led post-9/11 wars in Afghanistan and other countries is estimated to be between 48 and 59 million.

The impact of the war extends beyond those who have been directly displaced. Those who remain in Afghanistan continue to face insecurity, lack of access to food, healthcare, housing, employment, and clean water and sanitation. As of March 2022, there were approximately 4 million internally displaced people in Afghanistan, with almost 60% being children under 18. These internally displaced persons experience malnutrition, mental health challenges, and lack of access to healthcare, leading to high maternal and infant mortality rates.

The war has also contaminated Afghan land with unexploded ordnance and landmines, which continue to kill and injure civilians, especially children, long after the fighting has ended.

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