Esercitazione: Allestimento di un campo profughi a Kabul Scuola Ingegneria dell’Emergenza Aspetti sanitari e umani nella gestione delle Emergenze

NOTIZIE STORICHE. 1 1979: L’Unione Sovietica invade l’Afghanistan. La resistenza islamica si organizza. Prima ondata di profughi in Pakistan ed Iran. 1979-1986: guerriglia dei mujahiddin, guerriglia islamica afghana, contro il governo filosovietico (aiutati da USA e Arabia Saudita) Tra essi c’è anche Osama Bin Laden. 1988: inizia la ritirata delle truppe sovietiche. I mujahiddin si fanno sempre più forti. 1992: i mujahiddin prendono Kabul. 2 anni di guerra civile.Massoud è Ministro della guerra. I combattimenti continuano, le maggiori vittime sono tra la popolazione civile. Aumenta il numero di profughi.

NOTIZIE STORICHE . 2 1994: nasce nelle scuole coraniche del Pakistan il movimento dei Taliban (talib: studente del Corano) addestrati nei campi profughi dai servizi segreti del Pakistan. 1996: I Taliban entrano in Kabul. I mujaheddin, compattati nell’Alleanza del Nord, capeggiata dal tagiko Massud, continuano a combattere nella valle del Panshir. Instaurato un Emirato Islamico. 2001: Situazione umanitaria gravissima per la siccità. Aumentano gli sfollati. I Taliban fanno saltare in aria le statue dei Buddha di Bamyan.

NOTIZIE STORICHE . 3 11 Settembre 2001: attacco alle Twin Towers: inizia la “guerra contro il terrorismo”. Caduta dei Taliban. Insediamento del governo ad interim filoamericano capeggiato da Hamid Karzai, composto soprattutto da Ministri dell’Alleanza del Nord. 2002: Si instaura un governo di transizione che dovrebbe portare tra circa 2 anni l’Afghanistan a elezioni democratiche. 2003: Il Paese è ancora in uno stato di instabilità: le truppe “per la sicurezza in Afghanistan” (ISAF), i soldati americani e inglesi continuano ad essere presenti nel Paese.

Presentazione del caso studio: Contesto Marzo 2002: molti profughi stanno rientrando nel loro Paese con l’aiuto del governo afgano e dell’UNHCR che, per il rimpatrio, hanno offerto un’assistenza temporanea e una piccola somma di denaro. Le cifre dell’UNHCR parlano di oltre 1,3 milioni di persone che volontariamente tornano. In 4 mesi circa il rientro delle persone dal Pakistan ha superato l’1,2 milioni di persone, oltre 3 volte la previsione iniziale.

Presentazione del caso studio: Problemi Il ritorno massiccio in Afghanistan mette a dura prova la capacità di assistenza delle strutture governative, delle agenzie umanitarie e delle ONG. Come primo risultato dell’eccessivo rientro rispetto alle previsioni, gli aiuti promessi sono diminuiti drammaticamente. Si distribuisce dai 5 ai 40 USD a persona, un kit di soccorso, coperte, grano, con il rischio che i fondi a disposizione terminino in qualche mese, molto prima del previsto.

Presentazione del caso studio: Il campo profughi di Kabul Sono migliaia le persone che transitano quotidianamente attraverso il campo profughi alle porte di Kabul, per la registrazione e l’ufficializzazione del loro rientro. Con il coordinamento dell’UNHCR si sta organizzando, alle porte della città di Kabul, vicino la strada che porta a Jalalabad, un campo profughi temporaneo, che assicuri assistenza di base, registrazione dei profughi, fornitura di cibo e beni di prima necessità, smistamento nelle regioni di origine, evitando l’accumulo di famiglie nelle aree periferiche e malsane della città di Kabul.

Presentazione del caso studio: Situazione attuale L’UNHCR stima che i rifugiati di ritorno dal Pakistan in Afghanistan, al momento siano circa 100.000, che necessitano di una sosta transitoria (massimo 3 mesi), nel campo profughi di Kabul, in attesa di rientrare nelle loro città di origine, forniti di un aiuto economico minimo con il quale ricominciare piccole attività di sostentamento della famiglia.  

