Impact of Humanitarian Assistance in Afghanistan
(2001-2021)
Dost Mohammad Omar
Matricula N.: 125595
Conflict Management and Humanitarian Action
University of Siena Academic year 2021-22
11/July/2022
Abstract
In this paper, I’ve tried to find what impact has had after trillions of dollars were spent on
the reconstruction of Afghanistan. We will try to investigate most crucial sectors of social
life that got effective with these assistance.
I have studies improvements in the Public health system, educational reforms, local stability
of Afghanistan, and skill building programs of Afghan public sector employees. And we will
read, either the fate of ordinary Afghans after twenty years of international intervention
are changes or still living in the era of pre 2001. As it’s claimed that the American and
international aid NGO’s were not trying to implement long term project for lasting
prosperity in the country but for political and security goals of United states of America.
Introduction
Four decades of war have destroyed everything in Afghanistan. Whether it was education,
irrigation, agriculture and livestock, and other infrastructure projects, everything was equal
to zero. But when the international community came to Afghanistan after 9/11, many
aspects of life changed in the country. like If we do not ignore the fact, then we have to say
that highways have been built it’s mean major cities of the country have been connected
to the capital Kabul, new schools have been built and old ones have been renovated, girls
and boys have gone to school, private education centers have been built. The media has
become even more active than necessary. Women were given the opportunity to work in
private and public institutions, telecommunication services were provided, people accessed
the Internet, and entertainment facilities was provided to people in the cities. And so on.
But there has been no significant progress in infrastructure projects such as electricity that
should have been built from the country's own resources, agriculture and livestock renewal
and reform.
So I decided to use this article to assess international aid and see how effective it was. This
is because there have been reports from various surveillance agencies that deep
embezzlement has taken place in many areas which need to be assessed.
Training Technical Staff
The goal of the international community was to assist Afghanistan in establishing a
lasting, legitimate, and representative government, given sufficient security and stability.
After nearly three decades of civil war, this would be no easy task. Afghanistan was not
only experienced serious shortages in infrastructure, clean water, health care, and
education in 2001. The country was also plagued by underdeveloped governmental
structures and a dearth of technically skilled public workers. Rebuilding state ins titutions,
establishing norms, processes, and procedures, as well as training Afghans at all levels to
carry out crucial governmental responsibilities all required major support, as is nearly
often the case for nations recovering from years of conflict. Donors have funded technical
advisers whose purpose was to teach and enhance the capability of Afghan civil servants and
government personnel. These advisors were primarily foreigners in the beginning. But later
majority of them were Afghans, hence the term "national technical advisers" (NTAs). NTAs. In
this regard, President Ashraf Ghani and CEO Abdullah Abdullah took over a government that
was essentially a shell, with key technical departments reliant on Afghan contractors paid for by
donors to keep things running. When the new cabinet was formed in 2015, almost all of the
new ministers made capacity expansion a top priority in their ministries' 100-day plans. Many
of the new ministers acknowledged that their employees worked as contractors for donorfunded, time-bound projects. 535 full-time NTAs embedded in line ministries working in a civil
service capacity were being supported by USAID, according to a report given to President
Ghani's office in March 2015. This number included 120 in the Ministry of Public Health and 97
in the Ministry of Finance alone. This circumstance cannot continue. A significant government
civil service reform program called Capacity Building for Results is part of the Afghanistan
Reconstruction Trust Fund (ARTF), which was formed in 2002 to offer a coordinated financing
mechanism for Afghanistan's budget and priority national investment projects. In accordance
with the 2012 program, the government may employ up to 2,500 senior and higher mid-level
professional individuals as civil service (Tashkeel) staff. In place of donor-funded NTA
contractors, these are engaged at a civil service pay to occupy important government line
positions and carry out intrinsically governmental duties. As of the summer of 2015, the
initiative had hired fewer than one hundred new government employees. President Ghani
issued an executive order in July 2015 that increased the Ministry of Finance's responsibilities
and streamlined the employment procedure. As a result, both the government and the World
Bank are moving forward with widespread recruiting. Once these new tashkeel are in place,
donors—including USAID—should be able to drastically cut the number of pricey contractorfunded NTAs in ministries if they are properly managed inside each ministry.
