Afghan civilian casualties: a grim reality

Abstract

Civilian casualties in conflict, whether the result of intentional targeting or collateral damage, are always unacceptable. With 1319 deaths and 2533 injuries, the number of Afghan civilians killed or injured in the first 6 months of 2013 rose by 23% compared with the same period last year, according to the UN Assistance Mission in Afghanistan (UNAMA) mid-year report released on July 31. Improvised explosive devices (eg, roadside bombs), suicide bombings, and complex attacks accounted for 52% of all civilian casualties. Combat between Afghan forces and antigovernment insurgents accounted for 25% of all civilian casualties. Unexploded and abandoned explosives pose increasing risks to the safety of civilians. Of the 145 casualties from such explosives documented, 79% of the victims were children. The UNAMA mid-year report—with all the limitations linked to recording and verifying casualties—provides valuable data to promote changes in policy and practices, and to remind all parties of their obligations to protect civilians, during and after combat operations. The report also highlights the disproportionate price paid by women and children: deaths and injuries increased by 38% compared with the same period last year. In a country where children are already facing high malnutrition and mortality rates, and where women and girls' rights are severely repressed, this trend is particularly concerning. Civilians are affected by the conflict directly—as victims of violence, but also indirectly—because they face difficulties accessing health care. Although progress has been made with the implementation of the Basic Package of Health Services, access to health services is challenging: insecurity and violence, combined with the paucity of infrastructures and health-care workers, especially women, threaten access and delivery of health care. The fragile nature of Afghanistan's nascent health-care system coupled with continuing civilian casualties demands urgent and concerted action. Protecting civilians and providing access to a sustainable health system must be key strategic priority for national and international leaders even after 2014.