Presentazione del caso studio: Situazione in Pakistan.1 A seguito degli attacchi terroristici dell’11 Settembre 2001 il flusso di rifugiati dall’Afghanistan è nuovamente aumentato. Sebbene le frontiere siano state chiuse ufficialmente sin da Novembre 2000, i rifugiati raggiungono il Pakistan attraverso strade poco conosciute. Alla fine di Ottobre 2001 è stato stimato l’arrivo di circa 100.000 rifugiati.

Presentazione del caso studio: Situazione in Pakistan. 2 I rifugiati che arrivano in Pakistan, nonostante la situazione, sono accolti in campi allestiti da UNHCR vicino alle frontiere. Il Governo del Pakistan ha accolto, nelle ultime 2 decadi una delle più larghe popolazioni di rifugiati del mondo. Più di 1,2 milioni di afgani vivono in villaggi di rifugiati e, secondo le fonti governative, oltre 2 milioni di rifugiati vivono nei centri urbani.

Presentazione del caso studio: Problemi in Pakistan A seguito del deterioramento della situazione economica del Pakistan, il Governo ha gradualmente ridotto il supporto ai profughi tranne nei casi in cui esso sia sostenuto pressochè integralmente dagli aiuti internazionali. Tale situazione ha ulteriormente spinto il graduale rientro in Afghanistan dei profughi.

World Health Organization Selected indicators World Health Organization Demographic Indicators Afghanistan Pakistan Cina Tajikistan Iran Total population (000), 2001 22,473 144,971 1,292,378 6,135 71,368 Annual population growth rate (%), 1991 to 2001 4.5 2.6 0.9 1.3 1.8 Dependency ratio (per 100), 2001 86 83 45 76 66 Dependency ratio (per 100), 1991 88 84 49 89 89 % of population > 60 years, 2001 4.7 5.8 10.0 6.8 5.3 % of population > 60 years, 1991 4.7 5.6 8.6 6.3 4.7 Total fertility rate, 2001 6.8 5.2 1.8 3.1 2.9 Total fertility rate, 1991 7.1 5.9 2.1 4.7 48

Alcuni indicatori demografici Dependency ratio (per 100), 2001. Indicator used in population studies to measure the portion of the population which is economically dependent on the active age group. It is calculated as the sum of 0-14 year olds and over 60 or 65 year olds, depending on the working age limit considered, divided by the number of people aged between 15 and 59 or 64, respectively. For the purpose of the World Health Report, it is calculated as the sum of 0-14 year olds and over 65 year olds divided by the number of people aged between 15 and 64. Total fertility rate, 2001. The average number of children a hypothetical cohort of women would have at the end of their reproductive period if they were subject during their whole lives to the fertility rates of a given period and if they were not subject to mortality. It is expressed as children per woman.

World Health Organization Selected indicators World Health Organization Health indicators, 2001 Afghanistan Pakistan Cina Tajikistan Iran Life expectancy at birth (years) Total population 42.3 61.3  71.2 63.3 68.6 Males 41.1 61.0 69.8 59.9 66.4 Females 43.7 61.5 72.7 66.9 71.1 Child mortality (probability of dying <5 y) (per 1000) Males 252 105 34 93 45 Females 249 115 40 79 39 Adult mortality (probability of dying 15 -59y) (per 1000) Males 527 229 157 300 209 Females 418 203 106 197 137 Healthy life expectancy at birth (years) Total population 33.4 50.9 63.2 50.1 56.7 Males 31.1 50.4 62.0 47.0 55.5 Females 35.7 51.5 64.3 53.2 57.9

Alcuni indicatori sanitari Life expectancy at birth (years), total population, 2001. Life expectancy (LEX) is the average number of years of life that a person can expect to live if they experience the current mortality rate of the population at each age. Child mortality (per 1000), 2001. This refers to child mortality risk, which is defined as the probability of dying before age 5 (5q0). Adult mortality (per 1000), 2001. This refers to adult mortality risk, which is defined as the probability of dying between 15 and 59 years (45q15). Healthy life expectancy at birth (years), total population, 2001. Healthy life expectancy (HALE) is based on life expectancy (LEX), but includes an adjustment for time spent in poor health. This indicator measures the equivalent number of years in full health that a newborn child can expect to live based on the current mortality rates and prevalence distribution of health states in the population.