Additionally, and perhaps even more significantly, the donors have agreed to align
compensation for Afghan technical advisers employed by ministries under donor -funded
programs with the salary scale for Capacity Building for Results. This should clear up any
misunderstandings, create an even playing field, and enable the government to hire top
Afghan specialists by paying them salaries that are competitive with those of other donor funded contractors. In 2016, salary harmonization—officially referred to as the NTA
compensation scale—was put into effect. Compliance is still a top focus for USAID.
However, until the Afghan government showed the political will to hire tashkeel based on
merit rather than favoritism, donors had no alternative but to allocate NTAs with in
ministries to guarantee that government operations continued in a timely manner.
Contractors not wanted to lose their jobs, ministers were able to obstruct reform by
relying on NTAs funded by donor projects, and donors more than willing to fund those
projects to ensure continued operation of the government all served as disincentives for
real reform to the primarily patronage-driven system. However, later under President
Ghani's leadership, the way forward was obvious in terms of creating true government
institutions and supporting capacity building for a cadre of skilled government workers in
important ministries. By coordinating pay, making sure that any residual NTA contractors were
answerable to ministries, and establishing precise measures for capacity building.
Education Reforms, Development and Concerns
As I said in the introductory paragraphs, since the Russian invasion and the fall of the Taliban
regime in 2001, Afghanistan's education system was equal to zero, and most of the country's
children was busy working with their parents to keep themselves from hunger. Schools were
either closed or turned into battlefield hubs. And if there was a school in some areas, it was for
the boys only, because the girls' schools were closed all this time. So it would be a so-called school
with no teaching materials and no suitable environment. During snow and rain it would not be
possible for children to come to school because the schools would not have roofs. To short the
education system was not at all.
But with the advent of the international community in 2001 and with the special attention of the
Ministry of Education, schools were built in the country and the old ones were renovated. Equal
access to education for girls and boys provided. The modern curriculum was developed in line
with the demands of the present age and millions of books were printed and distributed to most
of the schools in the country. However, there were always concerns about the possible
corruption in the ministry, especially when people in the media hear that there is widespread
corruption in the Ministry of Education.
It is believed that 3.5 million children were not attending schooli, with girls making up three
quarters of the total (Mashal and Nahim 2018). Although violence had been the primary factor
in school closures, corruption had also been a significant factor. From the ministry to the school
level, corruption in the educational system occurred at most levels (MEC 2017). One problem
was particularly pervasive and serious: hiring instructors and personnel after accepting a bribe
(in other words, teacher jobs were bought, not earned). At the same time, qualified teachers
frequently struggled to obtain employment. The Ministry of Education had "severe levels of
nepotistic influence" at upper levels, according to MEC 2017:4. Bribery, non-competitive
procurement methods, theft, data manipulation, and the "ghost school" phenomena were so
commonplace in the past (MEC 2017). Poor management in the education system had a negative
impact on public confidence. The Ministry of Education was ranked as Afghanistan's second-most
corrupt institution by respondents to the national corruption study (Integrity Watch 2018),
However, universities were seen as the most transparent establishments in Afghan society
(Integrity Watch 2018). The government had taken action to combat corruption in the education
sector by establishing more open and competitive hiring procedures (OCCRP 2018). The Taliban
had also permitted schools to operate in the territory under its control, but this may have been
due to their desire for a cut of the bribe rentals and/or control over the curriculum and teacher
hiring (Mashal and Nahim 2018).
Local Stability Program
Following conflict and war, stabilization initiatives are typically used as a fast support system for
rural populations. Programs for post-conflict stabilization (and sometimes focused mid-conflict
stabilization) are meant to work closely with diplomatic and military efforts to establish and
sustain peace while boosting public support for the legitimate authorities and lowering support
for rebels. In order to directly address what frequently turned out to be local issues, USAID
frequently identified the origins of instability and then helped communities through adaptable,
short-term programs.
In 2001, USAID initiated its first stabilization effort in Afghanistan, which was run by the Office of
Transition Initiatives (OTI). The Provincial Reconstruction Team's (PRT) quick-impact initiative
was established in 2003. The military and civilian upsurge in 2009 and the emphasis on
counterinsurgency necessitated a considerable expansion of USAID's stabilization programming.
