setting the right priorities protecting children affected by armed conflict in afghanistan -...
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June 2010
Setting theRight Priorities:
Protecting Children Aectedby Armed Conict in Afghanistan
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Watchlist Mission StatementThe Watchlist on Children and Armed Conict strives to end violations against children in armed conicts
and to guarantee their rights. As a global network, Watchlist builds partnerships among local, national
and international nongovernmental organizations, enhancing mutual capacities and strengths. Working
together, we strategically collect and disseminate information on violations against children in conicts
in order to inuence key decision makers to create and implement programs and policies that eectively
protect children.
Watchlist works within the framework of the provisions adopted in UN Security Council Resolutions 1261,
1314, 1379, 1460, 1539, 1612, 1882, the principles of the Convention on the Rights of the Child and its
protocols and other internationally adopted human rights and humanitarian standards.
General supervision of Watchlist is provided by a Steering Committee of international nongovernmental
organizations known for their work with children and human rights. The views presented in this report
do not represent the views of any one organization in the network or the Steering Committee.
For further information about Watchlist or specic reports, or to share information about children in a
particular conict situation, please contact:
www.watchlist.org
Photo Credits
Cover Photo: Mats Lignell/Save the Children
Please Note: The people represented in the photos in this report are not necessarily themselves victims
or survivors of human rights violations or other abuses.
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Setting the Right Priorities: Protecting Children Aected by Armed Conict in Afghanistan
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Notes on Methodology. InormationcontainedinthisreportiscurrentthroughMarch1,2010.. Thisreportprimarilyrefectsinormationdrawnromsecondarysourcesavailableinthepublic
domain.Inormationiscollectedthroughanextensivenetworkoorganizationsthatworkwith
childrenaroundtheworld.Analysisisprovidedbyamultidisciplinaryteamopeoplewithexpertiseand/orexperienceintheparticularcontext.Somesourcesarecondentialandarenotlistedto
protecttheirsaety.Whencitingthisreport,inormationshouldbeattributedtotheoriginalsource
totheextentpossible.
. Duetoinsecurityandaccessrestrictions,thereislimitedinormationonthehumanrightsandhumanitariansituationintheareasoongoingarmedconfict.
. ThereportdealsmainlywithAghanistanbutmanyotheprotectionconcernsareinactoccurringalongtheAghanistan-Pakistanborderanddemandacross-borderorregionalapproach.Inormation
onthesecross-borderconcernsislimitedduetoaccessrestrictions.
Notes on Terminology
. ThereportollowstheUNdenitionoeightregionsinAghanistan:centralhighlands,eastern,southeastern,southern,western,northern,andnortheastern,andthecapitalregionaroundKabul.
. AghanistanusesthePersiancalendarwhosedatesdonotcorrespondtotheGregoriancalendar,theinternationallyacceptedcivilcalendar.ThisreportusestheGregoriancalendardatesandalso
includesthePersiancalendardatesitheywereprovidedintheoriginalsourcepublication,e.g.1387
(2008-2009).
. AghanSecurityForcescomprisethearmy,thearmyaircorpsandthenationalpolice.Important Updates
. OnMarch22,2010,theUNSecurityCouncil,initsResolution1917,extendedthemandateothe
UnitedNationsAssistanceMissioninAghanistan(UNAMA)oroneyearthroughMarch23,2011.The
newmandaterepeatedtheCouncilscallortheimplementationoSecurityCouncilResolutions(SCR)
1612(2005)andSCR1882(2009)onchildrenandarmedconfictanditsrequesttotheSecretary-
GeneraltourtherstrengthenthechildprotectioncomponentoUNAMA,inparticularthroughthe
appointmentochildprotectionadvisors.
. TheMarjahoensive,ajointAghan-NATOmilitaryoperationthattookplaceinFebruary2010,wasintendedtoserveasatestingcaseorNATOsnewstrategytoocusonprotectingciviliansin
counterinsurgencyeorts.Despitetheseeorts,TheAghanRedCrescentSociety(ARCS)estimated
that35 civilianshaddiedandanadditional37wereinjuredduringthemilitaryoperation.Surveys
among400menromMarjah,LashkarGahandKandaharalsoindicatethattheoensivenegatively
impactedlocalperceptionsoNATOorces,accordingtotheInternationalCouncilonSecurityand
Development(ICOS).
. WatchlistreportnotesthattherehadbeenareductionociviliancasualtiesbyinternationalmilitaryorcesinAghanistanrom2008to2009.OnMay12,2010,theU.S.DepartmentoDeense
announcedthatthenumberocivilianskilledbyU.S.andNATOorceshadincreasedby76percent
(to90reportedciviliandeaths)romJanuarytoApril2010comparedtothesameperiodin2009
(51deaths).TheU.S.governmentattributesthisrisetothestepped-upeortsinthewaragainstthe
Taliban,accordingtoReuters,CiviliansCasualtiesRisinginAghanistan,May12,2010.TheU.S.
DepartmentoDeensedidnotcommentonthepercentageochildrenkilledbyinternational
militaryorces.
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Table of ContentsList of Acronyms ............................................................................................. 1
Indicators ........................................................................................................ 3
International Standards ................................................................................. 4
Executive Summary ........................................................................................ 5
Context ............................................................................................................ 8
Major Armed Conicts...................................................................................................8
International Eorts for Peace and Security ............................................................ 8
The Return to Violence................................................................................................... 8
Rebuilding the Country ................................................................................................. 9
Humanitarian Access .................................................................................... 11
Deterioration of Humanitarian Access....................................................................11
Violating Humanitarian Principles ...........................................................................11
Killing and Maiming ..................................................................................... 13
Military and Other Attacks .........................................................................................13
Assistance to Survivors and Impunity for Perpetrators .......................................13
Children Living with Disabilities ...............................................................................14
Refugees and IDPs ........................................................................................ 16
Internally Displaced Persons ......................................................................................16
Refugees ..........................................................................................................................16
Health ............................................................................................................ 19
Access to Services..........................................................................................................19
Maternal Death and Reproductive Health .............................................................20
Infectious Diseases .......................................................................................................20
Malnutrition ...................................................................................................................21
Water and Sanitation ..................................................................................................21
Drug Addiction ..............................................................................................................21
Psycho-Social Disorders ..............................................................................................21
HIV/AIDS ........................................................................................................ 23
The Spread of HIV/AIDS ...............................................................................................23
Treatment and Care .....................................................................................................23
Education ...................................................................................................... 24
School Enrollment and Attendance .........................................................................24
Monitoring and Reporting on Attacks ....................................................................24
Attacks against Schools, School Children and Teachers .....................................24
Protecting Schools from Attacks ...............................................................................25
Conict-Related Barriers to Education ....................................................................25
Abduction ..................................................................................................... 28
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Gender-Based Violence ................................................................................ 29
Prevalence of Gender-Based Violence .....................................................................29
Silence and Impunity ...................................................................................................29
Lack of Services for GBV Survivors ............................................................................29
Child Soldiers ................................................................................................ 32
Recruitment by Afghan Security Forces ..................................................................32
Recruitment by Private and Auxiliary Forces .........................................................32
Recruitment by the Taliban and Other Armed Opposition Groups ..................32
Disarmament, Demobilization and Reintegration for Children .......................33
Detention of Children Formerly Associated with Armed Groups ......................33
Small Arms .................................................................................................... 35
Scope of the Problem ...................................................................................................35
Disarmament Eorts ...................................................................................................35
Landmines and Explosive Remnants of War .............................................. 37
Scale of Contamination and Impacts ......................................................................37
Demining and Mine Risk Education .........................................................................37
Other Violations and Vulnerabilities ........................... .............................. .. 39
Child Labor .....................................................................................................................39
Exploitation and Tracking ......................................................................................39
Illegal and Arbitrary Arrest of Children....................................................................40
UN Security Council Actions ........................................................................ 41
UNSC Resolutions on Children and Armed Conict .............................................41
UNSC Actions on Afghanistan ...................................................................................41
Implementation of UNSC Resolutions on Children
and Armed Conict in Afghanistan .........................................................................41
The UN Security Council Working Group on CAC .................................................42
Endnotes ....................................................................................................... 45
Sources .......................................................................................................... 50
Map of Afghanistan ...................................................................................... 53
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List of AcronymsAI AmnestyInternational
ACBAR AgencyCoordinatingBodyorAghanRelie
AIHRC AghanIndependentHumanRightsCommission
ANDS AghanistanNationalDevelopmentStrategy
ANSO AghanistanNGOSaetyOceAREU AghanistanResearchandEvaluationUnit
ARV AntiretroviralTreatment
BPHS BasicPackagesoHealthServices
CAC ChildrenandArmedConfict
CAAC ChildrenaectedbyArmedConfict
CEDAW UNCommitteeontheEliminationoDiscriminationAgainstWomen
CIVIC CampaignorInnocentVictimsinConfict
CPA ChildProtectionAdvisor
CPAN ChildProtectionActionNetwork
CTFMRM CountryTaskForceontheMonitoringandReportingMechanism
DIAG DisbandmentoIllegalArmedGroup
ERW ExplosiveRemnantsoWar
FATA FederallyAdministeredTribalAreasFRU FamilyResponseUnit
GBV Gender-BasedViolence
GOA GovernmentoAghanistan
HAP HumanitarianActionPlanorAghanistan
HRW HumanRightsWatch
ICG InternationalCrisisGroup
ICRC InternationalCommitteeotheRedCross
IDMC InternalDisplacementMonitoringCentre
IDPs InternallyDisplacedPersons
IEC IndependentElectionCommission
IED ImprovisedExplosiveDevice
ILO InternationalLabourOrganization
INGO InternationalNongovernmentalOrganization
ISAF InternationalSecurityAssistanceForce
MACCA MineActionCoordinationCentreoAghanistan
MoU MemorandumoUnderstanding
MRE MineRiskEducation
MRM MonitoringandReportingMechanism
MSF MdecinsSansFrontires
NATO NorthAtlanticTreatyOrganization
NDS NationalDirectorateorSecurity
NGO NongovernmentalOrganization
NLD NationalLeagueorDemocracy
NSAG Non-StateArmedGroups
NWFP NorthWestFrontierProvince
OCHA UNOceortheCoordinationoHumanitarianAairs
OEF OperationEnduringFreedom
OHCHR OceotheHighCommissionerorHumanRights
PRT ProvincialReconstructionTeams
RI ReugeesInternational
SCR UNSecurityCouncilResolution
SCWG-CAC UNSecurityCouncilWorkingGrouponChildrenandArmedConfict
SOP StandardOperatingProcedure
SRSG SpecialRepresentativeotheSecretary-General
SRSG-CAC SpecialRepresentativeonChildrenandArmedConfict
UN UnitedNations
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UNAMA UNAssistanceMissioninAghanistan
UNDP UNDevelopmentProgramme
UNDSS UNDepartmentoSaetyandSecurity
UNHCR UNHighCommissionerorReugees
UNICEF UNChildrensFund
UNIFEM UNDevelopmentFundorWomen
UNODC UNOceonDrugsandCrime
UNSC UNSecurityCouncil
USDA UnionSolidarityandDevelopmentAssociation
USFOR-A U.S.ForcesAghanistan
USDOS U.S.DepartmentoState
UXO UnexplodedOrdnance
WHO WorldHealthOrganization
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IndicatorsINDICATORS Afghanistan
Population 23.8millionpeoplein2005;1aso2008,46.5%wereyoungerthan142
Gross National Income (GNI)
per Capita
US$466in2008(UNStatisticsDivision)
Refugees and Internally
Displaced Persons (IDPs)
AsotheendoDecember2009,anestimated297,000IDPsinAghanistan,
including161,000children
AsoJanuary2010,approximately1.6millionregisteredreugeesinPakistan,including
about1.18millionchildren,andapproximately1millionregisteredreugeesinIran,
including345,000children 3
Infant Mortality 165/1,000in20084
HIV/AIDS AghanistansNationalAIDSControlProgramregistered559casesasoNovember2009;
UNAIDSandWHOputthenumberoreportedcasesmuchhigherat1,000to2,000.5
Education Estimated74%nationalnetenrollmentrateorboysand46%orgirls6;only11%oboys
and5%ogirlsenrolledinprimaryschoolcontinueontograde12.7
Gender-Based Violence (GBV) Rapeisawidespreadphenomenonthataectswomen,boysandgirls.Actsosexual
violencearecommittedbyarmedgroupsorcriminalgangsaswellasamilymembers,guardiansorcaretakers.Asaresultothetaboosurroundingtheissue,thereareew
publiclyreportedcasesandnocomprehensiveorocialdataavailableonrapeand
gender-basedviolence. 8
Childmarriageisalsocommon,withnearlyhaloallmarriagesinvolvingboysandgirls
undertheageo18.9
Tracking TrackingochildrenwithinthecountryandintoPakistanandIranisaseriousconcern;
somechildrenareexploitedbyarmedgroupsorcriminalgangstocarryoutillegalactivities
suchassmuggling.10
Landmines and Explosive
Remnants of War (ERW)
AsoDecember2009,therewere630km 2omine-aectedland;734recordedinstanceso
childreninjuredorkilledbylandminesandotherexplosivesin2008and2009;626weremales
and105emales.11
Small Arms Estimatesornumbersosmallarmsrangerom1.5millionto10million;
12
nostatisticaldataisavailableonchildreninjuredorkilledbysmallarms.
