For years after the end of the civil war in 1992, Tajikistan attracted little outside attention, despite insecurity, economic collapse, ethnic strife and humanitarian need. This all changed with the US war against the Taliban in neighbouring Afghanistan.
A year ago, Tajikistan faced another severe drought and food insecurity, the health system had collapsed and the economy was in ruins. Yet the country was deemed too insecure for many agencies to operate in, and there was no coherent regional strategy to tackle infectious disease outbreaks and the food deficit. Funding for humanitarian and development programmes fell short of needs, and consistently only a handful of committed donors funded international NGOs in the country. This all changed following the events of 11 September. For several months, between the arrival of foreign forces in neighbouring Afghanistan and the toppling of the Taliban regime, Tajikistan was catapulted into the limelight. Journalists from all corners of the world trooped in, looking for the scoop on refugees, pre-positioning themselves for the expected final battle for control of Afghanistan, seeking out stories of human disaster, demanding as a backdrop warehouses crammed with emergency supplies. With all eyes on Afghanistan, next-door Tajikistan was suddenly important.
From silent crisis to noisy emergency
Before 11 September and the Afghan conflict, even donors admitted that Tajikistan was a forgotten crisis. The country has limited natural resources, poor infrastructure, a fragile government system and, following the civil war in 199297, a history of ethnic violence and insecurity. On 8 September, just days before the attacks in the US, the minister of culture was assassinated. The previous April, the deputy interior minister was shot and killed in Dushanbe; two months later, a group of aid workers was kidnapped in Tavildara district by suspected militants apparently to force the release of his alleged killers. Only a handful of international organisations, donors and governments engaged with Tajikistan, and there was little donor support for humanitarian work. Needs were nonetheless great. Tajikistan, together with much of the region, faced another year of drought and food insecurity. The social structure and health systems were in collapse; poverty rates were estimated by the World Bank at 80% of the largely-rural population. Isolated and marginalised areas of vulnerability, such as the Rasht/Karategin Valley, received very little direct help. Favourable official health figures hid a much grimmer reality; the World Health Organisation acknowledged that, by the end of 2001, there were half a million confirmed cases of malaria, for instance. Bureaucratic obstacles meant that accurate information was hard to obtain.
Overnight in September, Tajikistan suddenly became headline news. Journalists jostled on the steps of the foreign ministry, seeking papers and making requests, and thronged Dushanbes bars and hotels, clutching satellite phones and waiting for up-links. The price of a seat for the ten-minute hop by military helicopter across the border into Afghanistan soared, and vehicles jammed Farkhor-Kokul, the principal unofficial crossing-point. Supermarkets emptied of water supplies, ketchup, beer and dried goods. Amid all this activity, humanitarian issues were sidelined. Our attempts to discuss the situation in Tajikistan with journalists looking for a scoop would often meet with yawns from young guns desperate to be on the front line in Afghanistan, asking is there an image of someone dying?. Agencies found themselves at the end of the queue for visas and permits, behind journalists willing to pay whatever it took to speed up the paperwork. The population stranded in disputed territory on the Pyanj islands became a sought-after and accessible site for eager photographers and news organisations. Some 12,000 people were stranded in this area, which is disputed territory between Tajikistan and Afghanistan. Yet important issues raised the previous year, that the sites were inappropriate and access difficult, were scarcely mentioned; instead, donors suddenly lavished on people more than generous food and other supplies. The British agency Merlin, which had been working with the displaced providing basic healthcare, had difficulty maintaining access amid this new-found attention.
