Afghanistan Committee on Feb. 7th, 2022

[The Chair, Liberal, Sukh Dhaliwal]

[Technical difficulty—Editor] measures in place to bring relief to the Afghan people.

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I would now like to welcome our witnesses and express our appreciation to them for being here with us this evening. Witnesses have five minutes per organization for opening statements.

From Doctors Without Borders, we have Martine Flokstra, operations manager; and Jason Nickerson, humanitarian representative to Canada. From UNICEF, we have Manuel Fontaine, director of the office of emergency programmes. Shortly, from CARE Canada, we will have Barbara Grantham, president and chief executive officer.

We will start with Doctors Without Borders.

Please go ahead. You have five minutes.

[Dr. Jason Nickerson, Humanitarian Representative to Canada, Doctors Without Borders]

Thank you for having us at tonight's hearing.

Doctors Without Borders, or Médecins Sans Frontières, MSF, is an international medical and humanitarian organization that has provided exclusively independent, impartial and neutral humanitarian assistance since 1971 in a manner consistent with international humanitarian law and principles.

MSF first worked in Afghanistan in 1980. In Afghanistan, as elsewhere, MSF negotiates our access and our protections with all parties to the conflict, and at all levels, from the most local to the most international, and everyone in between. It is this model of principled humanitarian action that today, and throughout the worst of the fighting, has allowed MSF teams to continue to deliver medical services, free of charge, in five projects throughout Afghanistan, in Herat, Kandahar, Khost, Kunduz and Lashkar Gah, while also retaining a coordination team in Kabul.

MSF runs its activities with 2,350 Afghan and 75 international staff, with a budget of $46.7 million in 2021. We rely solely on private donations and do not accept funding from governments for our work in Afghanistan. Our medical operations address significant unmet needs among the Afghan population. For example, we assist, on average, 4,000 births per month in Khost and Lashkar Gah, provide consultations to 20,000 people per month in our emergency departments and admit more than 170 babies per month to our neonatal ward in Khost.

The key focus and driver of our presence are the medical needs of people like you and me. The Afghan population has been chronically exposed to conflict for decades. Additionally, they are affected by the consequences of drought, the direct and side effects of COVID-19 and the transition of power in August 2021. For many years, the budget of the Afghan government was largely dependent on foreign donor money. This also included the health system, which has been chronically fragile and weak. Following the abrupt stop of structural development money and the freezing of assets in August 2021, the country has tumbled into an economic, banking and liquidity crisis, which has led to increased needs amongst the population.

We want to draw the committee's attention to the deteriorating health situation in Afghanistan and the reasons for this. Most health structures in the country are under great pressure with staff and equipment shortages, and many are closed or poorly functioning. This means that many patients cannot access the care they need, with private health care unaffordable for millions. “These days, you have to be rich to provide your family with a meal per day,” a patient told us recently. A doctor of a public hospital, who had not received a salary for five months, told us that they had to perform a Caesarean section with the light of a flashlight app on their mobile phone since the hospital could not pay for fuel for the generator anymore.

Recent funding announcements still leave the health system with far fewer funds than before, and will not improve a health system that was already failing. Short-term band-aids are being handed out while longer-term solutions are unknown. For months, MSF has seen increasingly higher numbers of malnourished children in its in-patient feeding centres in Helmand and Herat. This is likely due to a combination of factors—persistent drought, food scarcity, an economic and cash crisis, and a health system in a state of disarray.

September was the first month in years when Afghans could move freely without fear of being caught up in conflict, and this led to a significant increase in patient numbers in MSF's facilities. This period also coincided with the suspension of funding to the health system in August, meaning that many facilities closed or stopped functioning due to a shortage of staff, supplies and funds, leading to a further influx of patients coming to the few functional hospitals and health centres.

Malnutrition is a big concern. Although admissions have decreased since September, MSF's intensive therapeutic feeding centres in Herat and Helmand are extremely busy. Children who experience malnutrition have weakened immune systems, making them more vulnerable to the effects of other health conditions. Today, in addition to the failing health system, the country now faces recorded outbreaks of cholera, measles, COVID-19 and other infectious diseases that all necessitate their own response while placing a further strain on health systems.

The ripple effect of pre-existing sanctions and the financial measures against Afghanistan's new de facto government are being felt deeply nationwide. The country faces near economic and institutional collapse, including an inability to provide most basic services and pay civil servant salaries. The population is between a rock and a hard place. The banking sector is paralyzed, which bars people from accessing their savings and also makes it harder for organizations providing health care, like MSF, to pay salaries and cover the running cost of hospitals. In the places where MSF works, we see humanitarian needs are increasing while the humanitarian response is being made more complex as a result of interconnected factors, such as international sanctions, the cash flow crisis, disruptions to the banking system and others.

We are extremely concerned about a further deterioration of the current crisis faced by the people in Afghanistan. It is essential that this committee examine the impacts of Canadian anti-terror legislation, not only on the Afghanistan crisis, but more broadly on humanitarian assistance provided inside armed conflicts.

