In a Sick Country

OQA, Afghanistan — "Fatma Ghul. Ghul Jamal. Najia. Nuria." Abdul Khuddus recites the names of his dead children, starting with the youngest, who died last January at 4 months old. He pauses to squint at the unforgiving wasteland that girdles his tiny village: bristly with translucent dead thorns, scaly with miniature drifts of gray dust. "The other one was born dead," he says. "We did not name her."

Who knows why the baby was stillborn, why the others wasted away? There was no doctor on hand to ask for help, or for a postmortem. There has never been a doctor on hand in Oqa.

Oraz Ghul and Abdul Khuddus got married 10 years ago, around the time the United States toppled the Taliban regime and ushered in donations of billions of international aid dollars. Some of this money, allocated by the World Bank to the Afghan Finance Ministry, is supposed to make its way to the Ministry of Public Health, then to its provincial departments, and eventually fund free health care for villagers like Oraz Ghul and her children. But it does not, because of staggering corruption in Kabul, because of payment arrears and indifferent bureaucracy in the provinces, because of a byzantine process of procurement of pharmaceuticals. "We have very old procedures," says Asad Sharifi, a health-care official in Balkh province. "We have very corrupt procedures." As a result, as the U.S.-led NATO troops are contemplating a withdrawal after a decade of occupation, Afghanistan still has the second-highest death rate in the world. One out of four children still dies before reaching age 5; one in eight women dies in childbirth. Life expectancy is 44 years for men and 45 years for women.

Like millions of rural Afghans for hundreds of years, people in Oqa still live according to the harsh paradigm honed by centuries of survival in a war-torn country with an absentee government. The paradigm includes, among other things, the sacrifice of the weakest.

Five other children died last winter in Oqa, home to about 200 people. One was the daughter of Amin Bai, one of the village elders whom everyone here calls Commander. He perches with five other men on an uncovered bed frame outside Oraz Ghul’s house, clenching in his teeth a cheap Korean cigarette. "Every winter five or six children die," he says, and the other men echo in unison: "Every winter, five or six."

I ask Amin Bai how many people in his village, in his estimation, need medical attention. He pulls the cigarette from his mouth, whether to better articulate his response or to gape more fully in disbelief at my question, I am not sure.

"Everyone here needs it," he says.

Two mobile clinics operate in Oqa’s Balkh province. Their doctors visit two dozen or so remote villages each month, on a rotating schedule. Oqa has never been on the schedule. "This district has a security issue," explains Sharifi, who supervises the clinics. "It is dangerous for us to go there."

The Taliban are gathering strength in northern Afghanistan, claiming dominion over the villages to which Oqans trudge through the desert to barter dry tumbleweed, used as kindling, for rice and oil. Two months ago, in a stretch of spiny calligonum desert worn into bald grooves by herders’ feet halfway between Oqa and Mazar-e-Sharif, the provincial capital, they killed a village teacher, Sober, apparently as part of a campaign to intimidate government workers. Sharifi says the mobile clinics’ white trucks are too conspicuous to drive to Oqa: "It is clear from these trucks that we work for the government."

"No one will ever come here," Amin Bai says, and returns the cigarette to its spot between his teeth. Of the world’s effort to rebuild and modernize Afghanistan Oqans have heard much and seen nothing, except for the donation, three years ago, of a short power line that runs through the village on 12 iron poles, and a 23-horsepower Chinese generator. The power line is not connected to anything at all. The villagers have never used the generator because they cannot afford the fuel to run it.

And now Oraz Ghul, skeletal, with an ulcerated stomach, perpetually dizzy with hunger, is fading on a diet of tea, rice, and bread she is barely strong enough to bake in the large tandoor in front of her door. Two months ago Abdul Khuddus, who has no animals of his own — "Not even chickens!" the villagers click their tongues in disapproval — borrowed a neighbor’s donkey, helped his wife astride it, and walked them to the nearest government clinic, about 15 miles away.

There, the doctor charged her $12 for a bag of painkillers.

"They didn’t work," Oraz Ghul says, and leans against the crumbling mud wall of her house, exhausted by speaking. But what else is there to do? The other clinics are too far by donkey, and there is no money left for any more medicine.