Kamila is almost 3 years old, but she weighs just 11 pounds (5 kilograms). Her wrinkled skin sags off her skeletal limbs and stretches around her distended belly.
Kamila has been malnourished for eight months now, says her grandmother Bilqis, as she attempts to soothe her in a sparse hospital ward filled with other emaciated children in Kandahar, southern Afghanistan.
Too weak to cry, the little girl rubs her ears in pain.
“Her mother is sick and we are poor people,” Bilqis says. “She tried to breastfeed her but had no milk to give.”
Kamila’s family are among millions of Afghans struggling to survive severe food shortages during a harsh winter and economic crash. Rights organizations are pleading for more foreign aid, arguing the most vulnerable groups — women and children — are suffering.
In a statement to CNN, the ruling Taliban acknowledged the country’s “economic problems” — but vehemently denied there was a crisis, calling such claims “fake.”
“No one will starve cause there is no famine and the cities are full of food,” said Taliban spokesperson Zabihullah Mujahid — contradicting graphic images of starving children.
Even before the Taliban seized power in Afghanistan in August, poverty and food insecurity were widespread due to back-to-back droughts, economic decline, protracted conflict and the pandemic.
But three months after the takeover, the crisis has rapidly worsened. Billions of dollars of foreign development aid has dried up, depriving the country of money that had been propping up the economy, key services and aid workers.
As winter sets in, nearly 23 million people — more than half the population — are facing extreme levels of hunger, according to the United Nations. At least a million children under 5 are at risk of dying from starvation.
Conditions are so bad that some hospitals, without money for fuel, have resorted to cutting down trees to heat patients’ rooms, and aid groups warn the situation will only get worse if the international community doesn’t act now.
Desperate families sell everything
The unforgiving weather has exacerbated food shortages.
The vast majority of Afghans rely on agriculture for their livelihoods, but the country has lost 40% of its harvest this year to the drought, according to the World Food Programme (WFP). As food supplies dwindle, the cost of staples like wheat and bread have skyrocketed.
“We only have water and bread — sometimes we have it, but sometimes there’s nothing to eat,” said Musafer, a laborer and shopkeeper who goes by one name.
Earlier this month, he took his daughter to Ghor Provincial Hospital in the provincial capital Chagcharan.
Razia is almost 3 years old, but her ribs and spine jut out with horrifying clarity as she buries her face in her mother’s lap. This is her third hospital visit in just eight months — and she’s not getting better.
“There is no work, no income, no food to bring her,” Musafer said. “Every time I see her I get upset.”
Richard Trenchard, the Food and Agricultural Organization Representative in Afghanistan, described the situation as “disastrous” in a November statement.
“Every farmer we’ve spoken to has lost almost all of their crops this year, many were forced to sell their livestock, they have accumulated enormous debts and simply have no money,” he said.
Before the Taliban’s takeover, poverty had been common in many of the country’s rural areas — but now, middle class and urban residents have also been plunged into despair.
Government workers and school principals — many of whom have gone months without pay — are among those queuing up for food rations and medical attention, the WFP warned. Across the country, families are selling their clothing, furniture, livestock — sometimes even entire houses — for food, the agency said in a news release.
The risk of famine had once been restricted to rural areas — but now, 10 out of 11 of Afghanistan’s most densely populated urban areas are facing emergency levels of food insecurity, warned Deborah Lyons, head of the UN Assistance Mission in Afghanistan, in November.
In internal displacement camps, some of the poorest families who have nothing left to sell resort to offering their daughters as child brides. It’s the only way to keep their other children alive, several parents told CNN.
In the statement to CNN, Mujahid, the Taliban spokesperson, said Afghan people urgently need food and medical supplies.
He said the Taliban is “trying to increase this aid” and distribute it to the people, along with humanitarian groups.
Overwhelmed hospitals
Hospitals have been overwhelmed with starving patients, even as medical supplies and staffing run short.
Afghanistan’s nationwide health program had previously been financed by the World Bank — but funding came to a halt in August, leaving 2,300 facilities without the means to buy medical supplies or pay salaries.
By late September, most of those hospitals and clinics had closed, with fewer than one in five still open, according to a UN report.