World Health Organization Selected indicators World Health Organization Health accounts indicators, 2000 Afghanistan Pakistan Cina Tajikistan Iran Per capita GDP in dollars, 2000 820 1,834 3,852 1,154 6,120 Total health expenditure As % of GDP 1.0 4.1 5.3 2.5 5.5 Per capita at average exchange rate (US$) 9 76 205 29 336 Public health expenditure % of total expenditure on health 63.5 22.9 36.6 80.8 46.3 Sources: Social security % 0.0 50.0 50.7 0.0 93.3 External resources for health as % 5.9 8.2 0.6 19.5 1.0 Private health expenditure Private expenditure % 36.5 77.1 63.4 19.2 53.7 Prepaid plans as % 0.0 0.0 0.4 0.0 1.9 Out-of-pocket expenditure % 36.5 77.1 60.4 19.2 50.9

Alcuni indicatori economici Per capita GDP in international dollars, 2000. Gross domestic product (GDP) per capita is the per capita market value of the total final output of goods and services produced in a country over a specific period. The international dollar is a common currency unit that takes into account differences in the relative purchasing power of various currencies. Figures expressed in international dollars are calculated using purchasing power parities (PPP), which are rates of currency conversion constructed to account for differences in price level between countries. General Government expenditure on health as % of total expenditure on health, 2000. Public Health Expenditure (PHE) is the sum of outlays on health paid for by taxes, social security contributions and external resources (without double-counting the government transfers to social security and extra-budgetary funds). Per capita government expenditure on health in international dollars, 2000. Public Health Expenditure (PHE) per capita is the per capita amount of the sum of outlays on health paid for by taxes, social security contributions and external resources (without double-counting the government transfers to social security and extra-budgetary funds). The international dollar is a common currency unit that takes into account differences in the relative purchasing power of various currencies. Figures expressed in international dollars are calculated using purchasing power parities (PPP), which are rates of currency conversion constructed to account for differences in price level between countries.

Alcuni indicatori economici Public expenditure Social security expenditure on health as % of general government expenditure on health, 2000. Social Security and Extrabudgetary Funds on Health is the expenditure by these schemes to purchase health goods and services. Includes all compulsory schemes for a sizeable segment of the population. External resources for health as % of general government expenditure on health, 2000. External Resources are loans and grants for medical care and medical goods channelled through the Ministry of Health or other public agencies. Grants in-kind (capital equipment, pharmaceutical supplies and vaccines, technical assistance such as experts) should be estimated at their monetary values. Grants to non-governmental organisations should be accounted for as private (in practice, this is difficult). Private expenditure on health as % of total expenditure on health, 2000. Private Expenditure on Health (PvtHE) comprises the outlays of insurers and third-party payers other than social security, mandated employer health services and other enterprise provided health services, non-profit institutions and non-governmental organisations financed health care, private investments in medical care facilities and household out-of-pocket spending.

Afghanistan: Population estimates (Source WHO, 2003) Indicator Value     Total population (000), 2001 22,473     Annual population growth rate (%), 1991 to 2001 4.5     Dependency ratio (per 100), 2001 86     Dependency ratio (per 100), 1991 88     Percentage of population aged 60+ years, 2001 4.7     Percentage of population aged 60+ years, 1991 4.7     Total fertility rate, 2001 6.8     Total fertility rate, 1991 7.1 Health indicators, 2001 Indicator Value Uncertainty Interval     Life expectancy at birth (years)       Total population 42.3         Males 41.1 33.1 - 48.6       Females 43.7 34.8 - 52.6     Child mortality (probability of dying under age 5 years) (per 1000)       Males 252 205 - 298       Females 249 195 - 298     Adult mortality (probability of dying between 15 and 59) (per 1000)       Males 527 331 - 772       Females 418 215 - 645     Healthy life expectancy at birth (years)       Total population 33.4         Males 31.1 24.9 - 37.6       Females 35.7 27.4 - 44.6     Healthy life expectancy at age 60 (years)       Males at age 60 4.9 3.2 - 6.8       Females at age 60 8.7 6.9 - 10.7     Expectation of lost healthy years at birth due to poor health (years)       Males 10.0         Females 8.1       Percentage of total life expectancy lost due to poor health (%)       Males 24.4         Females 18.4  

