Between 2001 and 2009, according to the Afghan government, the country has received $36 billion in grants and loans from donor nations, with the United States disbursing some $23 billion of it.  U.S. taxpayers have anted up another $338 billion to fund the war and occupation.  Yet from poverty indexes to risk-of-rape assessments, from childhood mortality figures to drug-use stats, just about every available measure of Afghan wellbeing paints a grim picture of a country in a persistent state of humanitarian crisis, often involving reconstruction and military failures on an epic scale.  Pick a measurement affecting ordinary Afghans and the record since November 2001 when Kabul fell to Allied forces is likely to show stagnation or setbacks and, almost invariably, suffering.

Almost a decade after the U.S. invasion, life for Afghan civilians is not a subject Americans care much about and so, not surprisingly, it plays little role in Washington's discussions of “success.”  Have a significant number of Afghans found the years of occupation and war “successful”?  Has there been a payoff in everyday life for the indignities of the American years -- the cars stopped or sometimes shot up at road checkpoints, the American patrols trooping through fields and searching homes, the terrifying night raids, the imprisonments without trial, or the way so many Afghans continue to be treated like foreigners, if not criminal suspects, in their own country? 

For years, American leaders have hailed the way Afghans are supposedly benefiting from the U.S. role in their country.  But are they?

The promises began early. In April 2002, for instance, speaking at the Virginia Military Institute, President George W. Bush proclaimed that in Afghanistan “peace will be achieved through an education system for boys and girls which works.”  He added, “We're working hard in Afghanistan: We're clearing mine fields. We're rebuilding roads. We're improving medical care. And we will work to help Afghanistan to develop an economy that can feed its people without feeding the world's demand for drugs.”

When, on May 1, 2003, President Bush strode across the flight deck of the USS Abraham Lincoln to deliver his “mission accomplished” speech, declaring an end to “major combat operations in Iraq,” he also spoke of triumph in the other war and once again offered a rosy picture of Afghan developments.  “We continue to help the Afghan people lay roads, restore hospitals, and educate all of their children,” he said.  Five years later, he was still touting American aid to Afghans, noting that the U.S. was “working to ensure that our military progress is accompanied by the political and economic gains that are critical to the success of a free Afghanistan." 

Earlier this year, President Barack Obama seemed to suggest that efforts to promote Afghan wellbeing had indeed been a success: “There is no denying the progress that the Afghan people have made in recent years -- in education, in health care and economic development, as I saw in the lights across Kabul when I landed -- lights that would not have been visible just a few years earlier.”

So, almost 10 years on, just what are the lives of ordinary Afghans like?  Has childhood mortality markedly improved?  Are women, if not equal in terms of civil rights, at least secure in the knowledge that men are not able to rape them with impunity?  Have all Afghan children -- or even most -- started on the road to a decent education? 

Or how about a more basic question?  After almost a decade of war and tens of billions in international aid, do Afghans have enough to eat?  I recently posed that question to Challiss McDonough of the United Nation’s World Food Program in Afghanistan.

Food Insecurity

In October 2001, the BBC reported that more than seven million people were "at risk of malnutrition or food shortages across Afghanistan.”  In an email, McDonough updated that estimate:  “The most recent data on food insecurity comes from the last National Risk and Vulnerability Assesment (NRVA), which was conducted in 2007/2008 and released in late October 2009.  It found that about 7.4 million people are food-insecure, roughly 31 percent of the estimated population.  Another 37 percent are considered to be on the borderline of food insecurity, and could be pushed over the edge by shocks such as floods, drought, or conflict-related displacement.”

Food insecurity indicators, McDonough pointed out, are heading in the wrong direction.  “The NRVA of 2007/08 showed that the food security had deteriorated in 25 out of the 34 provinces compared to the 2005 NRVA.  This was the result of a combination of factors, including high food prices, rising insecurity and recurring natural disasters.”  As she also pointed out, “About 36 percent of the population lives below the poverty line and cannot afford basic necessities.  Staple food prices remain higher than they are in neighboring countries, and higher than they were before the global high-food-price crisis began in 2007.”