Before the Taliban takeover, there were 39 hospitals in Afghanistan that treated Covid-19; now, only three or four are still functioning, said Dr. Paul Spiegel from Johns Hopkins University, who has just returned from Afghanistan, as a consultant for the WFP.
The World Health Organization is among agencies that have resumed airlifting essential medical supplies to Afghanistan; the four shipments of supplies so far should cover 1.5 million patients, WHO said in November.
Meanwhile, the UN Development Programme provided $15 million to Afghanistan’s health sector in November, helping pay wages to more than 23,000 health workers, according to a UN news release.
But many humanitarian workers and doctors on the ground warn it’s not enough.
At the Ghor Provincial Hospital, up to 100 mothers and children arrive each day seeking treatment for malnutrition — as well as a host of other illnesses like measles, diarrhea, cold and flu, said Faziluhaq Farjad, head of the hospital’s malnutrition ward.
These problems are all linked, he added — malnourished mothers and children become more susceptible to illness and infection. Often they have to travel long distances to get to hospitals and arrive even weaker, he said.
But the hospital’s supply of equipment and medicine is rapidly dwindling — the malnutrition wing only has milk left to provide for its patients.
“Almost 70% of the cases are severe and this is in the city — imagine how bad the districts are,” Farjad said. “If nobody pays attention it’s going to get much worse.”
One of Farjad’s patients, 1-year-old Nasrin, is so severely malnourished she’s spent almost half her life in hospital, said her father, Abdul Rauf, who works as a laborer.
“Every 20 days, every 10 days, we are at the hospital,” Rauf said. “This is my life and we spend it like this.”
Calls for foreign aid
Foreign governments’ efforts to choke the Taliban of funds are having the unintended effect of starving the Afghan people, say aid organizations, who are calling on donor countries to change their strategy.
Spiegel, the doctor who visited Afghanistan for WFP, urged foreign countries to reconsider their move to freeze Afghan assets after the takeover, including funding for government-run hospitals.
“The US, UK, EU have to make some decisions quickly or its going to be too late and there’s going to be a tremendous amount of unnecessary death,” he said.
He acknowledged the desire of foreign governments to avoid legitimizing the Taliban and hold it to account but said the existing sanctions aren’t nuanced enough.
“The goal of change is a good goal, but is it worth tens of thousands of deaths?” he said.
The European Union pledged a 1 billion euro ($1.12 billion) aid package in October, and the World Bank’s board recently committed $280 million to the UN Children’s Fund and the WFP. The United States has also contributed nearly $474 million in humanitarian aid — separate from development aid — this year.
But even the international funds that have been pledged are just a fraction of Afghanistan’s $9.5 billion frozen assets. And those funds are being channeled to international organizations already working in Afghanistan, according to statements from the US and EU governments — meaning the money is not accessible to Afghan banks or public.
A number of US lawmakers, largely Democrats, have also urged the Biden administration to release frozen Afghan funds to the UN as humanitarian assistance.
When pressed Monday about the impact of sanctions on Afghan civilians, Ned Price, spokesperson for the US State Department, said Washington had warned the Taliban before the takeover that seizing control would jeopardize foreign aid from the US and other countries.
He said before the US can consider any future relationship with the ruling Taliban, the Islamist group must make certain human rights commitments, including forming an inclusive government. The US remains committed to assisting the Afghan people, Price said, pointing to the humanitarian aid provided so far.
Facing mounting pressure, the administration said Wednesday it would lift some restrictions on the type of aid humanitarian organizations can provide to Afghanistan, which will allow greater support for educational programs, including paying teachers’ salaries.
Martin Griffiths, the UN Emergency Relief Coordinator, said Afghanistan will not get through the winter on emergency aid alone.
“The need for liquidity and stabilization of the banking system is now urgent — not only to save the lives of the Afghan people but also to enable humanitarian organizations to respond,” he said in a statement on Sunday.
For Afghan families on the ground, there is nothing to do but wait for help to arrive. After 15 days of treatment, Nasrin was released from the hospital, weighing just over 14 pounds (6 kilograms). The family returned home, where there are four other hungry children waiting.
“I ask the international community to help every poor person who are suffering from poverty and hunger,” said Rauf, Nasrin’s father. “If they don’t help us, I will lose my kids.” (Courtesy CNN: Excludes headline)
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