Afghanistan: Selected national health accounts indicators YEAR 2000 (Source WHO, 2003) Indicator Value     Per capita GDP in international dollars 820     Total health expenditure        Total expenditure on health as % of GDP, 2000 1.0        Per capita total expenditure on health at average exchange rate (US$) 8        Per capita total expenditure on health in international dollars 9     Public health expenditure        Government expenditure on health as % of total expenditure on health 63.5        Government expenditure on health as % of total general government expenditure 2.9        Per capita government expenditure on health at average exchange rate (US$) 5        Per capita government expenditure on health in international dollars 5 Sources of public health expenditure        Social security expenditure on health as % of government expenditure on health .0        External resources for health as % of general government expenditure on health 5.9 Private health expenditure        Private expenditure on health as % of total expenditure on health 36.5   Sources of private health expenditure        Prepaid plans as % of private expenditure on health .0        Out-of-pocket expenditure on health as % of total expenditure on health 36.50

Pakistan: Population estimates (Source WHO, 2003) Indicator Value     Total population (000), 2001 144,971     Annual population growth rate (%), 1991 to 2001 2.6     Dependency ratio (per 100), 2001 83     Dependency ratio (per 100), 1991 84     Percentage of population aged 60+ years, 2001 5.8     Percentage of population aged 60+ years, 1991 5.6     Total fertility rate, 2001 5.2     Total fertility rate, 1991 5.9 Health indicators, 2001 Indicator Value Uncertainty Interval     Life expectancy at birth (years)       Total population 61.3         Males 61.0 59.4 - 62.5       Females 61.5 59.7 - 63.2     Child mortality (probability of dying under age 5 years) (per 1000)       Males 105 91 - 123       Females 115 97 - 134     Adult mortality (probability of dying between 15 and 59) (per 1000)       Males 229 202 - 254       Females 203 176 - 231     Healthy life expectancy at birth (years)       Total population 50.9         Males 50.4 48.9 - 53.3       Females 51.5 50.0 - 53.9     Healthy life expectancy at age 60 (years)       Males at age 60 9.3 8.6 - 10.3       Females at age 60 10.8 10.0 - 12.3     Expectation of lost healthy years at birth due to poor health (years)       Males 10.7         Females 10.0       Percentage of total life expectancy lost due to poor health (%)       Males 17.5         Females 16.3  

Pakistan: Selected national health accounts indicators (Source WHO 2003) Indicator Value     Per capita GDP in international dollars, 2000 1,834     Total health expenditure        Total expenditure on health as % of GDP, 2000 4.1        Per capita total expenditure on health at average exchange rate (US$), 2000 18        Per capita total expenditure on health in international dollars, 2000 76    Public health expenditure      Government expenditure on health as % of total expenditure on health, 2000 22.9      Government expenditure on health as % of total general government expenditure, 2000 4.0        Per capita government expenditure on health at average exchange rate (US$), 2000 4        Per capita government expenditure on health in international dollars, 2000 17 Sources of public health expenditure        Social security expenditure on health as % of general government expenditure on health 50.0        External resources for health as % of general government expenditure on health, 2000 8.2     Private health expenditure        Private expenditure on health as % of total expenditure on health, 2000 77.1     Sources of private health expenditure        Prepaid plans as % of private expenditure on health, 2000 .0        Out-of-pocket expenditure on health as % of total expenditure on health, 2000 77.10