Recently, the international risk management firm Maplecroft put together a food security index -- using 12 criteria developed with the United Nations’ World Food Program -- to evaluate the threat to supplies of basic food staples in 163 countries.  Afghanistan ranked dead last and was the only non-African nation among the 10 most food-insecure countries on the planet.

Refugees and Internally Displaced Persons

During the Soviet occupation of the 1980s and the grim years of Taliban rule in the later 1990s, millions of Afghans fled their country.  While many returned after 2001, large numbers have continued to live abroad.  More than one million registered Afghans reportedly live in Iran.  Another 1.5 million or more undocumented, unregistered Afghan refugees may also reside in that country.  Some 1.7 million or more Afghan refugees currently live in Pakistan -- 1.5 million of them in recently flood-ravaged provinces, according to Adrian Edwards, a spokesman for the U.N.'s refugee agency. 

Many Afghans who still remain in their country cannot return home either.  According to a 2008 report by the United Nations High Commission for Refugees (UNHCR), there were 235,833 internally displaced persons nationwide.  As of the middle of this year, the numbers had reportedly increased to more than 328,000.

Children’s Well-Being

In 2000, according to the United Nations Children's Fund (UNICEF), mortality for children under five years of age stood at 257 per 1,000.  In 2008, the last year for which data was available, that number had not budged.  It had, in fact, only slightly improved since 1990, when after almost a decade of Soviet occupation and brutal warfare, the numbers stood at 260 per 1,000.  The figures were similar for infant mortality -- 168 per 1,000 in 1990, 165 per 1,000 in 2008.

In 2002, according to the U.N., about 50% of Afghan children were chronically malnourished.  The most recent comprehensive national survey, done two years into the U.S. occupation, found (according to the World Food Program’s McDonough) about 60% of children under five chronically malnourished.

Childhood education is a rare area of genuine improvement.  Afghan government statistics show steady growth -- from 3,083,434 children in primary school in 2002 to 4,788,366 enrolled in 2008.  Still, there are more young children outside than in the classroom, according to 2010 UNICEF numbers, which indicate that approximately five million Afghan children do not attend school -- most of them girls.

Many youngsters find themselves on the streets.  Reuters recently reported that there are no fewer than 600,000 street children in Afghanistan.  Shafiqa Zaher, a social worker with Aschiana, a children’s aid group receiving U.S. funds, told reporter Andrew Hammond that most have a home, even if only a crumbling shell of a building, but their caregivers are often disabled and unemployed.  Many are, therefore, forced into child labor.  “Poverty is getting worse in Afghanistan and children are forced to find work,” said Zaher.

In 2002, the U.N. reported that there were more than one million children in Afghanistan who had lost one or both parents.  Not much appears to have changed in the intervening years.  “I have seen estimates that there are over one million Afghan children whose father or mother is deceased,” Mike Whipple, the Chairman and CEO of International Orphan Care, a U.S.-based humanitarian organization that operates schools and medical clinics in Afghanistan, told me by email recently.

Increasingly, even Afghan youngsters with families are desperate enough to abandon their homeland and attempt a treacherous overland journey to Europe and possible asylum.  This year, UNHCR reported that ever more Afghan children are fleeing their country alone.  Almost 6,000 of them, mostly boys, sought asylum in European countries in 2009, compared to about 3,400 a year earlier.

Women’s Rights

In his 2002 State of the Union address, President Bush told Congress: "The last time we met in this chamber, the mothers and daughters of Afghanistan were captives in their own homes, forbidden from working or going to school. Today women are free and are part of Afghanistan's new government."  Last year, when asked about a new Afghan law sanctioning the oppression of women, President Obama asserted that there were “certain basic principles that all nations should uphold, and respect for women and respect for their freedom and integrity is an important principle.”   

