Pakistan, with the aid group Médecins Sans Frontières. Image MSF.
My name is Nicky Smith and I am 31 years old. I am originally from the south of England, where my family still lives.

For the past 10 years, however, I have been a nomad and moved around the world. I have been with Médecins Sans Frontières (MSF) for almost five years and have worked in a variety of settings.

After a posting with MSF in Burundi, I accepted a job in Afghanistan. I had always wanted to work in the region, and it was my best experience. The Afghan people are amazing. They are such complex individuals and truly tough and loyal people.

The women are extremely courageous and I was very honored to have worked with them. This past August I accepted a new position in Pakistan to establish a new base of operations in Peshawar, train staff and take over the project as interim head of mission. This all changed on Sept. 11.

Facing the wrath of the world

The weeks following the World Trade Center bombing were an incredible time — it felt like the wrath of the world was focused on Afghanistan and Muslims in general.

I would be lying if I did not say that I was scared from time to time. Two colleagues and I worked to evacuate all of the international MSF staff from Afghanistan and some colleagues from Pakistan.

At a certain stage, after going for five days with a few hours sleep, dealing with many journalists and huge levels of stress, there was only two of us left in Peshawar. It was very late, and we had been watching the news and it was clear that the finger of blame was firmly pointed at Osama bin Laden.

My colleague and I could only guess what was coming. It was all very surreal. We sat together in the office, stunned by the barrage of emotions and feelings.

A unique crisis

The relief effort here is unique for me due to the political complexities of the situation. I am used to civil wars with militia and guerrilla and multi-ethnic groups, but this war is at a different level; it is something that few people have experienced. Afghanistan is a country that was already teetering on the edge of a humanitarian catastrophe.

After more than 20 years of war and three years of drought, the population's coping mechanisms are greatly reduced. The government of Pakistan is in an extremely difficult situation, and they are reluctant to open the borders to accept another huge influx of refugees as they have seen over the past two decades.

They want any new refugee camps to be established in the tribal agencies, and close to the Afghan border. These camps are located in areas that are desolate and dangerous and compromise all standards set by the United Nations High Commission for Refugees.

MSF is working in one camp called Jalozai Camp in Peshawar. This is a camp with approximately 60,000 people. They are refugees who arrived in November last year from all over Afghanistan and there are many ethnic minorities and vulnerable groups.

As the camp has not been officially recognized, the inhabitants are living in extremely difficult circumstances. Some do not have adequate shelter and live under a roughly sewn sheet of plastic sheeting and rags. MSF has a basic health clinic in the camp and we try to provide medical assistance to this extremely vulnerable population.

We are running a supplementary feeding program for the malnourished children and at the end of November, we will be opening a therapeutic feeding program for severely malnourished children. The survival instinct of every Afghan will be tested over the next few months, and I fear the worst.

By the beginning of December, winter will have well and truly arrived and life will become extremely difficult for the Afghan refugees. The weather pattern in this part of the world is very fierce. The summers are burning hot and the winters freezing cold. We had torrential rain and a hailstorm the other day. A huge clap of thunder roared over our heads at 5 a.m.; I thought it was a bomb. As I lay in the comfort of my house, I remembered the refugees at Jalozai Camp, who have little shelter from the elements.

Don't mix bombs and aid

We face many obstacles in working with refugees. My chief frustration is not having access to the people in Afghanistan. The most vulnerable are still in Afghanistan. In Jalalabad alone, more than 400,000 people have been displaced. My other frustration is how the international coalition engaged in the war is compromising the independent, neutral humanitarian assistance provided by nongovernmental organizations.

Bombs and humanitarian assistance should not be mixed! Many people in Europe ask me if the people of Afghanistan and Pakistan were happy when they heard about the people murdered in the World Trade Center attack. I can truthfully say that the majority of people were deeply shocked by the World Trade Center bombing.

When I speak to Afghan people in Pakistan, they explain that they were happy when they heard that there was to be a war against Taliban. They have never seen it as a war of Islam vs. Christianity, but more of a war of liberation for the people of Afghanistan. However, circumstances are changing and as more innocent civilians are being killed in Afghanistan, the people here become more concerned, angry and confused. Memories of the Soviet and mujahideen years are fresh in their mind. I have never felt any anti-American or Western sentiments coming from the people of the camp.

In truth, they have to concentrate on the daily task of surviving. Their energies and thoughts are directed toward receiving adequate food, water, shelter and medical assistance. In Pakistan, Iran, Turkmenistan, Uzbekistan and Tajikistan, MSF has experienced teams with full supplies of medical materials and drugs. We are ready to provide immediate humanitarian assistance to the most vulnerable population in Afghanistan, and yet we cannot have access. This is the biggest difficulty that my colleagues and I face.