KABUL, 14 May 2008 (IRIN) - The killing and abduction of dozens of health workers in the past two years has prompted officials to shut down at least 36 health facilities in Afghanistan's volatile southern and eastern provinces, depriving hundreds of thousands of people of basic health services, according to the Ministry of Public Health (MoPH).

"More than 360,000 people in Helmand, Kandahar, Farah, Zabul and Paktika provinces are deprived of health services due to insecurity," Abdullah Fahim, a spokesman for the MoPH, told IRIN in Kabul on 14 May.

Afghanistan has managed to reduce slightly its high infant mortality rate from 165 under-five deaths per 1,000 live births in 2001 to about 135 per 1,000 in 2006, but it is still struggling to deliver basic health services in some 85 percent of the country's territory, according to the preliminary findings of a Johns Hopkins University household survey in 2007 [http://web.worldbank.org/WBSITE/EXTERNAL/ACCUEILEXTN/NEWSFRENCH/0,,contentMDK:21317727~menuPK:64615830~pagePK:166745~piPK:459740~theSitePK:1074931,00.html].

However, insurgency-related violence and increased attacks on health workers have put the country's public health achievements at risk, experts warn.

Deaths, abductions

Taliban insurgents and other criminal groups have repeatedly attacked aid workers, including health providers, mainly for political reasons. The Taliban reportedly demanded the release of their fighters from jails in exchange for the release of health workers they held hostage in March 2007 [http://www.iht.com/articles/ap/2007/03/29/asia/AS-GEN-Afghan-Violence.php].

"Forty health workers have been killed and/or kidnapped while delivering health services in the past two years," said Fahim. "They were all innocent people who were working for a noble humanitarian cause," he said.

As the conflict has intensified and spread, the International Committee of the Red Cross, the UN and other aid agencies have increasingly voiced concern about the "diminishing humanitarian space" [http://www.irinnews.org/Report.aspx?ReportId=75902] which is increasingly impeding access to the most vulnerable communities across Afghanistan.

In April the president of the ICRC, Jakob Kellenberger, [http://www.irinnews.org/Report.aspx?ReportId=77755] said the Taliban had agreed not to attack humanitarian health activities in areas under their influence. However, an official of the Ibn Sina non-governmental organisation (NGO) which provides basic health services in the south and southwest said access had not improved since Kellenberger's talks with Taliban leaders.

"Our 14 health posts in Helmand Province and two in Zabul Province still remain closed and we see no positive signs that the Taliban will allow us to re-open them in the near future," said the official who preferred anonymity for security reasons.

Undiagnosed, untreated diseases

Health officials in Kabul said they did not know for sure what kind of diseases might be affecting isolated communities and what alternative treatment options were available.

"All we know is that TB [tuberculosis], malnutrition, polio, obstetric problems and some infectious diseases are common in those areas," Fahim said, adding that several polio cases had been reported in Kandahar and Helmand provinces in the past six months.

People in the affected areas either trek to provincial capitals for treatment or rely on medicines given to them by irregular traders who often sell medicines without a proper diagnosis having been carried out.

Taliban insurgents have responded negatively to repeated calls by the MoPH and NGOs involved in health activities to allow health workers to access insecure areas.

"Unless we receive reliable assurances that our staff will not be attacked, and will be treated humanely, we will not put their lives at risk by sending them to insecure areas," said Fahim.

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