Recently, the plight of women in Afghanistan again made U.S. headlines thanks to a shocking TIME magazine cover image of Bibi Aisha, an Afghan whose ears and nose were sliced off after she ran away from her husband’s house.  “What Happens When We Leave Afghanistan” was TIME’s headline, but reporter Ann Jones, who has worked closely with women in Afghanistan and talked to Bibi Aisha, took issue with the TIME cover in the Nation magazine, pointing out that it was evidently not the Taliban who mutilated Aisha and that the brutal assault took place eight years into the U.S. occupation.  Life for women in Afghanistan has not been the bed of roses promised by Bush nor typified by the basic rights proffered by Obama, as Jones noted:

“Consider the creeping Talibanization of Afghan life under the Karzai government. Restrictions on women's freedom of movement, access to work and rights within the family have steadily tightened as the result of a confluence of factors, including the neglect of legal and judicial reform and the obligations of international human rights conventions; legislation typified by the infamous Shia Personal Status Law (SPSL), gazetted in 2009 by President Karzai himself despite women's protests and international furor; intimidation; and violence."

Her observations are echoed in a recent report by Medica Mondiale, a German non-governmental organization that advocates for the rights of women and girls in war and crisis zones around the world.  As its blunt briefing began, “Nine years after 11 September and the start of the operation ‘Enduring Freedom,’ which justified its commitment not only with the hunt for terrorists, but also with the fight for women’s rights, the situation of women and girls in Afghanistan still is catastrophic.”  Medica Mondiale reported that 80% of all Afghan marriages are still “concluded under compulsion.”

The basic safety of women in Afghanistan in, and well beyond, Taliban-controlled areas has in recent years proven a dismal subject even though the Americans haven’t left.  According to the United Nations Development Fund for Women (UNIFEM), for instance, 87% of women are subject to domestic abuse.  A 2009 report by the U.N. Assistance Mission in Afghanistan (UNAMA) found that rape “is an everyday occurrence in all parts of the country” and called it a “human rights problem of profound proportions.”  That report continued:

"Women and girls are at risk of rape in their homes and in their communities, in detention facilities and as a result of traditional harmful practices to resolve feuds within the family or community... In the northern region for example, 39 percent of the cases analyzed by UNAMA Human Rights, found that perpetrators were directly linked to power brokers who are, effectively, above the law and enjoy immunity from arrest as well as immunity from social condemnation."

Afghan women are reportedly turning to suicide as their only solution. 

A June report by Sudabah Afzali of the Institute for War & Peace Reporting noted that, according to officials in Herat Province, “cases of suicide amongst women… have increased by 50 per cent over the last year.”  Sayed Naim Alemi, the director of the regional hospital in Herat, noted that 85 cases of attempted suicide recorded in the previous six months had involved women setting themselves on fire or ingesting poison.  In 57 of the cases, the women had died.

A study conducted by former Afghan Deputy Health Minister Faizullah Kakar and released in August gave a sense of the breadth of the problem.  Using Afghan Health Ministry records and hospital reports, Kakar found that an estimated 2,300 women or girls were attempting suicide each year.  Domestic violence, bitter hardships, and mental illness were the leading factors in their decisions. “This is a several-fold increase on three decades ago,” said Kakar.  In addition, he found that about 1.8 million Afghan women and girls between the ages of 15 and 40 are suffering from “severe depression.”

Drug Use

Rampant depression, among both men and women, has led to self-medication.  While opium-poppy cultivation on an almost unimaginable scale in the planet’s leading narco-state has garnered headlines since 2001, little attention has been paid to drug use by ordinary Afghans, even though it has been on a steep upward trajectory.

In 2003, according to Afghanistan's Public Health Minister Amin Fatimie, there were approximately 7,000 heroin addicts in the capital city, Kabul.  In 2007, that number was estimated to have doubled.  By 2009, UNAMA and the United Nations Office on Drugs and Crime (UNDOC) estimated that the city was home to up to 20,000 heroin users and another 20,000 to 25,000 opium users. 