Child Soldiers AghanSecurityForcesandarmedoppositiongroupshaverecruitedanunknownnumber
ochildrenthroughoutthecountry.
Mostothereportedcasesochildrecruitmentinnationalsecurityorcesweredueto
poorbirthregistrationsystems,weakageverication,andtherisingdemandorpolice
andsoldiers.
Armedgroupshaverecruitedchildrentobeusedasghters,campguardsorsuicide
bombers,particularlyalongtheAghanistan-Pakistanborder.13
Abductions and
Disappearances
Mostcasesoabductionanddisappearancearerelatedtotrackingbycriminalnetworks;
thereissomeconrmedinormationochildrenabductedortranserredtoPakistanwhere
theyhavereceivedmilitarytraining.14
Attacks on Humanitarian and
Human Rights Workers
Aghanistanrepresentsoneothemostviolentenvironmentsoraidworkers,especially
nationalsta,worldwide.15Areported19NGOstaandatleast11UNstawerekilledin2009.16
Please note: DuetoextremelylimitedaccesstocertainareasoAghanistan,especiallywhereactiveghtingistakingplace,there
isaseveregapinreliablenationwidedata.Thegenerallackosocio-economicanddemographicdataisurthercompoundedby
weakinstitutionalandtechnicalcapacitiestoproduceinormation.
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International Treaties Signed (S)/ Ratied (R)/
Acceded (A) (Year)
International Treaties Not Signed
ConventionontheRightsotheChild(R,1994)
OptionalProtocoltotheConventionontheRightso
theChildontheinvolvementochildreninarmed
confict(A,2003)
OptionalProtocoltotheConventionontheRightsothe
Childonthesaleochildren,childprostitutionandchild
pornography(A,2002)
TheGenevaConventionsI,II,IIIandIVo1949(R,1956)
ProtocolIotheGenevaConventions,Relatingtothe
ProtectionoVictimsoInternationalConficts(A,2009)
ProtocolIIotheGenevaConventions,relatingtothe
ProtectionoVictimsoNon-InternationalArmedConficts(A,2009).
ConventiononthePreventionandPunishmentotheCrime
oGenocide(A,1956)
ConventionontheEliminationoAllFormsoDiscrimination
againstWomen(R,2003)
InternationalCovenantonEconomic,SocialandCultural
Rights(A,1983)
ConventionagainstTortureandOtherCruel,Inhumanor
DegradingTreatmentorPunishment(R,1987)
InternationalCovenantonCivilandPoliticalRights(A,1983)
ConventionRelatingtotheStatusoReugees(A,2005)
ProtocolRelatingtotheStatusoReugees(A,2005)
ConventionontheProhibitionotheUse,Stockpiling,
ProductionandTranseroAnti-PersonnelMinesandon
theirDestruction(A2002)
ConventiononClusterMunitions(S,2008)
RomeStatuteotheInternationalCriminalCourt(A,2003)
ProtocolIIIotheGenevaConventions,relatingtothe
AdoptionoanAdditionalDistinctiveEmblem
ILOConvention182ontheWorstFormsoChildLabor
ProtocolagainsttheIllicitManuacturingoandTracking
inFirearms,TheirPartsandComponentsandAmmunition,
supplementingtheUnitedNationsConventionagainst
TransnationalOrganizedCrime
OptionalProtocoltotheConventionagainstTorture
andOtherCruel,InhumanorDegradingTreatment
orPunishment
InternationalLabourOrganization(ILO)Convention29on
ForcedLabor
ILOConvention87onFreedomoAssociationandRight
toOrganize
ProtocoltoPrevent,SuppressandPunishTrackingin
Persons,EspeciallyWomenandChildren,supplementing
theUnitedNationsConventionagainstTransnational
OrganizedCrime
UN Security Council Actions Relating to Children and Armed Conict in Afghanistan
UNSecurityCouncilResolutionsonAghanistan TheUNSecurityCouncilpassed27resolutionsonAghanistan
between2001andMarch1,2010owhichsixspecicallyreerredtochildren.Theseare1419(2002),1833(2008),
1806(2008),1868(2009),1890(2009)
UNSecurityCouncilResolutionsonChildrenandArmed
Confict(CAC)
1882(August2009);1612(July2005),1539(April2004),
1460(January2003),1379(November2001),
1314(August2000),1261(August1999)
UNSecurityCouncilWorkingGroupConclusionson
CACinAghanistan
S/AC.51/2009/1(July2009)
International Standards17
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Executive Summary
Children bear the brunt of the ongoingarmed conict in Afghanistan.In2009,atleast346childrenwerekilledinaerialstrikes
andsearch-and-raidoperationsbyinternationalspecial
orcesaswellasbyassassinationsandsuicidebombings
byanti-governmentelements.Inaddition,landmines,
explosiveremnantsowarandotherexplosiveshavekilled
orseverelyinjuredhundredsochildren,particularlyboys
whoplayoutside,tendanimals,orcollectood,wateror
wood.Armedgroupshavealsodamagedanddestroyed
schools,targetingstudents(especiallygirls),teachers
andotherswhoareseenassupportiveoAghanistans
educationsystem.
ThousandsoAghanamilieshavebeenorcedtofee
theirhomesduetoarmedconfictandeconomichard-
ships.Morethanhalothecountrysinternallydisplaced
approximately161,000peoplearechildren;anaddi-tional1.5millionchildrenarereugeesinPakistanandIran.
Despitesomeprogressinexpandingbasichealthservices
toawidepopulation,inantandmaternalmortalityis
alarminglyhigh.Aghanistanremainstheworstplace
intheworldoranewbornchild,accordingtochild
protectionagencies.
Current strategies of the Afghan governmentand its international supporters thoughaimed at protecting civilians - have largely
neglected the specic needs of childrenaected by armed conict.Thisreluctancetocommittotheprotectionochildren
isrefectedinpolicyandundingdecisions.TheLondon
Conerence18communiquoJanuary2010whichserved
astheroadmaptoaddresssecurity,governanceand
economicconcernsinAghanistanoverthenextveyears,
didnotreertochildrensneedsdespitethesevereimpact
thatitsdecisions,suchasplannedoersoamnestyto
Talibansoldiers,willhaveontheirsecurity.Onlyonechild
protectionadvisorhasbeenstationedattheUnited Nations
AssistanceMissioninAghanistan(UNAMA),despite
repeatedcallsbytheUNSecurityCounciltoallocatemore
resourcestobolsterUNAMAschildprotectioncapacity.
Keydecisionmakershavealsoneglectedtheadviceochildprotectionagencies.Duringthe2009presidential
electionorinstance,AghanistansIndependentElection
CommissionignoredrepeatedwarningsoUNagencies,
nongovernmentalorganizationsandsomegovernmental
agenciesnottousehealthacilitiesandschoolbuildings
aspollingstations.Thisdisregardultimatelyresultedin
multipleattacksonschoolsandhospitals.
The protection of childrens rights shouldnot be limited to safe areas, or stop atAfghanistans borders.In2009,approximately43percentothecountrywas
cutoromhumanitarianassistance,particularlyinthe
confict-aectedsouth,southeastandpartsothewest.
Limitedaccessresultedinthousandsochildrenmissing
outonurgentlyrequiredservicesoeredvianational
healthandeducationcampaigns.
Thelackoaccessduetoinsecurityhasalsoseverely
hamperedtheworkotheUN-ledMonitoringandReporting
Mechanism(MRM)inAghanistanwhichwassetupto
addressthesixgraveviolationsagainstChildrenand
ArmedConfict(CAC)inaccordancewithUNSecurity
CouncilResolutions1612and1882,whichincludekillingormaimingochildren,abductions,recruitmentoruseo
childsoldiers,attacksagainstschoolsandhospitals,rape
orothergravesexualviolenceagainstchildren,andthe
denialohumanitarianaccesstochildren.
