In the view of Médecins Sans Frontières, the UN renounces, with the Memorandum of Understanding, the principles that should guide its action, including the equality of men and women, especially in matters of health.

By giving in to rules imposed by the Taleban authorities, the UN sets a precedent and inflicts great harm on the efforts of organisations like Médecins Sans Frontières to defend the possibility of working according to humanitarian principles of intervention.

As a result, principles that guarantee access to health care for men and women are endangered.

Below is our detailed commentary on the Memorandum.

Part 1: Privileges, Immunities and Obligations of UN Staff

Article 2

[...] For this purpose, the United Nations may display the UN emblem on its premises and vehicles. To facilitate the implementation of the above-mentioned immunities, the Authorities may transfer the residences of international UN staff to a selected part of the city. The Authorities will select this part of the city with the understanding of the United Nations taking into account UN security requirements.

On 29 June 1998, humanitarian organisations working in Kabul received an order to move to one common location, a derelict building known as the polytechnic school within one month, or to leave the city. All organisations present in Kabul refused this instruction, considering it an illegal act by the authorities.

On 14 July, non-governmental organisations (NGOs) were given a new ultimatum: to move to the polytechnic school within four days. When announcing the ultimatum, the Ministry of Foreign Affairs and Ministry of Planning refused all negotiation and referred to the fact that the UN had already agreed to the idea of moving to a location assigned by the authorities.

Médecins Sans Frontières does not accept the enforced relocation of all NGOs to a single location. This measure would separate NGO staff from the people of Kabul. It is a fundamental principle of Médecins Sans Frontières that we ensure our action responds appropriately to the real needs of the population and are suited to the specific political, cultural and other conditions of the country.

Article 5

Prior to the recruitment of national staff, the United Nations shall submit the biographies of the candidates to the Ministry of Foreign Affairs and its relevant branches. The Ministry of Foreign Affairs will confirm the candidates within 15 days, and will identify those who are unsuitable for employment.

NGO local staff already work under very difficult circumstances, faced with religious, ethnic and sexist discrimination. This article of the Memorandum of Understanding further enables the Taleban authorities to further hinder the work of NGOs. This article also contradicts article 4, which stipulates a policy of non-discrimination concerning the recruitment of UN staff. In autumn 1997, Taleban authorities prohibited the employment of medical staff with communist beliefs and staff who were educated in former communist or western countries. Within two weeks, more than one thousand employees were dismissed as a result of this decree.

Médecins Sans Frontières recruits its staff according to the single criterion of a person’s competence, considering political, religious, ethnic or sexist criteria as intolerable.

Part 2: Participation of international and national female staff in UN assistance.

Article 11

The Islamic Emirate of Afghanistan is ready to discuss with religious scholars from Islamic countries the movement of international female Muslim staff of the UN who are not accompanied by Mahram in order to reach a solution in accordance with Sharia. It is believed that this issue will be resolved in the near future.

Since March 1998, Muslim women of non-Afghan nationality have been obliged to respect rules announced by the Taleban authorities, such as the obligation to be accompanied by a male member of their family and subjection to humiliating public punishment. As a consequence, the UN withdrew some of its female staff from Afghanistan. Article 11 does not provide any answer to this discriminatory measure and avoids mention or discussion of the problem. The risk is now that Taleban rules may soon also be applied to non-Afghan staff of Muslim faith.

Part 3: Access to Health and Education

Article 12

The Islamic Emirate of Afghanistan and the United Nations jointly commit that men and women shall have the right to education and health care and necessary development activities, based on international standards and in accordance with Islamic rules and Afghan.

The article does not specifically refer to the right of equal access to education and health for men and women. We believe this is a serious omission.

Article 13

The Authorities and the UN will make efforts to increase the participation of men and women in health, education - especially health education - and food security. Both parties acknowledge the economic difficulties and the specific cultural traditions that make this goal challenging. As a result, women's access to and participation in health and education will need to be gradual.

‘Especially health education...’

Since 6 October 1997 it has been illegal to possess drawings or photographs of human beings. Consequently, health educators have no longer been allowed to use posters of the human body for teaching. The day after the signature of the Memorandum of Understanding, medical staff working in education programmes were declared illegal. As a consequence, several NGOs suspended activities in Afghanistan.

‘ ... and food security’

Since the middle of 1997, widows have been prevented from receiving food rations by a decree allowing the distribution of rations to male family members only.