Stabilization was designated as a crucial mechanism on the civilian side to support military
counterinsurgency operations in a new civilian-military strategy developed in May 2009. In
accordance with this approach, the main goals of cooperative civilian and military actions were
broken down into four phases: shape, clear, hold, and build or transfer.
As soon as kinetic operations stopped and access to local leaders started during the clear phase,
stabilization efforts were to get under way. The agency's primary contribution was quickresponse grants at the local level to launch initiatives to reconstruct basic community
infrastructure, including nearby wells, roads, and schools. The hold phase continued communitylevel efforts while giving the Afghan government time to enhance the provision of fundamental
services and once more address the sources of conflict. Through the PRTs and district support
teams, Kabul-based programs were to provide province and district governments with assistance
during the build phase. Roads, energy, small-scale infrastructure (schools and irrigation systems),
market-led agriculture development, financial economic growth programs, civil service capacity
building, media training, and trade and economic growth programs were among the projects that
were to be undertaken by USAID partners.
In order to support the US military's counterinsurgency goals under the clear, hold, and develop
strategy in focal areas, often referred to as important terrain districts, the agency supported a
number of stabilization programs. Therefore, the east and south were the focus of an estimated
two-thirds of all agency aid for Afghanistan throughout the surge era. Some of these initiatives,
including the Community Cohesion Initiative and the Afghanistan Stabilization Initiative, were
managed by OTI and were intended to be short-term projects, however OTI was not sufficient
for this.
USAID was widely expected to work for regional stability rather than counterterrorism. The multimillion dollar Stabilization in Key Areas programs, the Afghanistan Vouchers to Increase
Production program, the Afghanistan Social Outreach program, and the Strategic Provincial
Roads Southern and Eastern Afghanistan program are four examples that show the difficulties in
moving swiftly in conflict areas with short-term, quick-response, quick-impact programs.
As seen by numerous final project reports and audits, the results have been inconsistent.
Additionally, trade-offs were challenging in a few cases, such as when USAID resources were
planned for short-term, high-impact programs at the price of longer-term agricultural
development initiatives. The long-term effects of various stabilization efforts were always
unknown. The Measuring Impact of Stabilization Initiatives project, labelled "the most
comprehensive trends analysis and impact evaluation of stabilization interventions that the U.S.
government has ever undertaken," sought to quantify the effects of the important neighborhood
and community cohesion stabilization programs. Nearly two hundred thousand one-on-one
interviews were conducted over a period of twenty-seven months in five waves of surveys that
were conducted every six months in just over five thousand villages across 130 districts in twentythree provinces of Afghanistan where stabilization programming was being carried out or taken
into consideration. Studies identify several, frequently converging concerns. A comparable
national Afghan government commitment to build and increase the number of qualified local
government officials and to enhance governance at the province and district levels was assumed
by community-level stabilization initiatives and cooperation with local leaders. The amount and
intensity of this were not met. Only 60% of the 376 districts in Afghanistan had judicial
employeesii, according to the Afghan government, who claimed this even in their final days.
A recent study by the Center for American Progress, which looked at the impact of US civilian
development, found that most of the gains were short-lived, that the Afghan government
formation process was unsystematic, and that within the Afghan government. Due to the lack of
coordination between the various levels, the work that was started at the local level stalled
before completion, the survey also states that USAID is working to strengthen the military rather
than the civilian institutions.iii
According to Carnegie foundation report, foreign aids were specifically to achieve US political and
security targets rather than Hard Aid, which clearly says that it was not about long term
traditional development goals.iv The difference between the two is distinct and significant, but
the report notes that the distinction is hazy and convoluted. This is particularly true in
Afghanistan, where the agency closely collaborated with the US military in locations picked by
the military and concentrated on short-term political and security goals connected to
counterinsurgency and stabilization.