Not all the effects of this massive attention were detrimental. Cynical though it may be, the latest crisis to inflict itself on the people of Afghanistan has prompted a recognition and understanding of the needs of people in Central Asia more widely, including in Tajikistan. Journalists who stayed beyond a week began to venture away from Dushanbe, and found stark images of civil war devastation, social collapse and need. More serious journalists did listen to what aid workers had to say, and some wrote excellent stories on the country. Kenzo Oshima, the UNs humanitarian coordinator, made a landmark visit to learn and review the context and situation in the country. The national nutritional survey conducted under the Action Against Hunger and CARE umbrella in October 2001 highlighted the food deficit, raised awareness of poor weaning practices and underscored a further deterioration in levels of chronic malnutrition. International organisations began to move in, some with the clear intention of managing cross-border activity into Afghanistan, but others motivated by the needs in Tajikistan; health, food and non-food and media organisations have since taken root. Far from the Dushanbe hotel bar, rural people try to survive, suffering daily shortages of electricity, gas pressure so low that it is impossible to cook, harvests which have not enabled a family to feed itself for more than a few months. They were seen, and there was a response.
While we may resent the intensity of effort that was required to attract awareness of the situation in Tajikistan, the result is more coherent attention and acknowledgement of the crises facing the country. Earlier in 2001, following an outbreak of haemorrhagic fever in Khatlon region, the Ministry of Health refused to acknowledge the standing WHO protocols for communicable disease notification and response; these protocols are now fully endorsed. There is more interest and genuine concern for the needs that MSF has been responding to: in-patients of psychiatric institutions, where high rates of mortality previously existed, and the population of the Rasht/Karategin Valley, which is in need of basic healthcare, including access to essential drugs, reproductive healthcare and the capacity to respond to outbreaks of diseases of epidemic potential, including brucellosis, typhoid and malaria. Both populations remain excluded and vulnerable. While the social context has changed, and the need for psycho-social care has shifted away from war-related stresses and trauma, longer-term treatment for domestic violence and drug and alcohol abuse needs more international support. The greatest threats to public health in the region HIV/AIDS, tuberculosis and malaria are now the subject of regional forums and consultative processes led by NGOs, the UN agencies, the World Bank and the Asian Development Bank.
The humanitarian challenge
What is needed now is funding for longer-term programme initiatives at the structural level. Short-term funding saturation will not relieve the more chronic issues, only the most acute humanitarian needs. If the food deficit is not addressed at the central and regional levels, by changing policy to prioritise food crops over cotton, then it will persist, as will the risk of deteriorated health. There is also a need for institutional support to tackle corruption. While much has indeed changed, political stability is still not assured, and security concerns still prevent many organisations from establishing projects in the Rasht/Karategin Valley.
While increased attention and assistance to Tajikistan and the region is clearly needed, the way this is provided requires careful scrutiny. The immediate reaction of some donors, notably the US, to provide military and development assistance as pay-back for Tajikistans support during the war in Afghanistan means that there is a risk that this tap will be turned off just as quickly should this support be withdrawn. Humanitarian agencies need to resist this, and to fight to ensure that humanitarian and development assistance is not confused with the politics of bilateral support and foreign policy concerns. Independent and impartial action, which has been critical in protecting agency presence in Tajikistan, must continue. Funding for humanitarian assistance should not be conditional on political support, but should be provided based on need in an impartial manner. This may be an old adage, but it has been called into question in this latest crisis.
Penny Harrisonis Head of Mission for MSFHolland in Tajikistan. She worked with MSFHolland in Pakistan/Afghanistan in 2000, and in Uzbekistan in 199899.
References and further reading
Politics of Compromise: The Tajikistan Peace Process, ACCORD, Issue 10, 2001.
Mohammad Reza Djalili, Frederic Grare and Shirin Akiner (eds), Tajikistan: The Trials of Independence (New York: St. Martins Press, 1998).
Tajikistan: An Uncertain Peace, International Crisis Group, December 2001.
MSF-Holland, Mothers Health Survey: Rasht/Karategin Valley, Tajikistan, April 2000.
Action Against Hunger (UK), Representative National Nutritional Survey Tajikistan (Sughd, RRS, Kouliab and Kurgan Teppe Regions), Final Report, OctoberNovember 2001.
Abduvakhid Baibabayev, Deborah Cunningham and Kaz de Jong, Update on the State of Mental Health Care in Tajikitsan, Journal of Mental Health Reforms, Third Quarter 2000.
Republic of Tajikistan Ministry of Health official health statistics are available at www.medinfo.tojikiston.com (in Russian).