To the Editor: The Commentary by Drs Loevinsohn and Sayed1 on the role of nongovernmental organizations (NGOs) in the rebuilding of Afghanistan's health sector provided an overview of an international, coordinated response to a chronic humanitarian crisis. However, it did not mention the role of the International Security Assistance Force (ISAF) and its member military organizations in those capacity-building efforts.
Afghanistan represents a complex emergency, a situation characterized by a humanitarian crisis in a militarized failed state. As attested to in the 2006 United Nations Disaster Assessment and Coordination Handbook2 and the 2005 US Agency for International Development Field Operations Guide,3 security is of paramount concern in rendering effective, sustainable assistance. In Afghanistan, the ISAF and the Afghan National Security Force (ANSF) are helping provide the physical security necessary for NGOs to conduct their work.
In addition, ISAF member militaries are involved in medical capacity building and are likely to be at least partly responsible for the improvements cited by Loevinsohn and Sayed. In Kandahar province, the Canadian-led NATO Role 3 Multinational Medical Unit Hospital provides preventive medicine, primary care, and trauma training to ANSF medical personnel. These efforts, in conjunction with those of locally operating NGOs, the Afghanistan Ministry of Public Health, and a US Hospital Embedded Training Team, enabled Kandahar's health care system to process scores of casualties after a February 2008 suicide blast at a dogfight in Kandahar City that left 80 dead and close to 100 wounded.4
These efforts are not limited to Kandahar. In Zabul province, an Emirati-constructed provincial hospital is mentored by the Jordanian military. In Uruzgan province, coalition military medical teams routinely work with local health care facilities. In Kabul, US and coalition military and civilian personnel work to improve the quality and accountability of both the undergraduate medical curriculum and the system of graduate medical education at the Kabul Medical University. The efficient functioning of this institute, which provides the majority of trained Afghan clinicians, is critical to enabling an autonomous Afghanistan medical system.
The role that ISAF member militaries play in enabling and aiding the NGO efforts to rebuild Afghanistan's shattered health infrastructure points to how closer civilian-military partnership may help address similar humanitarian emergencies in other locales.
This letter was shown to Dr Loevinsohn, who declined to reply on behalf of the authors.—ED.
Financial Disclosures: None reported.
Additional Information: Dr Saguil is the officer-in-charge for primary care of the medical unit. Dr Farnell is commander of the medical clinic.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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