Given the significance of short-term stabilization activities in post-conflict and counterinsurgency
operations, the duration of the Afghan conflict, the existence of databases pertaining to security,
stabilization, and community development, and the lack of more comprehensive quantitative
analyses pertaining to USAID-supported programs, USAID funded a quantitative assessment to
better understand the impact of stabilization programming in Afghanistan in order to prepare for
similar effort. Smaller initiatives can be better targeted and may be less likely to contribute to
instability and corruption, according to the review, which also concluded that stabilization
programs typically have only a limited influence on violent conflict and other important outcome
metrics.v
Public health of Afghanistan
Since the US invasion that toppled the Taliban in 2001, the majority of healthcare is provided by
NGOs. The health indicators for Afghanistan are among the lowest in the world. In 2004 vi,
Afghanistan received a score of 173 out of 178 on the UN's Human Development Index. The
burden of disease is largely influenced by infectious diseases, including measles, malaria, acute
respiratory infections, and diarrheal disorders. Malnutrition, physical and psychological harm, as
well as violations of human rights, are serious issues in the nationvii. Prior to 2001, when the
Taliban was in their 1st round of power, most of social welfare work, such as health, education
and food supply, was carried out by international charity organizations. But when the US-led
International Security Assistance Force (ISAF) arrived in Afghanistan, the health sector, among
others, got attention of the government and international aid agencies. For example, hospitals
were built in many safe areas of the country. However, it must be said that these were primary
health care level center and their services were weak and inadequate, due to the shortage of
talented doctors on the one hand and the lack of diagnostic equipment on the other. Of course,
in the capital, Kabul, which is the most populated city and five other big cities of Afghanistan
(Jalal Abad, Kandahar, Hirat, Mazar I Sharif), health services were somewhat better, but in other
provinces, even in the districts of Kabul health services were at an early stage, such that even a
patient with a common disease would go to Kabul if not he could have died.
For many years, the healthcare system has been in shambles. Several organizations, including the
Afghan government, several nongovernmental organizations (NGOs), and the US government,
worked together to rebuild the health care system in Afghanistan. Despite considerable progress,
there were still many obstacles to overcome.
In an effort to deliver healthcare that would have the most economical impact on common health
problems, the Ministry of Public Health had achieved progress in Afghanistan by implementing
the Basic Package of Health Service (BPHS). Under the BPHS, trauma and trauma-related
impairment were both listed as priorities, and work had started to address these issues. The
military and non-governmental groups provided the majority of the emergency care in
Afghanistan. It is necessary to address issues with safety, inadequate infrastructure, economic
hardship, difficult access to healthcare facilities, bad facility conditions, and a shortage of
qualified healthcare workers, particularly female staff.
Afghanistan's health has slowly improved since 2001, but considerable work remains. In
Afghanistan, emergency medicine was neither a developed field nor a recognized specialty. There
were no trustworthy emergency services available to the general people outside of US military
and NATO facilities. It is challenging for citizens to get ambulances due to extremely bad roads
and a scarcity of cars.viii
Although some tertiary care was being provided by the Afghan National Security Forces (ANSF),
which are made up of the Afghan National Army (ANA) and the Afghan National Police (ANP), it
was essential for the ANSF to continue to receive foreign help. With regional hospitals in
Kandahar, Gardez, Mazar-e Sharif, and Herat, the ANSF concentrated the majority of its tertiary
services in Kabul. By 2009, 82% of the total population resided in areas where NGOs are
contracted to provide primary healthcare services by the Afghan Ministry of Public Health or are
funded by grants. Tertiary care facilities have been built with a lot of money and labor, but this
nation does not yet have an integrated health care infrastructure. As a result, many people were
without access to basic medical treatment. Approximately 70% of the nation's medical programs
have been carried out by assistance organizations. Access to healthcare is still an issue despite
the achievements of these organizations. Afghanistan experienced a severe scarcity of healthcare
professionals. According to data from the World Health Organization, there were just 6,000
doctors and 14,000 nurses for a population of 38 million.ix
According to the Center for Disaster and Humanitarian Assistance Medicine, some progress was
made in rebuilding the Afghan medical system, notably in emergency medicine. This
development was mostly driven by the military. A standardized course focused on combat
casualty care that was adapted from US Army training was given to over 4,000 ANA combat
medics. For use by the ANSF, more than 700 ambulances were acquired, although it is still
unknown if medical personnel were adequately educated to drive, use, and distribute them. Class
sizes at Kabul Medical University were decreased to tolerable levels, the nursing and medical
school curricula were revised, teaching lab technology was enhanced, and positive working
connections with the ANA and Ministry of Public Health were established.