We thank the committee for the opportunity to speak with you today, and we're happy to provide answers to your questions.

[The Chair, Liberal, Sukh Dhaliwal]

Thank you, Mr. Nickerson.

Now we'll go to UNICEF and Manuel Fontaine, please, for five minutes.

[Manuel Fontaine, Director, Office of Emergency Programmes, United Nations Children's Fund (UNICEF)]

Thank you very much, Mr. Chair.

Thank you to the committee for convening this meeting, which comes at a crucial time for the people of Afghanistan.

I want to take this opportunity to thank Canada for being an important partner for Afghanistan and a force for good for years. Together, we've made a lot of progress over the past few years.

Right now, however, we're facing a very dire humanitarian situation. I've been a humanitarian for 30 years, and I can assure you that these are some of the largest numbers I've seen in my career. The country is currently facing the worst drought in 27 years, while at the same time suffering from the impacts of years of conflict and insecurity; the collapsing economy; multiple disease outbreaks, such as measles and diarrhea; natural disasters, such as the recent earthquake; the bank liquidity crisis; and COVID-19.

As a result of this, the needs of children and families are unprecedented in Afghanistan. More than 24 million people, including 13 million children, are in need of urgent humanitarian assistance. For UNICEF, what this means is millions of children in Afghanistan whose outlook for 2022 is not good. [Technical difficulty—Editor] of all children under five are facing acute malnutrition, and 1.1 million will face severe acute malnutrition this year. Four million children are out of school, 60% of them girls, and an estimated 8.8 million children are at risk of dropping out if schools don't start back and are not able to welcome them.

An estimated four million children are in need of protection. Nearly a quarter of the country lacks safe drinking water. Close to 35,000 cases of measles were reported in 2021, plus the issues we are facing with acute watery diarrhea, polio, dengue and COVID-19.

UNICEF is on the ground, just as MSF and other colleagues are. We're on the ground, and we've launched our largest appeal to reach 15 million people, including eight million children, in 2022. We really have, together, to avert what is the imminent collapse of critical social services, including health, nutrition, sanitation and education services for families.

Our priorities are the following. We have to prevent a collapse of basic services. We really [Technical difficulty—Editor] frontline workers, such as health workers, as part of the [Inaudible—Editor] program. We also need to start payments now to teachers to make sure they can remain in schools and welcome children when winter is over, which will be quite soon. To do this, we need the support of the international community for the long term as well.

It is about education. It is about making sure that children are not dropping out and that girls are going back to school. An important element will be the payment of teachers, including women teachers of course. However, in addition to the formal schools, we have community-based education, which is also quite important at the moment. We all know that children who are out of school are at risk of not going back, but they're also at risk of other protection risks, such as child marriage or child labour, and the potential risk of trafficking.

There is also health. UNICEF is aiming to provide 15 million people with life-saving care by supporting the health system through payments, community capacity and vaccination, and having the mobile health services that we've been running for quite some time. Bringing back and keeping health workers, nurses and doctors in health facilities is crucial.

We also have a cash program, which will allow us to help families meet their basic needs. We're expanding the use of humanitarian cash transfers and have so far reached about 35,000 households—a bit more than 250,000 people—since mid-December, just to get them through the winter. We need to accelerate that.

I want to thank Canada for the strong support over the years. I urge you to stay really engaged in Afghanistan over the next few months—I'm sure this committee is proof that this is the case—and work with us to make sure we avert the human disaster that we're about to see.

Thank you.

[The Chair, Liberal, Sukh Dhaliwal]

That was under five minutes.

We still don't have Ms. Grantham, so we'll wait for her to come later. In the meantime, I'm going to go to the members, first and foremost my own member of Parliament, Madame Findlay.

Please, go ahead for six minutes.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Thank you.

Do not ask the chair whom he voted for. You don't have to. He voted for himself in his own riding.

Thank you very much for being here this evening, especially Ms. Flokstra, who is here from Amsterdam, I think. That's above and beyond. Thank you very much.

I'm interested to know at what level the Canadian government engaged with your organization during the collapse and the evacuation from Afghanistan. I realize you represent two different organizations, so maybe each one could respond.

[The Chair, Liberal, Sukh Dhaliwal]

Who wants to go first?

Mr. Nickerson, go ahead, please.

[Dr. Jason Nickerson]

I'm happy to answer the question.

We maintain a line of dialogue with the Canadian government through Global Affairs Canada on a variety of different humanitarian crises, including in Afghanistan. As part of our mandate, we share information on unmet humanitarian needs and try to relay what we're seeing in the field. We've maintained an open line of dialogue on the Afghanistan crisis, specifically focused on the health system and unmet health needs, for many years and that's been ongoing throughout.

Thank you.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

I understand you've been involved there since 1980.

My question was, at the time of the collapse and the evacuation from Afghanistan, what was the level of your ability to engage with the Canadian government?

