LETTER FROM AFGHANISTAN Malnutrition and Mortality in Kohistan

ACIVIL CONFLICT IN AFGHANIstan for more than 2 decades has caused more than 3.5 million people to flee to neighboring countries, such as Pakistan and Iran, which are among the nations hosting the largest number of refugees in the world. Of the approximately 24 million people living in Afghanistan in March 2001, of whom more than 1 million are internally displaced, the World Food Programme estimated that 3.8 million persons would need food aid; this estimate increased to 6 million in October 2001. Afghanistan, with a life expectancy of 46 years and an infant mortality rate of 165 per 1000 live births, has some of the worst development indicators in the world. During the past 3 years, the situation has been exacerbated by a severe drought that has resulted in poor agricultural yields. In 2001, assessments in the west and north of the country indicated that the availability of food was deteriorating. However, populationbased data for nutrition, food security, and mortality indicators required to guide humanitarian interventions are not available for many regions of Afghanistan because of difficulty accessing remote mountain villages. Save the Children (SCF)–USA, which has been working in parts of Faryab province, Afghanistan, since 1995, undertook a survey, with technical support from the Centers for Disease Control and Prevention (CDC), from April 4 through April 10, 2001, in Kohistan district, Faryab province (FIGURE 1). One of the remotest districts in Faryab province, Kohistan, with an estimated population size of 57600, has few health services, no physicians, and no routine expanded program on immunization. It is representative of other highland districts within Faryab and surrounding provinces in Afghanistan that rely on rain for crop production and are normally inaccessible by car for approximately half of the year due to snow. Until the drought, Kohistan was not only self-sufficient in food production but actually supplied food to other regions in Afghanistan. Therefore, at the Context The humanitarian situation in Afghanistan has been deteriorating for more than 3 years because of civil war and severe drought. Because of recent events, the international community is predicting a severe worsening of the country’s current situation.