The development of a sustainable, efficient, and accessible healthcare system in Afghanistan was
hampered by numerous obstacles. Lack of security, poor infrastructure, economic hardship,
ineffective government and healthcare provider coordination, difficult access to medical
facilities, unsuitable hospital conditions, and a shortage of qualified medical personnel,
particularly women, were the main obstacles to rebuilding Afghanistan's health care system.
The level of medical treatment and resources varies greatly between urban and rural places.
Hospitals outside of Kabul struggled to offer anything more than minimal care. For instance, the
regional hospital in Kandahar City, Mirwais Hospital, had 0.15 beds per 1,000 residents,
compared to Kabul's 9.1 beds per 1,000 residents, according to research conducted by the
International Council on Security and Development. The hospital in Mirwais was without heat,
thermometers, or a way to preserve records. Running water was typically unclean, and electricity
was sporadic. There was a single 1960s-era X-ray machine there. Family members had to buy
medications for hospitalized patients from an outside pharmacy and transport them there. This
circumstance was typical across the nation. Even if there had medical equipment, the majority of
healthcare professionals lacked the necessary training to use or maintain it. Supplies and staff
were lacking in the medical laboratories. Afghanistan's healthcare system should continue to put
its emphasis on primary care, but hospitals need to be rejuvenated, particularly for the practice
of emergency medicine.x
The majority of funding for health care came from outside organizations including the World
Bank, USAID, and the European Commission. While outside money was important, there needed
to be more domestic support for health care. External funding was subject to erratic availability,
frequent policy changes, and the possibility of abrupt termination. At 0.6 percent of the nation's
gross domestic product per person by the conclusion of the previous administration, domestic
health care spending was a low priority (GDP). Health care would be more accessible and
affordable if the economy, internal funding sources, and government spending all improved.
The absence of skilled medical personnel presented another challenge to Afghanistan's
healthcare system. Many medical personnel perished or left the country during the Taliban era.
Afghanistan had a shortage of healthcare professionals due to the "brain drain." Because there
were no uniform training programs, the medical education of those who persisted was uneven.
In the 1990s, competition amongst medical schools was based on race and religion. As a result,
admission to medical school frequently involved nepotism. According to a WHO survey, 70% of
nurses, midwives, and laboratory technicians did not pass the required knowledge and
competency tests. Because they do not adhere to the government's stringent regulations, the
Ministry of Public Health cannot hire persons who have received training from some NGOs. This
led to a shortfall of at least 7,000 doctors and 20,000 nurses, midwives, and other allied health
workers, according to a national study.xi
Problems with health education persist despite the fact that there are 11,000 medical students
enrolled in 6 medical schools and 2,500–3,500 students enrolled in 9 Institutes of Health
Sciences. Physicians had to work at hospitals or public clinics in the morning and private clinics in
the afternoon because their pay was too low for a decent quality of living. There aren't many
resident training programs, and those that do offer minimal supervision, clinical practice, or
lectures. Courses must be available in both Dari and Pashto due to Afghanistan having two official
languages. After completing the programs, few healthcare professionals desired to work in rural
areas because of the subpar living and working conditions, lack of educational opportunities for
their kids, security concerns, and inadequate transportation. Although there were improvements
in the near future for health care worker education, there would still be numerous challenges
because 60 percent of primary school-aged children are still illiterate. 78 percent of women and
48 percent of males are illiterate.xii
The healthcare industry was likewise rife with minor corruption. Bribes were frequently used to
ensure access to and proper care, and the health sector shares many of the problems with
mismanaged human resource departments that afflict the education sector (MEC 2016). Despite
these corruption risks, the World Bank reports that health outcomes have improved to some
extent. There were more healthcare facilities and professionals with the necessary training
(World Bank 2017). In 2017, the death rate for children under the age of five was 67. Despite the
unrest in the nation, this was a high level that has been declining.