[Dr. Jason Nickerson]

As I said, it's a very standard open dialogue with the sharing of press releases, the sharing of information on unmet humanitarian needs, on realities that we were seeing on the ground. There was dialogue with Global Affairs throughout the summer and the fall, and that's ongoing.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Were you provided enough early warning and support by Canadian government departments on their departure? What was the impact on your relief operations?

[Dr. Jason Nickerson]

I'll ask my colleague to answer that question, please.

[Martine Flokstra, Operations Manager, Doctors Without Borders]

What I do know is that we—I also have Canadian colleagues who were with us in Afghanistan—had warnings on the situation. We as an organization stand next to the population. Throughout the violence, which started in May, we have been able to continue to run our activities with our international and national teams.

This we can only do by being in contact with all the armed actors in the conflict, and that's what we did, leading also to a situation where we had 300 staff members living for two and a half weeks with 500 patients in the Boost hospital in Lashkar Gah, and where all actors involved in the fighting ensured to avoid the hospital at that time. That was last summer.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Do you have any comments, Mr. Fontaine?

[Manuel Fontaine]

For UNICEF—just like the rest of the UN, but the humanitarian side of the UN—we made the decision that we would stay and deliver inside Afghanistan. I was, myself, actually in Kabul at the time, and so we stayed there. We did share, just like our colleagues from MSF, of course, information about humanitarian needs on a regular basis, but didn't necessarily have more regular contact on the actual issues around evacuation.

UNICEF did take part in the protection of children at the airport during the evacuations of children from Kabul, together with the people who were at the airport at the time, particularly the unaccompanied children, making sure they got reunited with their families. We did make our own decisions. The UN, of course, has our own decision-making process when it comes to security and whether we stay or don't stay, which we followed and decided to stay.

General information about what was happening was regular, yes, but that's pretty much it. For the rest, we went on with our own mission.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

I'm very interested in your experience with getting to the Kabul airport and the evacuation at the airport. Can you talk more about that and what level of assistance you had or whether you were dealing directly...? We know that it was pretty chaotic, but perhaps you could give us the benefit of your experience.

[Manuel Fontaine]

Well, we were basically asked, particularly by the U.S., which was managing the airport at that time last year, as you know.... We were told that they had a number of children who were unaccompanied and on their own and needed some assistance, so we did place a number of child protection officers inside the airport to make sure that the children were identified and registered, and that if they could be reunited with their families in Kabul, that happened, or if they were to be evacuated, that we did not lose track of them and they could be followed after that in Doha or other places and be reunited after that.

This is what a number of organizations do in situations like that, which is to keep track of children, making sure they do not get abandoned or forgotten and making sure that we reunite them, which is what we've done.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

How am I doing for time, Mr. Chair?

[The Chair, Liberal, Sukh Dhaliwal]

You have 10 seconds.

[Kerry-Lynne Findlay, Conservative, South Surrey—White Rock, BC]

Is there any country other than the U.S that you turned to in Canada's absence to help you out?

[Manuel Fontaine]

We did work with countries like Qatar, for example. Some of the children went to Qatar, so we had to be in touch with them, but the main issue was around the Kabul airport. We did not get involved in the rest.

[The Chair, Liberal, Sukh Dhaliwal]

Thank you very much.

I'm going to go to Mr. Sidhu for six minutes, please.

[Maninder Sidhu, Liberal, Brampton East, ON]

Thank you, Mr. Chair.

Good evening, everyone. Thanks for joining us today. It's quite a time and an experience to hear from you guys on your real journey and adventure on the ground there.

I want to turn to Ms. Flokstra and Mr. Nickerson in my question.

You mentioned some of the work that you're doing on the ground. You mentioned I think over 70 international team members in Afghanistan and hundreds of local individuals who are supporting your work on the ground. Can you speak more about how many of your members are there on the ground now? I don't know if that's past tense or current.

Have the Taliban allowed you to continue your operations in the five provinces that I think you mentioned you're operating in?

[Martine Flokstra]

We still have around 75 international staff on the ground and, in total, we have 2,300 local colleagues, so we are continuing to function. Since August 15, this has partially changed. On the one hand, we are able to move around more for the first time in decades. That was impossible before August 15. We can provide our health care exactly as before, with women and female staff working with us. As well, female patients are able to come to our facilities. In some areas, like the south, it was the situation already a year ago that women needed to be accompanied to come to the hospital, but we are fully accepted to deliver our impartial and principled medical care, which we've provided for decades in Afghanistan.

[Maninder Sidhu, Liberal, Brampton East, ON]

Thank you for all your hard work. It's a tremendous undertaking, so I really appreciate everything that you're doing.

Your organization and Mr. Fontaine's organization may have been in touch with local Canadian organizations on the ground or organizations from other countries. Have you heard from the other organizations that are still on the ground whether the Taliban are directing where some of the aid or your help flows? I think Mr. Fontaine mentioned that you're in touch with some of the frontline teachers on the ground. Could you speak more about that?