Discrimination against women since 1996:

• Prohibition of employment for women, except in the health sector, since 1997
• Prevention of women’s access to hospitals in Kabul, September to November 1997
• Obligation for female staff to register and carry identity cards, since May 1998.

The great majority of women staff working in Kabul is now declared illegal. Those who continue to work in hospitals and clinics are exposed to physical risk.

As a result of these measures, a large number of women and children in Kabul have no access to health care. A situation that was already extremely difficult for the most vulnerable groups has further deteriorated:

The maternal mortality rate is 1,700/100,000 births - four times higher than in Pakistan and a hundred times higher than in France. It has increased by almost 50 per cent in ten years.

Afghanistan has one of the world’s highest concentrations of land mines. Between 40 and 50 per cent of mine victims are civilians, women and children.

Respiratory infections are the major cause of death among children.

70 per cent of tuberculosis patients are women

Diarrhoea spreads as an epidemic; cholera and typhoid are present. Children are most at risk of these diseases.

Malnutrition is common, even in major cities. Thousands of children die in Afghanistan each year as a result of malnutrition.

Médecins Sans Frontières and other medical organisations working in Kabul have frequently requested the unconditional restoration of equal access to health care. Access to health care for women should be re-established without delay, not gradually, as agreed to by the UN. Furthermore, Médecins Sans Frontières finds the silence of the World Health Organisation (WHO) on this issue passive and unacceptable.

Article 14

[...] 2. The Authorities have facilitated the provision of health care for men and women in Aliabad and Maiwand hospitals and are planning to expand it in order to improve the services for both men and women. The United Nations is requested to provide assistance in the form of: equipment and medical instruments for the Ear and Throat Department of the Maiwand Hospitals; surgical equipment, neuromachines, and equipment for radiotherapy (cobalt) for cancer patients to the Aliabad Hospital; as well as incentives to health staff of the above-mentioned hospitals for an initial period of 24 months.

3. The Authorities are planning to further expand health facilities for men and women. The following health facilities need to be rehabilited and equipped; the Nour Eye Institute, the Sanitarium (TB hospital), the Malaria-Lashmania Hospital. United Nations support is necessary for the rehabilitation of these institutions.

The United Nations will provide teaching materials and diagnostic instruments to the Rabbia Balkhi Hospital, a female higher education institute of health.

To our knowledge, Maiwand Hospital has not accepted any female patients since September 1997.

Concerning Aliabad Hospital, the supporting NGO ceased its activity because it was impossible to maintain female medical staff in the hospital and therefore impossible to continue health care for women. Today, there are no longer any female staff in Aliabad Hospital.

Finally, Rabia Balkhi Hospital cannot be considered a ‘a higher education institute of health’. In September 1997, the dilapidated, disused building was designated the only institution able to treat female patients in Kabul. Renovation or support for Rabia Balkhi can only serve to encourage the discriminatory policy of the Taleban authorities towards health care.

Médecins Sans Frontières denounces:

• the support provided by the UN to health structures which refuse female patients
• the passive and silent abetting of the WHO
• the UN’s lack of respect for the role and activities of NGOs in Kabul.

Part 4: Coordination

Article 15

The United Nations will seek the opinion of the Ministry of Planning in activities that are implemented by NGOs for the UN in order to ensure increased efficiency of assistance and to reach the most needy.

Article 20

The Committee shall consist of high-ranking representatives of the Authorities and the Heads of United Nations agencies or their delegates. It shall be cochaired by the Minister of Planning and the UN coordinator. NGO Coordinating Bodies will be invited to the meeting.

Since 24 April 1998, the UN has sought to impose a unique co-ordination (‘principled common programming’) on NGOs working in Afghanistan. A consequence of this approach would be that NGO activities would be entirely controlled by the UN, in direct contravention of the independence and other principles of humanitarian intervention of non-governmental organisations. By inviting the NGO Coordinating Bodies, the UN (whose own agencies never managed to achieve a common policy in Afghanistan) hides its unwillingness to engage in dialogue with the NGOs. Moreover, the Coordinating Bodies represent only a small number of NGOs.

In the view of Médecins Sans Frontières, the UN renounces, with the Memorandum of Understanding, the principles that should guide its action, including the equality of men and women, especially in matters of health. By giving in to rules imposed by the Taleban authorities, the UN sets a precedent and inflicts great harm on the efforts of organisations like Médecins Sans Frontières to defend the possibility of working according to humanitarian principles of intervention. As a result, principles that guarantee access to health care for men and women are endangered.