Conclusion
The people of Afghanistan had to live in very difficult conditions from 1979 to 2001, so they were
very happy with the advent of the new regime and seeing the economic prosperity. Development
were seen everywhere in the country like Asphalt roads were built in Afghanistan, schools for
girls and boys were opened, businesses expanded, people's tables were painted with different
foods, the media and press were liberated, and women were able to work freely in government
and private institutions. However, the assistance provided to Afghanistan has been considerable
huge, but in the long run the impact has been minimal. Either so much money was lost in
corruption or there was no long-term strategy to build infrastructure for Afghanistan.
At first, most public welfare opportunities were limited to large cities such as Kabul, Jalalabad,
Herat, Mazar-e-Sharif or Kandahar, as everything in rural areas was limited, whether it was
education or public health or local reconstruction of irrigation system or economic stability,
everything was in short supply, but what was done in the urban areas or in Kabul was not for
long-term prosperity of Afghanistan. Everything was built in such a way that it could help
Afghanistan immediately, but not in the long run. Now, after 20 years of intervention by the
United States and its international allies, Afghans are repeating the same pre-2001 history. The
newly established Taliban regime limited education for girls as girls are not allowed to go to
schools after completing their primary education, Health sector is almost fail to provide services
without support of the international community to it’s citizen, and on the other hand educated
youth and professionals are leaving country as they see no prospect for them in the Taliban
regime, so the investment international donors paid in developing skilled employees actually
wasted and local stability was already about nothing. So as as in the era of civil war people lives
in darkness, disparity, poverty, unemployment and ignorance.
(Kukutschka, 2019)
Acerra, J.R., Iskyan, K., Qureshi, Z.A. et al. Rebuilding the health care system in
Afghanistan: an overview of primary care and emergency services. Int J Emerg
Med 2, 77–82 (2009). https://doi.org/10.1007/s12245-009-0106-y
i
There is no official census on the Afghan population, hence
all numbers on different groups within the population are
estimates
ii
Government of Afghanistan, “Summary of Districts’ Security Risks Assessment,” Kabul, June 2015.
iii
Ariella Viehe, Jasmine Afghar, and Tamana Heela, “Rethinking the Civilian Surge: Lessons from the Provincial
Reconstruction Teams in Afghanistan” (Washington, DC: Center for American Progress, 2015).
iv
Nathaniel Myers, “Hard Aid: Foreign Aid in the Pursuit of Short-Term Security and Political Goals” (Washington,
DC: Carnegie Endowment for International Peace, September 2015).
v
Ethan B. Kapstein, “Aid and Stabilization in Afghanistan: What Do the Data Say?,” Special Report no. 405
(Washington, DC: USIP, 2017); Jacob Shapiro and Radha Iyengar, “Afghanistan Stabilization Program: A Summary of
Research and Key Outcome Trends” (Princeton, NJ: Empirical Studies of Conflict, 2017).
vi World Health Organization. Country cooperation strategy for WHO and Afghanistan, 2006–2009. Available
at http://www.who.int/countryfocus/cooperation_strategy/ccs_afg_en.pdf. Accessed 7 Nov 2008
Kondro W (2007) Afghanistan: outside the comfort zone in a war zone. CMAJ 177(2):131–134
World Health Organization. Core health indicators, Afghanistan. Available via
http://www.who.int/whosis/database/core/core_select_process.cfm?country=afg&indicators=healthpersonnel.
Accessed 5 Nov 2008
x
War zone hospitals in Afghanistan: a symbol of wilful neglect. Senlis Afghanistan. The International Council on
Security and Development. February 2007. Available via
http://www.senliscouncil.net/modules/publications/War_Zone_Hospitals. Accessed 7 Nov 2008
xi
Allison M. Nationwide survey and assessment of OB/gyn and skilled birth attendant training and graduates in
Afghanistan. Hope worldwide Afghanistan, Center for Disaster and Humanitarian Assistance Medicine, July 2008
xii
USAID, Management Sciences for Health. Rural expansion of Afghanistan’s community-based healthcare.
Available at http://www.msh.org/Afghanistan/index.htm
viii
ix