Inaddition,thereisinsucientinormationavailableon
theextentoviolationsthatarecross-borderinnature,
includingchildrecruitmentortrackingandtheexploita-
tionochildrentosmuggledrugsorillegalgoods.Inorder
toholdperpetratorsotheseviolationsaccountableandto
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providemoresystematicresponsestochildren,
protectionactorsshouldmakeaconcertedeortto
engagewithallpartiestoconfict,concerned
governmentsandlocalcommunities.
Theprotectionowar-aectedchildrenmeritsspecial
attentionandmustbemadeastrategicpriorityasthe
Aghangovernment,withsupportromtheinternationalcommunity,laysoutplanstobringlastingpeaceand
stabilitytothecountry.
Theollowingarekeyrecommendationsrom
Watchlistsreport:
1. Ensure that the protection of children from
conict-related violence becomes a top priority
in policy and funding decisions on Afghanistan
The Government of Afghanistan (GoA) and its
international supportersshouldsetspecic
benchmarksonchildprotectionagainstwhich
progresscanbemeasured.ThiscouldincludedevelopinganAgendaorChildrenAectedby
ArmedConfictalongthelinesotheAghanistan
Compact,whichsetsoutspecicgoalsorthe
nextveyearsandestablishesacoordination
mechanismtoensureimplementationand
monitoringothisplan.
The UN Security Council Working Group on
Children and Armed Conict (SCWG-CAC)
shouldensurethatcoreconcernsrelatingtochildren
aectedbyarmedconfictarerefectedintheterms
oreerenceotheupcomingSecurityCouncileld
visitplannedormid-2010.ThisincludesollowinguponthecommitmentsmadebytheGoAand
internationalmilitaryorcestotheSpecial
RepresentativeonChildrenandArmedConfict
(SRSG-CAC)duringherrecentvisit.
The UN Secretary-Generalshouldensurethe
immediatedeploymentoadditionalchildprotection
advisersthroughoutthecountryinaneortto
strengthenthechildprotectioncomponento
UNAMA,asrecommendedbytheUNSecurityCouncil.
The SCWG-CAC and relevant donorsshouldrequest
aninormationalbriengwithchildprotectionactorsandcivilsocietyrepresentativesinordertobetter
understandtheroleocommunity-basedmecha-
nismsinAghanistantopreventattacksagainst
schools,andhowtobettersupporttheseinitiatives.
The SCWG-CACshouldrequestanindependent
assessmentotheimpactoprojectsthatareunded
oroperatedbyProvincialReconstructionTeams
(PRTs)onthesecurityandwell-beingochildren
inAghanistan.Theassessmentshouldexplore
alternativewaystoassistchildrenlivinginareasthat
arenotaccessiblebyUNagenciesorNGOs. DonorsshouldollowtheGoodHumanitarian
DonorshipPrinciplessothatundingisallocatedin
proportiontotheneedsothemostvulnerable
populations,includingchildren,andnottourther
politicalgoals.
2. Take eective measures to prevent violations
against children in armed conict and end
impunity for perpetrators
Non-state armed groupsshouldimmediatelyhalt
allviolationsperpetratedagainstthesecurityand
rightsoAghanchildren. Haltallsuicideandimprovisedexplosivedevice
(IED)attacksonciviliantargets.
Rerainromattacksandthreatsoattacksagainst
schools,teachers,educationsta,studentsand
parentsatthelocalandnationallevel.
Stopoperatingoutoschoolsandothercivilian
acilities,andendtheuseohumansasshields.
The GoA and international military forcesshould
ensurethatsystemsorinvestigatingalleged
violationsagainstciviliansaretransparent,timely
andindependentlymonitored.Theresultsotheseinvestigationsshouldbepubliclysharedandinclude
datadisaggregatedbyageoncombatantand
civiliancasualties.
All parties to the conictshouldullycooperate
withtheCountryTaskForceontheMonitoringand
ReportingMechanism(CTFMRM)toprepareand
implementactionplanstoendtherecruitmentand
useochildsoldiers,rapeandothergraveactso
sexualviolenceandkillingandmaimingochildren
inlinewithUNSecurityCouncilResolutions1540,
1612and1882.Commandersshouldequallywork
towardshaltingallviolationsagainstchildren.
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The GoAshouldrepealthereconciliationand
generalamnestylawandholdallperpetratorso
violationsagainstcivilians,includingchildren,
accountableinaccordancewithnationaland
internationallaw.
The GoAshouldunderallcircumstancesavoid
theuseoeducationandhealthacilitiesintheupcomingelectionsandorotherpoliticalpurposes.
The GoAshouldadapttheEliminationoViolence
againstWomenActtoincludeadenitionorape
thatcomplieswithinternationalstandardsand
bringsperpetratorstojusticeinaccordancewith
UNSecurityCouncilResolutions1820and1888.
The GoAshouldcriminalizechildrecruitmentand
theuseochildsoldiers,andactivelyprosecute
thosewhoexploitchildrenassoldiers.TheGoA
shouldworkcloselywithUNagenciestoreneage
determinationproceduresandgrantullaccesstoalltraininganddetentionacilities,includingthose
otheNationalDirectorateoSecurity(NDS),or
monitoringpurposes.
3. Strengthen monitoring, reporting and response on
all violations committed against children, including
those committed in Afghanistans conict zones and
across its borders
The UN Country Team in Afghanistan,underthe
dedicatedleadershipotheSpecialRepresentative
otheSecretary-GeneralorAghanistan(SRSG),
shouldcommitstaandresourcestoprioritize
childprotectionwithintheirrespectiveagencies,includingtheullimplementationoSecurityCouncil
Resolutions1612and1882throughoutthecountry.
The Country Task Force on the Monitoring and
Reporting Mechanism (CTFMRM)shouldworkwith
allpartiestotheconficttocapturecriticalinorma-
tionthatcouldpreventviolationsagainstchildren
andmoreeectivelyassistsurvivors,including
monitoringearlywarningsignsaswellasthe
circumstancessurroundingtheattacksandtheir
impact.Quarterlyreportsromtheirevaluations
shouldbeusedtotracktrendsandinorm
evidence-basedadvocacy.
Donorsshouldsupportstrengtheningthecapacity
oChildProtectionActionNetworks(CPAN),which
consistogovernmentalandnongovernmental
organizationsinAghanistan,torespondmore
eectivelytoviolationsagainstchildren.
The SCWG-CACshouldrequesttheUNHigh
CommissionerorReugees(UNHCR)and/ortheRepresentativeotheSecretary-Generalonthe
humanrightsointernallydisplacedpersons(IDPs)
toleadastudytodeterminevulnerabilitiesandrisks
ordisplacedandreugeechildrenromAghanistan.
Thestudysndingswouldbetherststeptowards
enactingacomprehensiveactionplantonddurable
solutionsordisplacedchildrenromAghanistan.
The Government of Pakistanshouldinvitethe
SpecialRepresentativeonChildrenandArmed
Confict(SRSG-CAC)toconductamissioninPakistan
toidentiypotentialwaystoimprovecoordinationin
endingcross-borderviolationsthatimpactchildren
aectedbyarmedconfictsuchasthedrugtrade,
trackingandsmallarmstrade.
The Secretary-GeneralshouldrequesttheUN
CountryTeamsinAghanistanandPakistan,under
theleadershipotheSRSG-CAC,toestablisha
UNregionalstrategytocontributeactivelytothe
protectionochildrenaectedbycross-border
violations.
The UN Country Team in Pakistanshouldestablish
aWorkingGrouponChildrenaectedbyArmed
ConficttomoreeectivelyaddresstheconcernsoAghanreugeechildren,andcooperatewiththe
CTFMRMandotherchildprotectionagenciesin
Aghanistantoaddressissuesocommonconcern,
includingcross-borderrecruitmentochildsoldiers
andtracking.
The Afghan Independent Human Rights
Commission (AIHRC)shouldcoordinateclosely
withtheindependentHumanRightsCommission
oPakistan(HRCP)toconductjointmonitoringand
reportingalongtheircommonborderareas.
Executive Summary
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Context
Major Armed ConictsIn1979attheheightotheColdWar,Sovietorcesinvaded
Aghanistantoghtaproxywar.Aterthewithdrawalo
theSovietorcesin1989,actionalghtingamongvarious
armedgroupscontinueduntil1996,whenthecapital,
Kabul,wastakenbytheTaliban,aundamentalistIslamic
group.By2001,theTalibancontrolled90percentothe
countryandimposedanewregimebasedonthestrictest
versionoSharia,orIslamiclaw,denyingbasicrightsto
womenandchildren,includingaccesstoeducation,and
subjectingthemtocruelpunishments.
FollowingtheterroristattacksoSeptember11,2001,a
U.S.-ledcoalitionintervenedinAghanistanandwiththe
NorthernAlliance,anAghanoppositionarmedgroup,
soonremovedtheTaliban,whichhadharboredAlQaeda,a
terroristnetwork,rompower.Thisinterventioninitiateda
processopolitical,securityandsocialreormsaimedat
establishingademocraticallyelectedAghangovernment
andrebuildingpeaceinthesocietyaternearlythree
decadesowar.
International Eorts for Peace and SecurityTheBonnAgreementoDecember2001laidtheoundation
orAghanistansuturegovernment,whichledtothe
establishmentoatransitionalauthorityin2001,the
adoptionoanewconstitutionin2004,andpresidential
andparliamentaryelectionsin2005.Inordertosupport
theAghanSecurityForcestomaintainsecurity,theUN
SecurityCouncilauthorizedmemberstatestoormthe
InternationalSecurityAssistanceForce(ISAF),which
operatesunderChapterVIIotheUNCharter.Since2003,
ISAFhasbeenledbyNATOandasoMarch5,2010,is
comprisedoapproximately89,480troopsrom44dierent
countries.Moretroopsareanticipatedtoarriveintherst
halo2010,bringingthetotalnumberoISAFtroopsto
about100,000.InadditiontoISAF,atleast12,000mostly
U.S.orcesaredeployedalongtheAghanistan-Pakistan
borderunderthemandateoOperationEnduringFreedom
(OEF),ajointU.S.,UKandAghanoperation.Allinterna-
tionalmilitaryorcesoperatinginAghanistanwhether
underISAForOEFareplacedundertheoperational
controlotheU.S.ForcesAghanistan(USFOR-A).Linked
tothesemilitaryeorts,ISAFmemberstateshavealso
deployed26ProvincialReconstructionTeams(PRTs)in
Aghanistan,whichincludemilitaryandciviliancompo-
nentstoacilitatedevelopment,reconstructionand
governanceeortsinvariouspartsoAghanistan.
