As US troops retreat from Afghanistan, ending Washington’s longest war in history, a new era has begun for a country that has seen invading forces move in and out of its territory for centuries .
The news was dominated by Taliban forces quickly taking control of provincial capitals and taking Kabul without resistance, beyond the sight of abandoned Western embassies, Afghans desperately trying to leave the country, foreigners fleeing en masse and many non-governmental organizations ceasing their operations.
Unlike these scenes, Médecins Sans Frontières (MSF) and a small number of other humanitarian agencies maintained their presence and activities during the height of the fighting, providing care that saved the lives of the sick and injured.
How was this possible? MSF has had successes and failures in Afghanistan, but the principles that guide our actions have remained the same: we only work if we have the explicit agreement of all parties involved in the conflict. This included the Taliban, US forces, the Afghan National Army and, in some cases, militias active in the region.
Our principles of neutrality, independence and impartiality, which sometimes seem abstract, have been put into practice by engaging with all parties, by refusing public funding, by being clearly identified so as not to be confused with other groups with different interests, and making our own local hospitals where guns are not allowed. Anyone entering an MSF medical center must literally leave their weapons outside before entering.
When we worked in hospitals in Kunduz or Lashkar Gah, we often explained to American, Afghan and Taliban soldiers that we would never refuse to rescue a patient, whether it was an injured government soldier, victim of a traffic accident or a Taliban fighter.
Screening performed in our hospitals is based solely on need. We work on medical ethics, not on who is considered a criminal, terrorist, soldier or politician. We often had to ask American or Afghan soldiers to leave and come back without their weapons if they wanted to enter the hospital.
Our approach often contrasted with how the aid system, including humanitarian agencies, came under pressure from donors to build the Afghan state, create stability in areas taken over by Afghan government troops, and help the legitimacy of a newly created government. -installed with the help of the USA. The aid was the “soft power” used to bring the population to join the Afghan government, a key part of the “hearts and minds” strategy, complementing the power exerted by force through military action in the country.
This was revealing when we found a Western humanitarian aid provider in Kabul, and they were unable to tell us where the humanitarian needs were most acute. Instead, they showed on a map the areas controlled by coalition forces (green), Taliban-controlled (red), and conflicted (purple). Aid was being sent to the green and purple areas to relaunch the military effort.
International NGOs receiving money from Western governments involved in the conflict have been shocked to notice the use of counterinsurgency military language, such as “clear the field and maintain control”, in connection with the funding of their activities. . As one of the biggest government donors in Kabul once explained to us: “The Taliban are winning in this province, we told the aid agency to cover the province with wheat, and they did.” .
But the way we act has not always protected us. It was in 2015 that US special forces bombed our hospital in Kunduz after the province was temporarily occupied by the Taliban. It showed us the “gray areas” that exist in conflicts of this kind.
Aid is tolerated and accepted when it strengthens the legitimacy of the state, but it becomes susceptible to destruction when it enters territory where entire communities are identified as enemies and when the state feels threatened. This “gray area” is fueled by legal ambiguities between national and international laws, creating environments conducive to what US authorities have called “mistakes”.
After the destruction of our hospital, MSF again contacted all parties involved in the conflict to convey the need to respect our medical activities. It was probably the broad public support we received and the political cost of the attack on MSF that ultimately served as protection against future deception by US or Afghan forces.
Despite this, this kind of protection given by commitment and public pressure did not help when our motherhood was brutally attacked in Dasht-e-Barchi, most likely by the Islamic State group in Afghanistan, with which we did. were unable to establish a dialogue.
While MSF was able to operate in the provincial capitals, we were unable to access rural areas to meet the needs of these places. This has been one of the failures of the organization’s work in recent years.
Despite this, two weeks ago, when the Taliban entered the cities, we were able to continue the work of taking care of patients: the sick and wounded were able to receive medical care in structures adapted to cope with the intensity of the fighting. In Helmand, Kandahar, Kunduz, Herat and Khost, our teams continued to work. Our medical facilities are now full of patients.
That is why, at MSF, we seek to negotiate with all parties to a conflict: so that our teams can provide assistance when it is most needed.
These moments often occur in the midst of shifts in power and control. This is also why we resist efforts to integrate our activities into political state-building processes. That’s why we raise our voices when our facilities and staff are affected.
Afghanistan’s future is uncertain and our activities will continue to be under pressure. The challenges we face will change and the safety of our teams and our patients remains a concern. But to weather the future storms that will sweep through Afghanistan, aid workers would do well to decide their own path based on existing needs, rather than being pushed by unstable political winds.
Afghanistan is a demonstration of how nation-building initiatives led by foreign actors can fail, and how the contributions of humanitarian actors to such efforts are minimal. It also shows that our work can save more lives, the more independent we are, both when a state is built and when it collapses.