Q&A: UNICEF in Afghanistan

July 14, 2014

An inside look at UNICEF's work in Afghanistan, one of the most dangerous places in the world for children.

Akhil Iyer took over the leadership of UNICEF Afghanistan’s country office last December, just a few weeks before two UNICEF employees were killed in Kabul. Iyer says that was by far the most difficult experience of his long career at UNICEF, and lack of security remains a significant challenge for UNICEF’s work in the region. It has not slowed his team’s determination to improve the lives of Afghanistan’s children, particularly as UNICEF Afghanistan embarks on a new five-year strategy to reach the country’s most deprived and most dangerous provinces. Following are excerpts from an interview with Iyer in New York on June 26.

Q: Your country office is now starting a new five-year program. Can you describe it and explain the rationale?

Iyer: Indeed, it is a very ambitious program. We are going to make a very dedicated effort to try and reach the most deprived provinces and districts within the country.  Even though, I suppose, all provinces have high levels of deprivation, there are about ten provinces that are the most deprived, and so we are looking to invest more and more of our resources at the sub-national level, so most of the programs and the projects supported by UNICEF will be in communities and villages within these 10 most deprived provinces. I think in order to be loyal with the equity approach of the organization, one has to determine where the greatest need is and the greatest vulnerability is, and so we did an analysis of this using what we call a multiple deprivation analysis, and we were able to find where the need is greatest.

Q: The situation on polio is still obviously a concern, but there is some progress. What strategies are working to reach conflict-affected areas?

Iyer: The number of polio cases within Afghanistan has decreased considerably over the last four years.  So far we’ve only found four cases of polio in 2014 in Afghanistan.  Now the success has been because polio eradication or polio immunization has reached all areas of the country, including inaccessible or difficult-to-reach, insecure areas, and the secret, in my opinion, has been the ability to effectively negotiate access for polio immunization in Afghanistan, including negotiating successfully with anti-government elements.

Q: So what is it like to negotiate with the Taliban? How do you do that?

Iyer: The most successful approach is basically very local level access negotiation using intermediaries, including community elders, to speak with people like local commanders and convince them regarding the importance of polio immunization and eradicating the polio virus from the country, and always emphasizing the neutrality and the impartiality of polio immunization.

Q: Afghanistan has extremely high levels of malnutrition. Can you explain how UNICEF is addressing that?

Iyer: In a few weeks, UNICEF and the Ministry of Health will release a national nutrition survey.  This is the first national nutrition survey conducted successfully in Afghanistan in about 10 years.  What it will show is stunting levels which are the highest in the world, with over half of the entire child population being stunted or chronically malnourished, and it will also show extremely high rates of wasting or acute malnutrition, particularly in the age category of zero to three.  These indicators certainly justify a very strong investment in a very wide and ambitious nutrition program.  It’s what the country needs.  It’s what the children need.

I think there are probably some quick wins.  We can probably make a big dent in terms of the high anemia rates by supplementing women more regularly with iron and folic acid at regular intervals and at a national scale.  Another nutritional problem in Afghanistan is in the area of micronutrient deficiencies, so our efforts to iodize all salt produced in Afghanistan and to ensure that all salt imported into Afghanistan from neighboring countries is iodized is something that we’ll continue doing; and we’re also going to continue with vitamin  A supplementation at a national scale.

Q: You are starting to work in Nuristan. What are you able to do there, and how do you do it?

Iyer: Nuristan is arguably the most insecure province among the 34 provinces in Afghanistan.  It’s an area where no international organization has been able to establish an office or a presence for a number of years, and this is due to the security situation.  However, we have been able to implement programs such as polio immunization, routine immunization, etc. in Nuristan, but we’ve had to do this without being able to establish an office in that province.  So we have been supporting such programs that are implemented by other partners, but there’s a strong attention given before implementation starts to 1) local access negotiation, and 2) gaining community acceptance from community development committees, village elders, etc., and that has allowed us to implement programs in the area of immunization, most notably. It’s more challenging, however, to monitor programs in such areas, and so we have been increasingly using third-party monitoring, and also remote monitoring, basically using SMS types of technologies to monitor and report back to us.

Read more about UNICEF's work in Afghanistan.