Since2002,theUNAssistanceMissioninAghanistan
(UNAMA)hasbeenmandatedbytheSecurityCouncil
tosupportthegovernmenttobuildpeacethroughthe
promotionohumanrights,reconstructionanddevelop-
ment.UNAMAworksasanintegratedmission,meaning
thatitaimstoaddressdevelopmentandhumanitarian
issues,aswellaspoliticalaairs.UNAMAhasalsoassisted
thegovernmentinimplementingkeyrameworksorcooperationwiththeUnitedNationsandtheinternational
community,includingtheAghanistanCompacto2006
andtheAghanistanNationalDevelopmentStrategy(ANDS).
Withastao1,500militaryandcivilianemployees,mosto
whicharenationalsta,UNAMAisoneothesmallerUN
operationsworldwide.Inthebeginningo2009,UNAMA
addedachildprotectionadvisor,whoworksclosely
withthemissionsvarioussections,particularlythe
HumanRightsUnit.
The Return to Violence
Thenewgovernmentandinternationalsupportorthepeace-buildingprocesssparkedhopeamongmany
Aghans,instigatingthevoluntaryrepatriationomillions
oreugeesromIranandPakistantoAghanistanimmedi-
atelyaterthedeeatotheTaliban.However,thesecurity
situationdeterioratedsignicantlyater2004.19From2004
to2010,theareasexperiencingongoingattackshave
extendedromthesouthandsoutheasttotheareasthat
wereearlierdeemedsecure,includingthenorthernand
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easternregions.Violenceagainstcivilianshasnotonly
spreadthroughoutthecountrybuthasalsointensiedin
thelastewyears,asdemonstratedbytheriseincivilian
casualtiesromabout1,500civilianskilledin2007,toover
2,100killedin2008andmorethan2,400civilianskilledin
2009,accordingtoUNAMAsannualreportsonthe
protectionociviliansinarmedconfict.20
ManyTalibanorcesandotherarmedgroupsneverlet
theirstrongholdsinAghanistan.Othersregroupedinto
areasalongtheAghanistan-Pakistanborderandgained
strength,largelyoperatingromthesemi-autonomous
tribal-dominatedareaowesternPakistan,includingthe
FederallyAdministeredTribalAreas(FATA),Baluchistan
andtheNorthWestFrontierProvince(NWFP).Giventhe
Talibansrequentcross-borderattacks,Aghanauthorities
andtheinternationalcommunityhaveincreasedpressure
onthePakistanigovernmenttotakestrongeraction
againsttheinsurgentsinnorthwestPakistan,including
throughmilitaryoperations.21
Thesearmedoppositiongroupshaveusedinsurgency
tacticstounderminethegovernmentandpushout
internationalorces.Theyhavealsospecicallytargeted
thoseseenassupportinggovernmenteortssuchas
teachers,healthproessionalsandstudents.Common
tacticsincludeattacksonschoolsandhospitals,theuse
oindiscriminateimprovisedexplosivedevices(IEDs)and
employingsuicideattacksinhighlypopulatedareas.The
authorityothecentralgovernmentisurtherlimitedby
theexistenceoshadowgovernmentsestablishedbythe
Talibaninmanyprovinces,warlordsclaimingownership
ocertainareasandtheexpansionocriminalnetworks.Insomeareas,localmilitiasallegedlywithclandestine
supportromtheAghanandAmericangovernmentsalso
conductmilitaryoperationsagainstinsurgentswhichrisk
underminingtheruleolawduetotheirlackoormal
trainingandaccountabilitystructures.22
Intensiedaerialattacksbyinternationalmilitaryorces
havealsokilledcivilians.Inseveralinstances,theAghan
governmentandinternationalandnationalhumanrights
organizationshavequestionedwhetheraerialbombard-
mentswereproportionalandnecessary.23Inresponse,the
commanderoU.S.andNATOorcesinAghanistan,General
StanleyMcChrystal,revisedthestrategyointernational
militaryoperationsandissuedtacticaldirectivestotroops
underhiscommandwiththespecicgoaloavoiding
civiliancasualtiesandincreasingtransparencyand
accountabilityomilitaryoperations.24Thisstrategyhas
resultedinareductionorecordedciviliancasualtiesby
internationalorcesin2009andintherstewmonthso
2010.25Yet,thecontinuingdeteriorationothesecurity
situationandthelackobasichealthandsocialservicesin
manyareashavemadeitdicultorinternationalmilitary
orcestogaintheAghanpeoplessupportorcounterin-
surgencyandreconstructioneorts.
Rebuilding the CountryAterdecadesoconfictandcorruptgovernance,
Aghanistancurrentlydependsalmostentirelyoninterna-tionalsupportormaintainingsaety,rebuildingits
economic,politicalandlegalstructuresandpayingor
suchbasicservicesaspolicing,healthcareandeducation.
Despiteprogressachievedinthehealthandeducation
sectorinrecentyears,Aghanistanhasbeenconsistently
rankednearthebottomotheHumanDevelopmentIndex
withthemajorityoAghanslivinginextremepoverty.26
Incontrast,economicactivityintheblackmarketoten
coupledwithcriminalactivityhasbeengrowing,partly
duetothegovernmentsinabilitytoenorcetheruleolaw,
particularlyintheborderareas.Forinstance,asignicant
shareotheestimatedUS$4billionnetprotodrugtrackinggoestoarmedgroupsthroughdirectinvolve-
ment,briberyandtaxation,accordingtotheUNOceor
DrugsandCrime(UNODC).27Extortionandmisbehavioras
wellasimpunitybythepoliceandseniorgovernment
ocialshaveletlocalpeopleinsomepartsothecountry
resentultowardstheirowngovernment.28
Moreover,institutionalizedcorruptionpreventsthe
governmentromestablishingtheruleolawandinstilling
trustamongcitizensintheirstateinstitutions.Local
powerbrokershavebeenaccusedobribinggovernment
ocialsandlawenorcementagencies,orusingpatronage
linkagestoevadeprosecution,accordingtothe2009reportotheUNOceotheHighCommissionerorHuman
RightsonthesituationohumanrightsinAghanistan.29In
the2009elections,HamidKarzaiwasarmedasPresident
oAghanistanatertherstroundwasdeclaredraudulent
byaUN-backedcommissionandthesubsequentsecond
roundwithdrawaloKarzaismainrivalwhocitedalacko
transparencyintheproceedings.Suchreportsocorruption
byhigh-levelstateocialsriskunderminingnotonlythe
credibilityotheAghangovernmentbutalsootheUN
andthewiderinternationalcommunitybackingit.
AttheLondonConerenceinJanuary2010,theAghan
leadershipanditsinternationalpartnersagreedtoa
roadmapsettingoutave-yearmilitaryandcivilian
strategytoaddressthesecurity,governanceandeconomic
concernsothecountry.Conerenceparticipantsagreed
thatinternationalmilitaryorceswouldgraduallytranser
responsibilityorAghansecuritytothenationalgovern-
mentandbytheendo2011,theAghanarmywould
expandtrooplevelsrom97,000to171,600,andthe
nationalpoliceorcesrom94,000to134,000.30Further,
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donornationspromisedtosupportthegovernments
plansoranAghan-ledNationalPeaceandReintegration
Programmetolurelow-andmid-levelinsurgentsaway
romviolencebyoeringeconomicincentives.Theyalso
welcomedthegovernmentsplanstoholdaloyajirgathat
wouldbringgovernmentocials,triballeadersandsome
moderateTalibanleaderstogethertodiscussstepstowardsresolvingthecurrentconfict.TheLondonConerence
participantsannouncedUS$1.6billionindebtrelie,and
appealedtodonorsorUS$870millioninhumanitarianaid.
Thespecicsotheve-yearplanareexpectedtobe
determinedataconerenceinKabulinmid-2010.
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Humanitarian Access
Deterioration of Humanitarian AccessTherewereapproximately1,300nationalNGOs,300
internationalNGOsand16UNorganizationsengagedin
humanitariananddevelopmentassistanceinAghanistan
asoJanuary2010,accordingtotheAgencyCoordinating
BodyorAghanRelie(ACBAR).Intenseghting,landmines
andtargetedattacksorthreatsagainststamembersoten
preventtheseaidorganizationsromassistingchildren
andtheircommunitiesintheareasmostaectedbythe
confict.31Aghanistanrepresentsoneothemostviolent
environmentsoraidworkersworldwide,accordingtothe
HumanitarianPolicyGroup,anindependentthinktank.32
In2009,approximately43percentothecountrywas
consideredhigh-riskbytheUNDepartmentoSaety
andSecurity(UNDSS)andwascutoromhumanitarian
assistance,particularlytheconfict-aectedsouth,south-
eastandpartsothewest.33Asaresultolimitedaccess,
nationalhealthandeducationcampaignsmissthousandsochildreninneed,andthecampaignseectivenessis
undermined.Forexample,130,000childrendidnotbenet
romtheUN-ledvaccinationcampaignagainstpolioin
2009(seebelow:Health).
Despitelarge-scaleinternaldisplacement,ongoing
confictandnaturaldisasters,mostdonorstateshave
largelyneglectedgrowinghumanitarianneeds.34The2010
UNHumanitarianActionPlanorAghanistan(HAP),the
mainmechanismorcoordinatinghumanitarianresponse,
requestsatotaloUS$870millionrominternationaldonors,
a30percentincreaseinrequestedundingcomparedto
the2009HAP.However,thedesireotroop-contributingnationstoreinorcedevelopmentintheprovinceswhere
theyareactivemeansthataidisnotnecessarilychanneled
totheareaswiththehighestneedsorhumanitarianor
developmentaid.
