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Afghanistan: Will we talk to the Taliban? We always have

20 Aug 21

Afghanistan: Will we talk to the Taliban? We always have

The front gate to an MSF trauma hospital in Kunduz, Afghanistan, December 2011 Caption
The front gate to an MSF trauma hospital in Kunduz, Afghanistan, December 2011

MSF analysis experts Christopher Stokes and Jonathan Whittall have each spent years helping to coordinate life-saving care in Afghanistan.

With the recent surge in violence and eventual fall of the Afghan government to the IEA (Islamic Emirate of Afghanistan, or Taliban), they explain how MSF’s approach to negotiations has helped to ensure that we can deliver medical aid under complex and dangerous conditions.


"As United States forces withdraw from Afghanistan, putting an end to the longest war in US history, a new era has begun again for a country that has seen invading forces come and go over the centuries.

The news has been dominated by the Taliban forces swiftly taking control of the provincial capitals and seizing Kabul unopposed, as well as the sight of western embassies packing up, Afghans desperately trying to leave, the spectacle of foreigners fleeing en masse and many NGOs ceasing to operate.

In contrast to these scenes, Médecins Sans Frontières / Doctors Without Borders (MSF) and a handful of other humanitarian agencies have maintained their presence and activities at the height of the fighting, providing life-saving assistance to the sick and wounded.

“Whoever came to a privately funded MSF hospital had to literally leave their gun at the door”

Christopher Stokes and Jonathan Whittall
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MSF

How has this been possible? MSF has had successes and failures in Afghanistan, but the core of our approach has remained the same: we would only work if we had the explicit agreement of all parties to the conflict. That included the Taliban, the US forces, the Afghan National Army and in some cases local militia groups.

Our principles of neutrality, independence and impartiality, that can at times seem abstract, were operationalised by talking to all sides, refusing funding from governments, clearly identifying ourselves so as not to be confused with other groups that may have other interests, and by making our hospitals weapon-free zones.

Whoever came to a privately funded MSF hospital had to literally leave their gun at the door.

When working in Kunduz or Lashkar Gah hospitals, we regularly explained to US, Afghan and Taliban soldiers that we would never turn away any patient, be they a wounded government soldier, a car crash victim or a wounded Taliban fighter.

Our hospitals triaged based on needs alone. We worked according to medical ethics, not according to who was deemed a criminal, a terrorist, a soldier or a politician.

We often had to request US and Afghan soldiers to leave and return without their weapons if they wished to visit the hospital.

Emergency surgery taking place at the MSF-supported Boost hospital in Lashkar Gah, Afghanistan

MSF and the Afghanistan crisis

Our approach was often in contrast to the way in which the aid system – including humanitarian agencies – were being pushed by donors to build the Afghan state, to create stability in areas taken by Afghan forces and contribute to the legitimacy of a fledgling US-backed government.

Aid was the “soft power” to win over the population to the Afghan government, a key component of the hearts and minds strategy bolstering the “hard power” of military deployment.

An MSF doctor checking on a child in the paediatric intensive care unit at Boost Hospital, Lashkar Gah, June 2016 Caption
An MSF doctor checking on a child in the paediatric intensive care unit at Boost Hospital, Lashkar Gah, June 2016

Tellingly, when meeting a western humanitarian donor in Kabul, they were unable to tell us where the humanitarian needs were the greatest but instead referred to a map of areas under control of coalition forces (in green), under Taliban control (in red) and contested areas (in purple). They were sending aid to green and purple areas to help boost the military effort.

International NGOs taking government funding from western states involved in the fighting were shocked to see counter-insurgency language such as “clear and hold” creep into their funding grants. As one of the biggest government donors explained to us in Kabul: “the Taliban are making gains in this province, we told the aid agency to cover the province in wheat, and they did”.

“This is why as MSF we seek to negotiate with all parties to a conflict. It’s to enable our teams to deliver assistance when needed the most.”

Christopher Stokes and Jonathan Whittall
|
MSF

But our approach did not always protect us. It was in 2015 that US special forces bombed our hospital in Kunduz after the province had been briefly taken over by the Taliban.

It demonstrated to us the grey zones that exist in such conflicts: aid is tolerated and accepted when it boosts the legitimacy of the state, but it becomes susceptible to being destroyed when it falls into a territory where entire communities are designated as hostile enemies and when the state is on the back foot.

This grey zone is cultivated by legal ambiguities between international and national law, creating environments conducive to what US authorities categorised as “mistakes”.

Following the destruction of our hospital, MSF engaged again with all parties to the conflict to clarify the respect for our medical activities. It was arguably our widespread public support and the political cost of the attack on MSF that ultimately served as our best safeguard against future so-called mistakes by US and Afghan forces.

However, this form of deterrence through engagement and public pressure was of no use when our maternity hospital was brutally attacked in Dasht-e-Barchi, most likely by the Islamic State in Afghanistan who have remained out of reach of our dialogue.

While MSF has been able to operate in provincial capitals, we have been unable to go into rural areas to address needs there. This has been one of the failures of MSF’s work over the past years.

Kunduz Hospital Aftermath - 14 Oct 2015 Caption
The attack on MSF's Kunduz hospital killed 42 people in October 2015

However, two weeks ago, when the Taliban entered the cities, we were able to continue working to treat patients: the sick and the wounded were able to receive care in facilities which we adapted to cope with the intensity of the fighting. In Helmand, Kandahar, Kunduz, Herat and Khost our teams continued to work. Our health facilities are today full of patients.

This is why as MSF we seek to negotiate with all parties to a conflict. It’s to enable our teams to deliver assistance when needed the most.

Often these moments are in the midst of changes in power and control. It’s also the reason we resist against efforts to incorporate our activities into political processes of state building. It is why we speak out loudly when our facilities and staff are harmed.

The future of Afghanistan is uncertain, and our activities will remain under pressure. The challenges we face will evolve and the security of our teams and patients remains a concern. But, to weather future storms in Afghanistan, humanitarian actors would do well to firmly plot their own course based on the needs that exist, rather than being steered by the changing political winds.

Afghanistan shows how foreign-led nation building can fail and how humanitarian actors’ contributions to such efforts are minimal. It also shows that our work can save the most lives when we are able to be as independent as possible, both when a state is being built and when it collapses."

About the authors

Christopher Stokes is a Senior Humanitarian Specialist at MSF and Jonathan Whittall is the Director of the Analysis Department. Both have previously worked in Afghanistan.

Christopher was the Head of MSF in Afghanistan in 1996 when the Taliban took over Kabul for the first time and has regularly returned to the country over the past two decades to support and represent MSF operations. He has previously worked as Director of Operations and General Director of MSF’s Operational Centre in Brussels. He was most recently in Afghanistan in 2021.

Jonathan helped to set up MSF's Kunduz trauma hospital as a Project Coordinator in 2011/2012 and has also returned on multiple occasions, including to carry out research on access to health in Helmand as a Senior Humanitarian Advisor. He supported MSF teams with negotiations in Kabul after the attack on our Kunduz hospital in 2015.

MSF and the crisis in Afghanistan

In May 2021, there was a significant surge in violence, with fierce clashes between Afghan forces and the Islamic Emirate of Afghanistan (IEA, also known as the Taliban) claiming thousands of lives and forcing many more people from their homes. By mid-August, the IEA entered the capital city of Kabul and Afghanistan's President Ashraf Ghani fled the country. Throughout this time, MSF teams have continued to provide life-saving medical care to people caught in the chaos.