December 2001, US troops invade Afghanistan, and Talibans must leave the country or at least hide in the mountains... It is the end of a dramatic period of oppression and tragedy. Nearly four millions emigrates come back from Iran and Pakistan after years of exile. Among them thousands very young women, who hardly knew their own country, are forced to get married by their parents, versus money, when coming back home… and the tragedy goes on…

Every year in Herat, second town in Afghanistan, 350 young girls, aged 12 to 18, unhappy and mistreated by their husband , are committing ( or forced to commit) suicide by self immolation.

June 2002, a team of plastic surgeons , from the French NGO HumaniTerra, is organizing two surgical missions to Afghanistan, in Chagcharan, Ghor Province, (in the Indu Kush mountains, two days four-wheel drive trip at 3200 meters altitude) and in Herat, former intellectual capital of Persia, 80 km from the Iranian border.

In Herat they are absolutely shocked and horrified to discover at the Regional Public Provincial Hospital such a great amount of burn young patients, agonizing in the corridors of the wards, without nearly any care… Everyday more and more of these cases where admitted at the hospital, and no one was really treating them. The decision was immediately taken by the HumaniTerra team to organize a proper treatment for those patients, and all the other burn patients.

In 2003, Political and working meetings were organized with the local authorities, including the famous war lord Ismael Khan, who offered us his complete support. National Health Administration was also of course included in the process, and the coalition forces, under the leadership of the US army helped us to raise money for the construction of a true Pilot Burn Hospital.

The architectural planning of the three floor burn centre was done by HumaniTerra, 36 beds, including an acute burn unit for women, an other one for men, a unit for burn sequellae, a unit for rehabilitation (given to Handicap International), an outpatients unit, a specific double operating theatre with a very modern sterilisation unit, a department for teaching on the third floor, and a unit for burn prevention and for psycho-social problems…

The hospital was built under the control of the NGO’s architects, and after three years of meetings, discussions, training, controls… the first patients could be admitted in October 2007

The European Union participated to the furbishing and medical and administrative training of local doctors and nurses. Other donors helped us to insure the daily material and consumables

The total cost of the pilot burn hospital was evaluated to 2 millions dollars.

In 2010, 1250 burn patients are admitted every year, including out patients.

Afghanistan, is not a very peaceful country, and life is still dangerous there if very severe security rules are not strictly respected. Permanent medical teams of HumaniTerra are living there, all year long, locals and Europeans. Besides this, eight to ten surgical teams are going on the field from Europe, every year, for training, teaching, administrative tasks, operating, rehabilitation…

HumaniTerra has decided to share this activity on the field, with other European or international surgical teams, through the European humanitarian network SHARE (ESPRAS) and the world surgical cluster HUGS (IPRAS).

A lot of work still needs to be done…

When I first led the initial surgical team there, in 2002, there was nothing but desolation, misery, and sadness. Women were considered as animals, and sometimes less than that. Young girls were not taught nor educated… they had absolutely no rights. There was no music, no papers, no life… everything was to be rebuilt.

We have built, we have educated, we have tried to give them sustainability, we have saved lives, we have put them back to a decent live…

We have taught doctors, technicians, and health officers how to run hospitals, operating theatres, medical and surgical wards… One of them, Doctor Homayoun Azizi, who has been invited four times to France for specific training, is now an important minister of the afghan government in Kabul. All together, from Afghanistan, more than 20 hospital directors, regional health directors, surgeons, anaesthetists, nurses… have been fully invited and taken in charge in France and Europe, for training, congresses, international meetings… Some of them have even been participating, sponsored by our NGO, to the wonderful world ISBI meeting organised by our friend Nelson Piccolo in Brazil, speaking, together with an other good friend Rajeev Ahuja, about burn suicides in women, for a round table that we had organized, on that occasion.

But this not enough… more must be done. Even if it is still very difficult, even if danger is still there, even if it costs a lot of money…

In 2008 we have set up a regional campaign against violences to women, traumatic aggressions, acid attacks, and of course burn suicides and self immolations… this campaign, with the help of the EU funding, was done on a population of 20 000 persons, including women, men and children. 52 sessions for Women, 24 sessions for men were organized in the only province of Herat with the help of a local NGO, Voice of Women. Since then the incidence of burn suicides admitted at the Herat Burn Hospital decreased from 45% of the total burn patients in 2003 to 15% in 2009! A good success… but not enough yet…

A second burn suicide prevention campaign will be starting in the early weeks of 2011, with funding from the French ministry of foreign affairs, UNICEF, and other donors… And the help, we hope of IPRAS…

Fighting for women rights is also our goal… it must be the role of everyone. Many NGOs among our Networks, such as Women For Women-IPRAS, are really willing to follow this way. A good example is, for instance, the recent cooperation established between HumaniTerra / Women for Women / Acid Survivors Foundation / Frienship International, in Bangladesh…

All this is the promise of collaboration and good understanding between the numerous surgical NGOs members of SHARE and HUGS…

In Afghanistan, much more can be done for civilian burn patients. A proposal of a burn unit in Kabul has been done by local authorities, including Medecins du Monde, with the expertise of HumaniTerra… this should be one of our next goal… together with the help of teams coming from different countries of the world, through IPRAS/ HUGS.

In Phnom Penh, Cambodia, the first “National Plastic Surgery and Burn Department” will be set up in 2013, under the leadership of HumaniTerra, but it will be opened to all teams of the world willing to participate… In Haiti, an other Burn Department is on its way, build by Europeans teams, together with HumaniTerra, Interplast Germany, Interplast France …all members of SHARE…

Burn care is a whole thing… We must absolutely never forget to have a holistic approach of this dreadful pathology, particularly during our surgical camps in poor countries, or our proposals for new burn units in less developed countries.

Physiotherapy, for instance is very important…. There is no success in burn surgery without a good physical rehabilitation. Our missions always bring everywhere a good physio with the surgical team; in Afghanistan, a specific training has been provided during months and a big part of the Burn Hospital is now run by Handicap International. Psycho-social problems also have to be taken into account… our patients must return to a normal life… this is the role of our social workers teams or the task of local NGOs that we hire there to insure the job…

Surgery is not enough…! We must also think of what happens before… and after…

What has been done in Afghanistan is a good example for a holistic approach of humanitarian burn care. It has not been done in the easiest and the most quiet place of the world… but I have the strong feeling that we can, all of us, SHARE this, and make it better, there, and in other parts of the world, in order to give our warmest HUGS to the ones who need our help, I mean to the poorest of the poorest, on our fantastic Earth…

A happy, peaceful, and fruitful new year to all…

CHRISTIAN ECHINARD

President, HumaniTerra

Chairman ESPRAS/SHARE (Surgical Humanitarian Aid Recourses Europe)

Co-chairman IPRAS/HUGS (Humanitarian Union for Global Surgery)