Inadditiontodeprivingchildrenotheirbasicrights,the
lackoaccesstosomeotheareasmostaectedbythe
confictmakesitdicultoraidorganizationstodene
theneedsochildrenandothervulnerablegroups.For
example,thecampaignotheAghangovernment,with
supportromtheUnitedNationsChildrensFund(UNICEF),
toregisterallnewbornchildrenby2009hadtoleaveout
allchildrenlivinginremoteorinsecureareas.35Withonly
1 percentoAghansholdingabirthcerticateaso2008,
inormationromthisregistrationexercisewouldhave
allowedthegovernmenttoobtainaccurateandcompre-
hensivenumbersochildrentoinormitsplanningor
buildingschoolsandhealthacilities,aswellasvaccination
initiatives.Moreover,thepossessionoabirthcerticate
endowschildrenwiththerighttobenetromthespecial
legalprotectionramework,includingthespeciclawson
juvenilejustice,andontherecruitmentanduseochildren
byarmedgroupsororces.
Violating Humanitarian PrinciplesThemilitaryinvolvementindevelopmentactivitieshas
endangeredAghanciviliansandaidworkersastheseprojectsotenbecomethetargetsoarmedopposition
groups,leadingtotheblurringolinesbetweenthe
militaryandhumanitarianmission.36TheUNOceor
theCoordinationoHumanitarianAssistance(OCHA)
re-establisheditspresenceinAghanistaninOctober2008
toadvocateormoreprincipledhumanitarianactionand
tostrengthenindependenthumanitariancoordination
bytheUN.37Despitethispositivedevelopment,ona
structurallevelOCHAremainsconnectedtoUNAMA
andtherebyitspoliticalmandateasitisledbythe
HumanitarianCoordinatorwhoalsounctionsasDeputy
SpecialRepresentativeotheSecretary-Generaland
ResidentCoordinator.
ThedeteriorationoaiddeliveryinAghanistanistoa
signicantextentduetothenatureoPRTsandtheway
theyhavebeenimplemented.PRTs,whichusuallyconsist
oamilitaryandasubstantiallysmallerciviliancontingent,
carryoutrelieworkbutaredirectlymanagedbyISAF
memberstates.PRTstendtooperateinsomeothemost
insecureareasthatareolimitstotheUN,theAghan
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governmentandmanyNGOs.However,theirunderlying
politicalagendatogainsupportorthegovernment
andtheinternationalpresenceundercutshumanitarian
principlesoneutralityandimpartialityandmakesiteven
harderoraidagenciestoretaintheirspaceinother
areas,accordingtoastudybyTutsUniversitysFeinstein
Institute.38
Moreover,NGOshavecriticizedPRTsortheirlackotechnicalexpertiseandtheabsenceoacoherent
nationwidestrategyamongthevariousPRTs,whichare
currentlyonlyaccountabletotheirhomegovernments.39
InstanceswherePRT-ledprojectshaveprovenunsustain-
abletendtonegativelyaecthowcommunitiesviewand
acceptinternationalaidworkers.
Inordertoclariythespecicrolesandresponsibilitieso
civilandmilitaryactors,UNagencies,ISAFandNGOsagreed
tonon-bindingCivil-MilitaryGuidelinesinMay2008.40
TheGuidelinesarmthatinprinciple,governmentand
humanitarianactorsareresponsibleorprovidinghumani-
tarianassistance.Incontrast,theroleothemilitaryisonlytoassistcivilianactorstoprovidebasicinrastructureand
urgentreconstructionassistanceinexceptionalcasesand
asaproviderolastresort.Thisusuallyreerstocases
wheretheprotectionothepersonsphysicalsecurity
requiresamilitarypresence.Inaddition,theGuidelines
callortheclearlyvisibledistinctionbetweenhumanitarian
andotheractors.However,somemilitaryactorshave
violatedtheGuidelinesandinternationalhumanitarian
principlesbyengaginginrelieactivitiesororceprotection
purposes.41Humanitarianactorshavealsonotedalacko
awarenessotheGuidelinesamongPRTstaorlacko
commitmentamongtroop-contributingcountriesto
implementthemduetotheirvoluntarynature.Inaddition,theimpactotheGuidelinesislimitedastheUS-ledOEF
hasnotagreedtoitsprovisionsandtheTalibanandother
armedoppositiongroupsremainlargelyunawareoit.42
Intherecentpresidentialelections,Aghanistans
IndependentElectionCommission(IEC)usedhealth
acilitiesandschoolbuildingsaspollingstations,citing
thelackoalternativepublicbuildingsorthisuse.UNICEF,
theWorldHealthOrganization(WHO),OCHA,theUN
Educational,ScienticandCulturalOrganization(UNESCO),
NGOsandseveralgovernmentocialsrepeatedlywarned
othesevereriskstothesecurityostudentsandpatients
giventheTalibansoppositiontotheelections.43InAugust2009,themonthotheelections,therewere249reported
incidentsagainsteducationcomparedto48reported
incidentsinthemonthoJuly,accordingtotheUN-led
CountryTaskorceontheMonitoringandReporting
Mechanism(CTFMRM).Inmanyothesecases,insurgents
hadattackedpollingstationslocatedinschools.
Recommendations on Humanitarian Access UN agencies, ISAF and NGOsshouldintegratechildprotectionbestpracticesandrelevantprovisionso
SecurityCouncilResolutions1612and1882intotheCivil-MilitaryGuidelines,includingprohibitionsagainst
theuseoschoolsandstudentsorpoliticalpurposes.AdherencetotheGuidelinesshouldbereportedto
theExpertCommitteeonProtectionoCivilianstoinormitsrecommendationsregardingUNAMAs
mandaterenewal.
International military forcesshouldensurethattheirstandardoperatingprocedures(SOPs)areinlinewith
theCivil-MilitaryGuidelines.ThisincludesprovidingregulartrainingsontheGuidelinesorallsta,including
civiliansandPRTsandhighlightingtherelevantprovisionsrelatedtotheprotectionochildren.
The SCWG-CACshouldrequestanindependentassessmentotheimpactoprojectsthatareundedor
operatedbyProvincialReconstructionTeams(PRTs)onthesecurityandwell-beingochildreninAghanistan.
TheassessmentshouldexplorealternativewaystoassistchildrenlivinginareasthatarenotaccessiblebyUN
agenciesorNGOs.
The GoAshouldunderallcircumstancesavoidtheuseoeducationandhealthacilitiesintheupcoming
electionsandorotherpoliticalpurposes.
Humanitarian organizationsshouldinvolvelocalcommunitymembersintheplanning,executionand
evaluationodevelopmentassistanceprojectstoincreasetheirapplicabilityandlong-termimpact.
DonorsshouldollowtheGoodHumanitarianDonorshipPrinciplessothatundingisallocatedinproportion
totheneedsothemostvulnerablepopulations,includingchildren,andnottourtherpoliticalgoals.
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Killing and Maiming
Military and Other AttacksThenumberocivilianskilledandinjuredsince2006asa
resultothearmedconficthasrisenatanunprecedented
rate.Nearly6,000civilianswereinjuredorkilleddueto
confict-relatedviolencein2009,andothisnumber
2,412 werekilled,accordingtoUNAMAsannualreport,
Protection of Civilians in Armed Conict in Afghanistan,
2009.44Thismarksa14percentincreaseinciviliandeathsas
comparedtothesametimeperiodthepreviousyear.Most
otheincidentswererecordedinthesouth,southeast
andeasternregionswhereaidorganizationshavelimited
accessandhostilitieshaveescalated.In2009,346 children
werereportedlykilledduetoconfict-relatedviolence,
including131throughairstrikesand22innightraidsby
SpecialForces,and128werekilledthroughassassinations,
suicidebombingsandotherattacksbyarmedopposition
groups,accordingtoUNAMA.45Thisnumberdoesnot
includeincidenceswherechildrenwerekilledbylandminesandexplosiveremnantsowar(ERW),andmightonlybea
ractionotheactualcasesashumanrightsmonitorshave
limitedaccesstoconfictzonesduetoinsecurity.The
AghanIndependentHumanRightsCommission(AIHRC)
reported520childrenkilledbywarringpartiesbetween
March2009andMarch2010,whichalsoincludesmine-
relatedvictims.TheAghanistanRightsMonitor(ARM),a
localhumanrightsgroup,reportedatleast1,050children
killedbysuicideattacks,airstrikes,improvisedexplosive
devices(IEDs),ERWsandincross-rebetweenwarring
partiesin2009.46
WhiletheTalibansCodeoConductinstructseverymemberotheMujahideen[to]dotheirbesttoavoid
civiliandeaths,civilianinjuriesanddamagetocivilian
property,armedoppositiongroupshaveattimesdirected
theirviolenceatcivilianstointimidatethemandunder-
minethegovernment,stagingsuicidebombingsinhighly
populatedareas,detonatingIEDsonbusycivilianroads,
andattackingschoolsandhospitals(seebelow:Education
andHealth).Childrenhavealsobeentargetedbythese
armedgroupsandexecutedonallegationsospyingor
governmentorinternationalmilitaryorces,according
toUNsources.Therearealsoreportsoarmedgroups
deliberatelyusingchildrenashumanshields.47
Mostotheciviliandeathsattributedtopro-government
orceswereasaresultoairstrikesand,toalesserextent,
nightraidsoteninvolvingexcessiveuseoorce.Forexample,inMay2009,theU.S.claimedthatitresponded
tocallsbyAghanArmedForcesorprotectionagainst
insurgentattackbyusingaerialbombardments,which
killedatleast65childrenand21womeninavillagein
theBalaBulokdistrictoFarahProvince,southwestern
Aghanistan,accordingtoAIHRC.Independenthuman
rightsorganizationshavestruggledtoveriysuchclaims
duetothelackotransparencyininvestigationsconducted
byinternationalmilitaryorces.48Inmanyothesecases,
theuseounreliablesourcesoraultyintelligencehave
contributedtoincreasedciviliancasualties.49
OneothemostproblematicaspectsorchildprotectionactorsisthatcontrarytotheConventionontheRightso
theChildsdenition,ISAFsCivilianCasualtiesTrackingCell
denesachildasapersonundertheageo15.Thismakes
itextremelydiculttoaccuratelyassesstheimpacto
militaryattacksonchildrenandmayleadtounderestimates
othenumberochildrenassociatedwitharmedgroups.
Childrenhavealsobeencaughtinthecross-reasghting
betweentheAghanorcesandinternationalmilitary
orcesagainstarmedoppositiongroupscontinues.
Similarly,landmines,ERWandotherexplosivesplaced
byarmedorcesandothergroupshavekilledhundreds
ochildrenandinfictedpermanentinjuriesonothersthroughouttheconfict(seebelow:LandminesandERW).