Unfortunately, Kabul has no monopoly on the problem.  "Three decades of war-related trauma, unlimited availability of cheap narcotics, and limited access to treatment have created a major, and growing, addiction problem in Afghanistan," says Antonio Maria Costa, the Executive Director of UNDOC.  Since 2005, the number of Afghan opium users nationwide has jumped by 53%, while heroin users have skyrocketed by 140%.  According to UNODC’s survey, Drug Use in Afghanistan, approximately one million Afghans between the ages of 15 and 64 are addicted to drugs.  That adds up to about 8% of the population and twice the global average. 

AIDs and Sex Work

Since the U.S. occupation began, AIDS and HIV, the virus that causes the disease, have reportedly also been on the rise.  In 2002, only eight people tested positive for HIV.  In 2007, Public Health Minister Fatimie reported 61 confirmed cases of AIDS and 2,000 more suspected cases.

Fatamie blamed intravenous drug use for half the cases and the NGO Médecins du Monde, which works with intravenous drug users in Kabul, found that HIV prevalence among such users in the cities of Kabul, Herat, and Mazar had risen from 3% to 7% between 2006 and 2009.  A 2010 report by the Public Health Ministry revealed that knowledge about HIV among intravenous drug users was astonishingly low, that few had ever been tested for the virus, and that of those who admitted to purchasing sex within the previous six months, most confessed to not having used a condom.   

This last fact is hardly surprising, given the findings from a recent study by Catherine Todd and colleagues of 520 female sex workers, almost all mothers, in the Afghan cities of Jalalabad, Kabul, and Mazar-i-Sharif.  Only about 30% of the women surveyed reported clients had ever used a condom with them and about 50% had received treatment for a sexually transmitted infection in the three months prior to being interviewed.

The same study also sheds light on the intersection between high-risk behaviors, socio-economic conditions, and the freedom and opportunities promised to Afghan women by Presidents Bush and Obama.  The most common reasons Afghan women engaged in sex work, Todd and colleagues found, were the need to support themselves (50%) or their families (32.4%).  Almost 9% reported being forced into sex work by their families.  Just over 5% turned to prostitution after being widowed, and 1.5% were forced into the profession after they were sexually assaulted and, consequently, found themselves unable to marry.

A Decade of Progress?  

In the near-decade since Kabul fell in November 2001, a sizeable majority of Afghans have continued to live in poverty and privation.  Measuring such misery may be impossible, but the United Nations has tried to find a comprehensive way to do so nonetheless.  Using a Human Poverty Index which “focuses on the proportion of people below certain threshold[s] in regard to a long and healthy life, having access to education, and a decent standard of living,” the U.N. found that, comparatively speaking, it doesn’t get worse than life in Afghanistan.  The nation ranks dead last in its listing, number 135 out of 135 countries.  This is what “success” means today in Afghanistan.

The United Nations also ranks countries via a Human Development Index which includes such indicators of wellbeing as life expectancy, educational attainment, and income.  In 2004, the U.N. and the Afghan government issued the first National Human Development Report.  In its foreword, the publication cautioned:

“As was expected, the report has painted a gloomy picture of the status of human development in the country after two decades of war and destruction. The Human Development Index (HDI) value calculated nationally puts Afghanistan at the dismal ranking of 173 out of 178 countries worldwide. Yet the HDI also presents us with a benchmark against which progress can be measured in the future.“

The only place to go, it seemed, was up.  And yet, in 2009, when the U.N. issued a new Human Development Report, Afghanistan was in even worse shape, ranking number 181 of 182 nations, higher only than Niger.

Nick Turse is the associate editor of TomDispatch.com.  An award-winning journalist, his work has appeared in the Los Angeles Times, the Nation, and regularly at TomDispatch. His latest book, The Case for Withdrawal from Afghanistan (Verso Books), which brings together leading analysts from across the political spectrum, has just been published.  He discusses why withdrawal from Afghanistan hasn't been on the American agenda in Timothy MacBain's latest TomCast audio interview, which can be accessed by clicking here or downloaded to your iPod here. Turse is currently a fellow at Harvard University’s Radcliffe Institute.  You can follow him on Twitter @NickTurse, on Tumblr, and on Facebook.  His website is NickTurse.com.

Copyright 2010 Nick Turse