Last week, the infamous Jalozai Camp for Afghan refugees, near the city of Peshawar in the Northwest of Pakistan closed. Conditions there were so severe a Pakistani newspaper once called it 'a living cemetery'. Now the 'cemetery' is empty and closed, with the tens of thousands of Afghans relocated to new sites along the Afghanistan-Pakistan border.

The closure of Jalozai also signalled the end of MSF activities. MSF served the camp - where numbers once reached 60,000 people - throughout Jalozai's existence. Both the supplementary feeding centre and the health clinic stopped activities in mid-February of this year.

From the beginning in September 2000 until April 2001, MSF was the only international non-governmental organization present. Thanks to ongoing lobby efforts, MSF was able to get the camp on the international agenda resulting in involvement of NGOs and UN agencies. The history of Jalozai and the fate of its population have been controversial issues. Pakistan has been accommodating up to two million Afghan refugees since the early eighties.

Up until 1998 Pakistan granted asylum to them on a prima facie basis - meaning the entire group was considered refugees without giving individuals refugee status. That changed in 1998 when Pakistan no longer considered new arrivals as genuine refugees. However drought and ongoing conflict caused an ongoing influx of Afghans seeking refuge in Pakistan.

While in other locations such as Shamshatoo a whole system was being set up with food distribution, health care and education, Jalozai was neglected, despite a rapidly rising population lacking any assistance, let alone refugee status. 'Deplorable and inhumane', were words describing the situation inside Jalozai.

It was overcrowded, filled with make-shift tents, no water or sanitation and no firebreaks. These conditions were serious risks for the spread of infectious diseases such as meningitis, measles and tuberculosis.

Thousands of Afghans arrived in Jalozai fleeing the ongoing drought in their country as well as the fighting between the Taliban, the opposition Northern Alliance and other pockets of resistance against the Afghan government. Some 57 percent of them were Pashtuns, 33 percent were Tajiks and 10 percent Uzbeks and Hazaras coming mainly from the Northeast of Afghanistan.

MSF started to work in Jalozai in September 2000, initiating activities through a measles vaccination campaign. On Christmas day 2000, after strong lobbying, a mobile health clinic addressed the health care needs. Initially a semi-permanent structure, such as a tent, was not allowed. It was to be replaced by a basic health care unit weeks later in order to deal with the most common diseases like skin infections, diarrhoea and respiratory diseases. It marked the beginning of a strong MSF commitment with the people of Jalozai.

Willemieke van den Broek, who worked as a nurse for MSF in the camp in early 2001, said at that time 'I knew it only from TV and the first time I saw Jalozai it was a big shock, but what impressed me the most was that the people were so hospitable despite their deplorable situation.

We were working once on a measles vaccination campaign and were constantly invited to drink tea with them. The strength of the people was unbelievable.' What MSF did to help During its existence MSF expatriate and local staff saw over 52,000 patients including 15,000 five year-olds, helped bring more than 350 babies into the world and cared for over 4,000 malnourished children, pregnant and breast-feeding women.

Tens of thousands of children were vaccinated against diseases such as measles and polio. In addition MSF has been working to improve the water supply and sanitary conditions in the camp: building up to 1,200 latrines, placing 48 water reservoirs and 498 taps and digging drainage and ditches in order to prevent the spread of diseases and improve hygiene by distributing jerry cans and soap.

The basic health care unit saw over 250 consultations a day including minor surgery, with the severe cases transferred to a local hospital in Peshawar. At a certain moment one million litres of water a day were being trucked into Jalozai, causing constant traffic of trucks through the camp as permanent structures, including water pumps, were not allowed. 'It was all urgently needed', states Mr. Iftikar Ahmad, the camp commander for the Pakistani Government Committee for Afghan Refugees, in December 2001 'This time last year, the people who had come from Afghanistan were living in a desert.

There was nothing for them; no tents, no water and no basic health care service, (people) sleeping on the ground. Many are still not living in perfect conditions, but slowly it has got better. There have been food rations and distributions for basic needs by the UNHCR, NGOs and private donors. And of all the NGOs in the camp, MSF has been the one that has consistently done the work.'