Assistance to Survivors and Impunityfor PerpetratorsFollowinganattack,childrenandtheiramiliesusuallydo
notevenreceivebasicinormationastowhohascommitted
thecrime,thecircumstancesotheincidentorthestatus
andollow-upoinvestigations,includingpotential
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prosecutions.50Todate,therehasneverbeenanindictment
orconvictionoTalibancombatantsorcrimesagainst
humanityorwarcrimes,whichcanbepunishedunder
internationalanddomesticcriminallaw.Moreover,in
February2010,theAghangovernmentputintoorce
thereconciliationandgeneralamnestylawwhichgives
immunitytoprosecutionorthoseengagedinthecurrenthostilitiesitheyagreetoengagewiththegovernmenton
reconciliation.HumanRightsWatch(HRW),theTransitional
JusticeCoordinationGroup,whichconsistso24Aghan
civilsocietyorganizationsandotherhumanrights
organizationshaveraisedseriousconcernsregarding
theamnestylaw,arguingthatitwouldultimatelyunder-
minethereconciliationandpeaceprocessandviolate
internationallaw.51
Theresponsesointernationalmilitaryorcestoattacks
involvingtheinjuryordeathocivilianshasvaried
dependingonthetroopsinvolved.However,thelacko
publicacknowledgement,prosecutionandcompensationhaveincreasinglycausedAghancivilianstoloseaithin
internationaltroops,accordingtoAIHRC.52InAugust2009,
GeneralStanleyMcChrystal,thecommanderoNATOISAF
andU.S.Forces,puttheprotectionociviliansromattacks,
thereductionociviliancasualtiesandtransparencyand
accountabilityormilitaryoperationsatthecenterohis
counter-insurgencystrategy.53Aspartothisstrategy,
GeneralMcChrystalissuedaseriesoTacticalDirectivesto
ISAFandU.S.ForcesinAghanistanthatprovidespecic
instructionstotroopsregardingorceprotection,air
strikesandnight-timeraids.54ISAFsCivilianCasualties
TrackingCellsandaparallelunitwithinUSFOR-A,thecommandandcontrolheadquartersorU.S.orces
operatinginAghanistan,wereestablishedtoensurea
moresystematicmonitoringandresponsetoreported
incidents,includinginvestigationsandcompensation.
Asaresultotheseinitiatives,ewercivilianswerereportedly
killedinairstrikesin2009thanin2008,accordingto
UNAMAsgures.Theocusonciviliansisalsorefectedin
someothedrasticresponsesthatsometroopshavetaken
ininstanceswherecivilianshavebecomethevictimso
militaryoperations:TheorderoGermanNATOorcesto
carryoutanairstrikeinKunduzonSeptember3,2009,
whichappearedtocontraveneMcChrystalsdirectivesandISAFstandardoperatingprocedures,ledtotheresignation
othreeGermanseniorocials.ANATOinvestigation
conrmedthatthemilitaryhadwithheldinormation
thatcivilianshadbeenkilledintheincident.55
However,thereisstillnotransparent,comprehensiveand
independentlymonitoredsystemtoinvestigateviolations
committedbymilitaryorcesandtoholdperpetrators
accountableorauniormstrategyorcompensating
civilians.Compensationalsolargelydependsonthetroops
perpetratingtheattackandisprovidedonacase-by-case
basis,accordingtotheCampaignorInnocentVictimsin
Confict(CIVIC).56Whilemosttroopsoeranex gratia
paymenttocivilianssueringlossesincombatoperations,
survivorsaceseriousobstaclesinobtainingthisassistance
inatimelymannerduetothedicultyinidentiyingthemilitaryunitresponsible,thelengthybureaucratic
processinvolvedandthelackoaccesstooces
receivingcomplaints.57
AnumberoNGOshavethuscalledoramorepro-active
andsystematicapproachincontactingvictimsandtheir
amiliestooerocialapologies,inormthemaboutthe
circumstancesotheincidentandtoexplaintothemhow
theycanraisecomplaintsandhavethemheardbyISAF.
Theyalsourgedalltroop-contributingcountriestodevelop
asystematic,transparentwayocompensatingamilies
andvictimsthatisstandardizedbyalltroop-contributing
countries.58
Children Living with DisabilitiesMorethan200,000childreninAghanistanlivewith
permanentinjuriesanddisabilitiessueredduringhostilities
orasaresultoinadequatemedicalsupport,accordingto
themostrecentsurveybyHandicapInternationalin2005.
ThegovernmentpaysamonthlypensionoUS$6toUS$10
topersonswithdisabilities,whichbarelycoversthecosto
medicaltreatment,accordingtoHandicapInternational.59
Schoolacilitiesandteachersarenotequippedtoaddress
thespecialneedsostudentswithdisabilities,which
urthercaststhechildrenintodisadvantageandisolation,accordingtoocialsattheMinistryoEducation.60Only
22.4percentothe196,000childrenwithdisabilitiesin
Aghanistanwhowouldhavequaliedorschoolwere
abletoattendschool,accordingtotheInternational
OrganizationoPersonswithDisabilities.61
AghanistanhasnotsignedtheUNConventiononthe
RightsoPersonswithDisabilities,whichaskssignatory
statestoensurethatchildrenwithdisabilitiesarenot
excludedromreeandcompulsoryprimaryeducation,or
romsecondaryeducation.Nationallegislationrelatedto
personswithdisabilitiesiscurrentlyintheprocessobeing
approved.Inordertoacilitateintegrationochildrenwith
disabilities,theMinistryoEducationhasintroduced
awareness-raisingcomponentsintheschoolcurriculum
andisworkingonstrategiestoprovidespecializedand
inclusiveeducation.62
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Recommendations on Killing and Maiming All parties to the conictmusttakeallpossiblemeasurestoavoidciviliancasualties.Allallegedperpetrators
shouldbeheldaccountableinaccordancewithnationalandinternationallaw.
The GoA and international military forcesshouldensurethattheirinvestigationsintoallegedviolations
againstciviliansaretransparent,timelyandindependentlymonitored.Theresultsotheseinvestigations
shouldbepubliclysharedandincludedatadisaggregatedbyageoncombatantandciviliancasualties.
The GoAshouldrepealthereconciliationandgeneralamnestylawandholdperpetratorsoviolations
againstcivilians,includingchildren,accountableinaccordancewithnationalandinternationallaw.
International military forces,incoordinationwiththerelatednationalmechanism(PresidentialFundand
theMinistryoLabor,SocialAairs,Martyrs&Disabledcompensationmechanism),shoulddeviseauniorm
strategyorcompensatingciviliansurvivorsoattacksandensurethatthesecompensationsystemsaremade
easilyaccessibletovictims,includingchildren.
The GoAshouldimmediatelysignandimplementtheUNConventionontheRightsoPersonswith
Disabilitiesand,withinternationalsupport,moreeectivelyassistchildrenwithdisabilities.
Killing and Maiming
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Refugees and IDPs
Internally Displaced PersonsThousandsoAghanchildrenandtheiramilieshave
beenorcedtofeetheirhomesduetoarmedconfictand
economichardship.Inaddition,moreandmoreAghan
reugeesarereturningromothercountriesonlytoall
againintodisplacementintheirowncountrydueto
insecurityintheirplacesooriginorlackoaccesstotheir
previouslyownedland.Largeandmountingnumbers
otheinternallydisplacedremaininvisibletothe
governmentandinternationalorganizationsdueto
ongoinghostilitiesandseriousaccessconstraints.
Asotheendo2009,anestimated297,000internally
displacedpersons(IDPs)werelivinginmakeshitcamps,
inormalsettlements,orbeinghostedbyAghanamilies
towhichtheyhavecloseties,accordingtotheUNHigh
CommissionerorReugees(UNHCR),whichco-chairsthe
NationalIDPTaskForcetogetherwiththeAghanMinistry
oReugeesandRepatriationAairs.Morethanhalo
theseIDPsapproximately161,000arechildren,according
toUNHCRestimates.Despitetheirlargenumberand
specialneeds,humanitarianagenciesontheground
conrmedthattherewasadearthocomprehensive,
disaggregateddataontheirsituationtoinormpolicy
andprogrammaticresponses.
AssistancetoIDPswhetherresidingincamps,settlements
oroutsidethecamps,includinginurbanareasomajor
Aghancitiesremainsminimal,uncoordinatedand
partiallyad-hoc.Healthworkersrequentlydescribe
childrensueringrompreventablediseaseslikemeasles,
dysenteryanddiarrheaasaresultothelackovaccina-
tions,unhygienicconditionsinIDPsettlementsandthe
lackoaccesstosaedrinkingwater.63Manyothese
childrenaredeprivedoaccesstoeducationalopportunities
inthesettlementsasone-thirdoallsiteslackeducation
acilitiesandvirtuallynoneoeraccesstohighereduca-
tion.64DisplacedparentsresidinginKabulsmakeshit
campshavereportedlyevensoldtheirchildrento
criminalandtrackingcirclestosurviveorprovide
ortheirotherchildren.65
Moreover,thestateodisplacementotendepriveschildren
oprotectivecommunityoramilystructuresandexposes
themtoagreaterriskorecruitmentintoarmedorcesorgroups.Whilemoreevidenceisneeded,availabledata
seemstoindicateacorrelationbetweenchildrecruitment
andhighlevelsodisplacement,accordingtothe2008
Secretary-GeneralreportonCACinAghanistan(seebelow:
ChildSoldiers).Inact,thethreatochildrecruitmenthas
causedsomeamiliestofeetheirhomes,accordingtothe
samereport.
Inparticular,ndingdurablesolutionsorchildrenatrisk,
includingunaccompaniedandorphanedchildren,remains
achallenge,accordingtoUNHCR.WhiletheGovernment
oAghanistans2006NationalStrategyorChildrenat
Riskocusedondevelopingcommunityandamilybasedsupportorvulnerablechildrenandreducingtheemphasis
oninstitutionalcare,theorphanagesrunbythegovernment
andtheAghanRedCrescentSocietyprovidemostly
temporaryshelteranddonotalwaysadmitboyso
15 yearsandolder.66Childprotectionagencieshave
alsowarnedothepoorlivingconditionsinsomeorphan-
ages.Forexample,asurveyconductedbyAIHRCwith
43 childreninAlahuddinOrphanageinKabuloundmost
childrentobedissatisedwiththeacilities,citingpoor
oodquality,lackosanitationacilitiesandphysicaland
verbalviolence.
RefugeesInthemid-1990s,atthepeakothedisplacementcrisis,an
estimated8millionAghanreugeeslivedinneighboring
countries,mainlyinPakistanandIran,representingone
othelargestreugeepopulationsworldwide.67Withthe
arrivaloanewgovernment,internationalorcesand
unding,morethan5.6millionpeopledecidedtoreturn
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totheirhomecountrybetween2002and2009.68Othe
4.4 millionassistedreturneesromPakistanandIran,over
2 millionwereundertheageo18,accordingtoUNHCR;
theagencyurtherreportsapproximately1.6million
registeredreugeeslivinginPakistanandabout1million
inIranasoJanuary2010.69WhileupdateddataonAghan
reugeechildreninPakistanandIranisnotavailable,UNHCRestimatesabout1.18millionchildrenamongAghan
reugeesinPakistanand345,000childrenamongAghan
reugeesinIranbasedonstatisticsromregistration
exercisesconductedin2007.70
Pakistanisnotasignatorytothe1951ReugeeConvention
andits1967Protocol,whichestablishtheinternationallegal
standardsorreugeeprotection.WhileIranisasignatory
toboththeConventionandtheProtocol,regimesater
1979havereusedtoabidebytheprovisionsothe1951
Convention.Theprolongedreugeepresenceandsecurity
issuesduetocross-bordermigrationandcrimehaveled
toconcernsthatthecountrieswouldclosetheirbordersandputpressureonAghanreugeestoreturnhome,according
totheInternationalCrisisGroup.71Since2004/2005,both
PakistanandIranhavetightenedtheirasylumpoliciesand
increasedpressureonAghanstoleavethecountryby
closingreugeecamps,cuttingoassistanceandinsome
instancesarrestinganddeportingreugees.
MostotheregisteredreugeesinPakistan(around
85 percent)arelivinginthetwoprovincesadjacentto
AghanistanNorthWestFrontierandBaluchistantwoo
themostdestituteprovinces.Thereareseriousprotection
concernsorreugeeslivingintheseareasassomearmed
groupshavereportedlyusedthecampsasbasesortheirmilitaryoperationsinAghanistan.72
Citingsecurityconcerns,theGovernmentoPakistanhas
limitedtheaccessoaidorganizationsandonlyallowsaid
tobeprovidedtoreugeesthroughitsownprograms
despiteitslimitedexpertiseonprotectionissuesandits
directpoliticalinvolvementintheconfict.73
InMarch2010,anewTripartiteAgreementbetweenthe
governmentsoPakistanandAghanistan,andUNHCR
onvoluntaryrepatriationwassigned,whichextendsthe
stayoregisteredreugeesthroughDecember31,2012.
Between2005andthebeginningo2010,about25Aghanunaccompaniedminorslargelyundocumentedlabor
migrantsweredeportedromPakistan,according
UNHCRsstatisticsrombordermonitoring.
ThesituationorreugeesinIranalsoremainsprecarious.
Since2002,about5,818Aghanunaccompaniedminors
havebeendeportedromIran,accordingtoUNHCR.While
themajorityothesechilddeporteesareundocumented
labormigrants,humanrightsorganizationswarnthatchild
deporteesmaybeataheightenedriskosexualexploitation,
physicalabuse,humantrackingandvariousexploitations
andabusesupontheirreturn,accordingtoAIHRC.74Some
deporteeshaveaccusedtheIranianpoliceobeatings,
illegalandarbitrarydetention,andtheIraniansecurity
orcesoinsultsbeoretheirexpulsion.75TheIranian
governmenthasalsomadeitmoredicultorAghanreugeestostayinthecountrybybanningthemrom
22 provincesaspartoitsno-goareapolicyandgradually
cuttingotheiraccesstosubsidizededucation,health
careandood.76In2009,thegovernmenttooksomesteps
toeasetheserestrictivepoliciesbybeginningtogivework
permitstoregisteredAghanreugeesandallowingall
school-agechildren,includingregisteredandunregistered
reugees,toenrollingrades1-12inthesamemanner.77
However,gapsintheimplementationothesepolicies
remain,accordingtoUNHCR.
MostregisteredAghanreugeesdonotwanttoreturn
totheirhomecountryduetothedeterioratingsecuritysituation,thelimitedabsorptioncapacityocommunities
inAghanistanandthelackosocio-economicopportuni-
ties.Withoutland,jobs,accesstobasicservicesandwith
ongoingsecurityrisks,returneesareatahighrisko
reneweddisplacementwithinAghanistanororced
re-migrationtoneighboringcountries.78UNHCRalluded
tothespecicprotectionconcernsoreturneechildren,
includingchildlabor,smugglingandhumantracking,
andearlyororcedmarriage.79Moreover,abouthaloall
reugeesgrewupinanothercountryand80percenthave
livedthereormorethantwodecades,makingitdicult
orthemtoreintegrateupontheirreturntoAghanistan.80
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Recommendations on Refugees and IDP Children The UN Security Council Working Group on Children and Armed Conict (SCWG-CAC)shouldrequest
UNHCRand/ortheRepresentativeotheSecretary-GeneralonthehumanrightsoIDPstoleadastudyto
determinevulnerabilitiesandrisksordisplacedandreugeechildrenromAghanistan.Thestudysndings
wouldbetherststeptowardsenactingacomprehensiveactionplantonddurablesolutionsordisplacedchildrenromAghanistan.
The GoAshouldensurethatunaccompaniedandseparatedchildrenreceiveadequateinterimcareuntilthey
arereunitedwiththeiramilies,placedwithosterparentsorotherlong-termarrangementsorcarearemade,
inaccordancewiththeInter-agencyGuidingPrinciplesonUnaccompaniedandSeparatedChildren.The
governmentshouldmonitorthatthestandardsoprotectionandcareprovidedbyprivateandpublic
orphanagesaremet.
The Government of Iranshouldcomplywiththe1951ReugeeConventionandits1967Protocol;the
Government of Pakistanshouldsignandcomplywiththe1951ReugeeConventionandits1967Protocol.
Inparticular,theyshouldprovidereugeechildrenromAghanistanwithaccesstoeducation,healthand
documentationtoacilitateopportunitiesorlocalintegrationorrepatriationandensurethattheirprotection
againstharassmentordeportationisinlinewithinternationalstandards.
The Governments of Afghanistan, Pakistan and IranshouldworkwithUNHCRtoensurethatchildren
cancontinuetheireducationorvocationaltrainingupontheirreturn.
AIHRCshouldcoordinatecloselywiththeindependentHumanRightsCommissionoPakistan(HRCP)to
conductjointmonitoringandreportingonhumanrightsandchildrightsviolationsalongtheircommon
borderareasandtotakespecicmeasurestopreventthem.
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Health
Access to ServicesThedestructionromthewarandensuingpoliticaland
economicinstabilityhaveletAghanistanshealthcare
systeminshambles,andnearlyullydependenton
externalundingandassistance.Since2002thegovern-
menthastakensomeimportantstepsinimprovinghealth
care,whichhaveresultedintheincreaseohealthacilities
rom400in2002to1,788in2009andasubstantial
increaseintrainedhealthpersonnel,accordingtothe
MinistryoPublicHealth.81Withtheexpansionobasic
healthservices,preventableatalitiesamonginantsand
youngmothershavemarginallydecreased.However,
intensiedconfict,attacksandintimidationagainsthealth
workers,andlowqualityservices,havecontinuedtokeep
inantandmaternalmortalityratesalarminglyhigh.
Aghanistanisstilltheworstplaceoranewborninterms
oaccesstohealthcareandsurvivalopportunities,
accordingtoUNICEFandSavetheChildren.82Oneinour
Aghanchildrendonotreachtheirthbirthday,partly
duetolackoaccesstoadequatehealthcare.83Savethe
Childrenreportsthat15percentovulnerablepeople,
includingchildren,inurbansettingsand30percento
thoseinruralareasdonothaveaccesstoanygovernment,
nongovernmentalorganizationorprivatelyrunhealth
acilitiesinAghanistan.84Newlydevelopednationalhealth
carepoliciestoprovidepeoplewithbasichealthservices
(BasicPackagesoHealthServicesBPHS)generallydo
notreachpeoplelivinginthesouthernandwesternparts
othecountry,partlyduetoinsecurity.85Asaresult,
childrenhavecontractedordiedodiseasesthatareeasilypreventableorcontrolledinmostcountriesaround
theworld,includingrespiratoryinections,diarrhea
andvaccinepreventabledeaths,especiallymeasles,
accordingtoWHO.86
Atleast1millionAghans(15percentothepopulation)
weredeprivedobasichealthcareservicesduetoattacks
onhealthcareacilitiesandhealthworkersin2008,and
insucientcoveragebytheBPHSsystem.Thisnumberhas
doubledsince2007,accordingtotheMinistryoPublic
HealthandWHO(seeabove:HumanitarianAccess).87
Thesituationintheconfict-aectedsouthernregion
(Helmand,Kandahar,ZabulandNimroz)isparticularly
severeandcontinuestodegrade.Somehealthacilities
havebeenclosed,damagedordestroyedbythearmed
oppositionandthedeliberatetargetingohealthacilities
andworkerslimitsaccesstohealthservicesormuchothe
populationlivingininsecureareas.Manysecurityincidents
involvingtheharassment,intimidationandkidnapping
ohealthworkersremainunreportedbecauseoearo
retaliation.AsoNovember2008,13southerndistrictshad
nounctionalpublichealthacilities,potentiallyaecting
hundredsothousandsopeople,includingchildren,
accordingtotheUN.
Armedgroupshavelargelybeenresponsibleorattacking
healthacilities,stamembersandpatients.Forexample,
armedoppositiongroupsdestroyedseveralNGO-runclinicsintheeastandabductedstabetweenJuly1st
andSeptember30,2009.88AghanSecurityForcesand
internationalmilitaryorceshavealsonotalwaysrespected
thespecialprotectionaordedtomedicalpersonneland
acilitiesunderinternationallaw.Forexample,inAugust
2009,Aghanmilitaryorcesreportedlyoccupiedtwo
BasicHealthCentersinHelmandprovince.89TheSwedish
CommitteeorAghanistanalsoaccusedISAFoinvading
itshospitalonSeptember6,2009.90Inordertoprevent
urtherincidentsinvolvingtheoccupationohealth
acilitiesbymilitaryorces,theHealthClustermembers,
whocoordinatethehealthresponseamongUN,govern-
ment,NGO,academicandprivateactors,havedeveloped
acodeoconductorallmilitaryactorsregardingentry
intohealthacilities(seeabove:HumanitarianAccess).