Despite this huge effort Jalozai became a symbol of the suffering of the Afghan population. But also a symbol of the lack of support of the international community towards Pakistan, which was left alone for a long time in dealing with the enormous influx of Afghan refugees. Donor countries did not live up to their promises causing a constant shortage of funds for the UN to deal with the problems in Afghanistan and Pakistan.

From the beginning, MSF pleaded for recognition of this neglected group of Afghans. MSF called for improvement of the humanitarian situation and lobbied for refugee registration and screening. Pakistan refused, stating that the Afghans were economic migrants and were not eligible for any kind of refugee status.

A report from MSF in August 2001 showed that 78 percent of the population indicated that they had fled drought and conflict in Afghanistan. The lobby efforts of MSF did not go unnoticed. From April 2001 onwards there was growing involvement of other NGOs like IMC, OXFAM and Care who started activities as well. The UNHCR also became more involved, resulting in a visit of Ruud Lubbers in the spring of 2001.

Despite his efforts he later declared that his visit had failed to achieve improvements at that time. Some weeks ago Lubbers looked back to that period stating 'Jalozai's very existence was a sad reminder of the international community's neglect of the Afghan situation prior to the events of September 11th.' Long term solutions were not allowed in Jalozai, since it was an unofficial site filled with, in the government of Pakistan's words, 'economic immigrants'. The government of Pakistan refused any kind of permanent assistance as this could give the impression that these people were viewed as refugees on a prima facie basis - a signal the government wished to avoid sending, at all costs.

For months the UNHCR and the Pakistani authorities wrestled over the status of these Afghan refugees. This resulted in an agreement between the government and the UNHCR arranging the screening of the population and voluntary repatriation back to Afghanistan. Those who were not recognized as genuine refugees would be sent back to Afghanistan.

During series of meetings in Pakistan, Geneva and New York, MSF expressed its concerns on the voluntary basis of the repatriation. MSF felt that the push factors were too strong and that the situation inside Afghanistan was far from safe. 

September 11th stopped the whole process. The UNHCR had to stop the screening because of the rising insecurity and the outlook for the population of Jalozai never looked so grim. That day in September changed the international perspective on Afghanistan. In the first weeks after the attacks on New York and Washington world media travelled en masse to Pakistan to cover the upcoming war against the Taliban and Al Qu'aida.

The border was closed and journalists needed a story. Jalozai became again the symbol of the suffering of the Afghan people. Once Afghanistan opened up after the toppling of the Taliban regime, Jalozai disappeared from the initial headlines of the media and disappeared into oblivion.

The closure of the camp in mid-February 2002 went largely unnoticed. Camps were built in the so-called Tribal Areas, the western part of the North-Western Frontier Province bordering Afghanistan. Anticipating a new influx of Afghan refugees the UNHCR looked also at possibilities to relocate Jalozai.

So, last November, the first peoples moved to the new sites of Kotkai, Old Bagzai, Basu, Shalman and Ashgaro in the Khyber-, Bajaur and Kurram agencies in the Tribal Areas. This operation ended last week. MSF is not thrilled by this development. 'Yes, they gained more material assistance, which is good', says Nicoll van der Haak of MSF and one of the last staff members to have worked in Jalozai, 'The down side is that they are now 100 percent dependent on humanitarian assistance. In Peshawar many of them had little jobs.

Where they are now is remote, and in an insecure area. Despite the improved living conditions they are in a much more vulnerable position than ever before.' Improvement of living conditions does not mean you can push aside or ignore the basic rights of any refugee. Voluntary basis is the key word in the whole process of repatriation.

MSF remains concerned about the voluntary character of the refugee relocations. Especially since plans are now emerging to repatriate them from the Tribal Areas back to Afghanistan. 'Of course we welcome any attempt to improve the situation of the refugees.

That is what we have worked for from the beginning onwards, in the field and during our lobby efforts', said Marcel van Soest, Operational Director of MSF, 'but we have our worries about the pressure being put on the refugees, the insecurity within the Tribal Areas. And, after all, they still have not been granted any status, thus leaving them without any legal protection. That has been our main point from the beginning.'