Inaddition,theHealthClusterincoordinationwith
theUN-ledCountryTaskForceontheMonitoringand
ReportingMechanism(CTFMRM)establishedamecha-
nismormemberstoreportattacksagainsthealthsta
andacilities(seebelow:UNSecurityCouncilActions).
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Thereisalsoacriticalshortageohealthcareworkersin
confict-aectedorremoteareas.91Onaverage,onedoctor
isresponsibleortreatingmorethan5,500patients,and
80 percentohealthclinicslackadequateequipment.92In
particular,thelackoemalemedicalstaposesaserious
obstacletoprovidingessentialservicestowomenand
children.InPaktikaprovince,orexample,thereisnotasingleemaledoctorandonlyaewemalenursesand
midwivesintheentireprovince,wheremorethan
180,000 womenlive,accordingtoAghanistansCentral
StatisticsOce.93
Withoutaccesstomedicalsuppliesandproessionalsta,
someAghanshavereliedoninormalmedicaladvicerom
amilyeldersorboughtmedicineromlocaldrugsellers
suchasopium,withharmulconsequences.94Inparticular,
thesmallnumberoemalehealthworkersdiscourages
girlsandwomenromseekingmedicalassistance,espe-
ciallyorreproductivehealthconcerns,accordingtothe
samereport.Currently,lessthanone-thirdohealthacilitieshaveatleastoneemalehealthworker,according
totheSecretary-GeneralsreportonWomen,Peaceand
Security,September16,2009(S/2009/465,para.16).
Maternal Death and Reproductive HealthInspiteoimprovements,Aghanistancontinuestohave
oneothehighestmaternalmortalityratesworldwide
with1,800/100,000livebirths.95Onemotherdiesevery
halhourinAghanistanbecauseobirth-relatedproblems,
accordingtoUNICEF.96Theinantmortalityratestandsat
165orevery1,000livebirths.97Theprevalenceoearly
marriagehasresultedingirlsgivingbirthatayoungagewhentheyarenotyetphysicallymature,whichcarries
serioushealthrisksorthemotherandinant.Forexample,
anadolescentgirlistwotovetimesmorelikelytodie
rompregnancy-relatedcomplicationsthana20-year-old
woman,accordingtoSavetheChildren.98
Inaddition,traditionalgendernormspreventwomenand
girlsromlearningaboutreproductivehealth,visitingmale
doctorsoraccessinghealthacilitieswithoutamaleperson
accompanyingthem,accordingtoUNICEF.Theagency
urtherreportsthatthehighmaternalmortalityrateis
duetoverylimitedaccesstocomprehensiveemergency
obstetriccareorwomenlivinginruralareas,pooraware-
nessaboutsaedeliverypracticesandthescarcityo
proessionalhealthworkers,particularlyemales.99More
than70percentobirthstakeplaceathomewithoutany
medicalsupportandanyemergencyplaninplace.100While
thenumberomidwiveshasincreasedsubstantiallyrom
400in2001toapproximately2,500in2008,morethan4,500
moremidwivesarerequiredtomeetcurrentneeds.101
Theenrollmentostudentsorcommunitymidwiery
schoolsishamperedbythelowliteracyratesamong
emalesintheruralandremoteareasandevenmore
bythethreatsandintimidationotheiramiliesbythe
armedoppositiongroups,accordingtoWHO.Someo
itsimplementingpartnersoperatinginsecuritychal-
lengingdistrictsreporteddropoutratesobetween30 40percent.Progressinimprovingtheaccessto
skilledbirthattendantsislikelytobeslow,especiallyin
areaswherethiswouldbemostneeded,namelyinrural,
remoteandinsecurelocations.
Infectious DiseasesUntreatedcommunicablediseasesthreatenindividuals
andcommunitiesinAghanistan.Othecasesreported
totheDiseaseEarlyWarningSystemadministeredbythe
MinistryoPublicHealth,morethan60percentposedthe
threatodevelopingintoamajorepidemic,accordingto
WHO.Thissituationisespeciallydireininsecureareaswheregovernmentandhumanitarianagencyoperations
arerestrictedduetoconfict. SourcesatWHOreportthat
50percentooutbreaksaretakingplaceininsecureareas,
whereevenaccesstoemergencyhealthcareisimpossible.
Forexample,duringthecholeraoutbreako2009,aatality
rateo13percentwasrecordedinunstablepartsothe
southernregion.Theseuntreated,otenseriousdiseases
contributetoAghanistansunder-vemortalityrateo
25 percent,whichisoneothehighestintheworld.102
NationwidecampaignsbytheAghangovernmentwith
UNsupporttoeradicatepoliohaveresultedinthenear-
eradicationothepandemicinthelasttwotothreeyearswithinthecountry,accordingtoWHO.However,insecurity
haspreventedagenciesromaccessing110,000childrenin
theconfict-aectedsouthernprovinces,where20othe
23caseswereregisteredin2009,accordingtoaWHO2009
reportonthepolioeradicationcampaign.Healthagencies
considertheAghanistan-Pakistanregionasaprimaryrisk
areaorpolioasitinvolvestwootheourremaining
countrieswherepoliostillremainsendemicduetoinsecu-
rityanddisplacement,accordingtoWHO.103Whileinsecurity
haspreventedaccesstocertainareas,partiestoconfict
havenotdirectlyobstructedvaccinationeortsinareas
undertheirinfuenceorcontrol,andtheTalibanpubliclydeclaredthatitwouldnotopposeimmunizationcam-
paigns.104Thesuccessulengagementohumanitarian
agencieswithnon-statearmedgroupsinnegotiatingaccess
orimmunizationcampaignshasallowedWHOandits
partnerstoinclude30,000childrenromdicult-to-reach
areas,andtoestablishadditionalDiseasesEarlyWarning
Systemsortheidenticationandresponsetooutbreaks.105
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MalnutritionTheHumanitarianActionAppealwarnedosevere
malnutritionamongunder-vechildren,andinpregnant
andlactatingwomenin2008duetodrought,risingood
pricesandinsecurity.Inact,40percentochildrenunder
veinAghanistanareunderweightand54percentdisplay
severesignsostuntingaccordingtoUNICEF,State of the
Worlds Children 2008.Accordingtothesamesurvey,
24 percentolactatingwomenaremalnourishedand
over19 percentopregnantwomenhavepoornutritional
status.Therearestrongindicationsthatyoungmothers
andchildrenregularlydieomalnutrition-relateddiseases,
accordingtoUNICEFandtheAghanMinistryoPublic
Health.106UNinitiativesocusoneedingchildrenunder
veandpregnantandbreasteedingwomenthrough
eedingcentersandoerdailylunchestostudentsto
encourageparentstosendtheirchildrentoschool.107
Water and SanitationInadequateaccesstocleanwaterandsanitationurther
exacerbatesthehealthsituationorchildreninAghanistan.
Lessthanone-quarteroallAghanscurrentlyhaveaccess
tosaewatersources,andlessthanone-thirdothe
populationisabletouseadequatesanitationacilities.108
Threeoutoourpublicschoolsdonothavesaesanitation
acilitiesorstudentsandapproximately2millionstudents
attendingtheseschoolsdonothaveaccesstosae
drinkingwater,accordingtoUNICEF.109
Basichygienicmeasuressuchaswashinghandswithsoap
atervisitingthetoiletorbeoreeatingcanreducetheriskoachilddyingodiarrhealdiseasesbyhal,accordingto
UNICEF.UNICEFurtherarmsthatespeciallyoldergirls
areextremelyunlikelytoattendschoolsthatlackgender-
separatedlatrines.Improvingaccesstowaterandsanitation
atschoolscanthuscontributetobothincreasingschool
attendanceandreducingchildmortalityinAghanistan.
Drug AddictionThelargesupplyoopiumtogetherwithpoverty,
unemployment,mentalillness,lackoawarenessand
widespreaddespairhascreatedanincreasingdemandor
drugsinAghanistanswar-tornsociety.ThemostrecentUNOceonDrugsandCrimeDrug Use Survey 2005
estimatedthatnearly1millionAghans,including
60,000 childrenundertheageo15,wereaddictedto
drugs.Childrenweremostlyreportedasusinginhalant
tranquilizers.Figuresondrugabuseamongyouthare
believedtobemuchhighertodayandencompassawider
rangeosubstancesduetoavailabilityandcontinuing
stresses,accordingtoUNODC.Mostothewomenusing
opiumareoreproductiveage,makingbabiestheymay
havemoresusceptibletowithdrawalsyndromes,prematu-
rity,accidentalpoisoningandotherhealthissues.110
Morerecently,aewhealthagencieshavereportedentire
amiliesinAghanistanbecomingaddictedtodrugs.111An
AIHRCstudyoundthat15percentodruguserssurveyed
gavetheirchildrendrugstokeepthemquietwhiletheywork.112Theuseodrugshasparticularlyharmulconse-
quencesorchildrenbecausetheyaremoreeasilyaddicted
andsuerpermanentmentalandphysicaldamage.113
Intheirdrivetoacquiremoredrugs,somechildrenjoin
criminalnetworksorarmedgroups,accordingtoUNAMAs
2007report.Healthexpertsalsowarnotheimpending
risksrelatingtodiseasesthatcanbetransmittedby
sharingneedlessuchasHIV/AIDSandhepatitisC(see
below:HIV/AIDS).
OnlyoneoutoourreporteddrugaddictsinAghanistan
receivesthenecessarytreatmentandrehabilitation
services,accordingtoUNODC.Patientsexpectingtreatment
otenhavetowaitmonthsoroneothe100bedsreserved
ortreatment.114Theearobeingstigmatizedalsokeeps
manywomenandchildrenromseekinginormation
andservices.
Psycho-Social DisordersTraumaticeventsexperiencedorwitnessedduringthe
confictcontinuetohauntmanychildren,makingit
dicultorthemtoreadjusttonormallie.Arecentsurvey
oundthat22percento1,011childrenbetweentheages
o11and16yearsattendinggovernment-operated
schoolsinKabul,BamiyanandMazar-i-Shariexhibited
signsopsychiatricdisorder;girlsweretwo-and-a-hal
timesmorelikelytohavedisordersthanboys.115
However,thereislimitedpsycho-socialtraumasupport
providedinthecountry,accordingtoHandicap
International.Standardhealthresponsesorvictimso
violenceevenrapevictimsocusonphysicalcarewith
littleattentionpaidtothepatientsmentalwell-being.
Theproessionocounselingdoesnotevenexistinpublic
healthservices.Somechildprotectioninitiativesengage
confict-aectedchildreninactivitiestopromotecreativity
andplayasanalternativetomoretraditional