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Esercitazione: Allestimento
di un campo profughi a
Kabul
Scuola Ingegneria dell’Emergenza
Aspetti sanitari e umani nella gestione
delle Emergenze
NOTIZIE STORICHE. 1
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1979: L’Unione Sovietica invade l’Afghanistan.
La resistenza islamica si organizza. Prima
ondata di profughi in Pakistan ed Iran.
1979-1986: guerriglia dei mujahiddin,
guerriglia islamica afghana, contro il governo
filosovietico (aiutati da USA e Arabia Saudita)
Tra essi c’è anche Osama Bin Laden.
1988: inizia la ritirata delle truppe sovietiche.
I mujahiddin si fanno sempre più forti.
1992: i mujahiddin prendono Kabul. 2 anni di
guerra civile.Massoud è Ministro della guerra.
I combattimenti continuano, le maggiori
vittime sono tra la popolazione civile.
Aumenta il numero di profughi.
NOTIZIE STORICHE . 2
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1994: nasce nelle scuole coraniche del
Pakistan il movimento dei Taliban (talib:
studente del Corano) addestrati nei campi
profughi dai servizi segreti del Pakistan.
1996: I Taliban entrano in Kabul. I
mujaheddin, compattati nell’Alleanza del
Nord, capeggiata dal tagiko Massud,
continuano a combattere nella valle del
Panshir. Instaurato un Emirato Islamico.
2001: Situazione umanitaria gravissima per la
siccità. Aumentano gli sfollati. I Taliban fanno
saltare in aria le statue dei Buddha di
Bamyan.
NOTIZIE STORICHE . 3
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11 Settembre 2001: attacco alle Twin Towers:
inizia la “guerra contro il terrorismo”. Caduta
dei Taliban. Insediamento del governo ad
interim filoamericano capeggiato da Hamid
Karzai, composto soprattutto da Ministri
dell’Alleanza del Nord.
2002: Si instaura un governo di transizione
che dovrebbe portare tra circa 2 anni
l’Afghanistan a elezioni democratiche.
2003: Il Paese è ancora in uno stato di
instabilità: le truppe “per la sicurezza in
Afghanistan” (ISAF), i soldati americani e
inglesi continuano ad essere presenti nel
Paese.
Presentazione del caso studio:
Contesto
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Marzo 2002: molti profughi stanno rientrando
nel loro Paese con l’aiuto del governo afgano e
dell’UNHCR che, per il rimpatrio, hanno offerto
un’assistenza temporanea e una piccola somma
di denaro.
Le cifre dell’UNHCR parlano di oltre 1,3 milioni di
persone che volontariamente tornano.
In 4 mesi circa il rientro delle persone dal
Pakistan ha superato l’1,2 milioni di persone,
oltre 3 volte la previsione iniziale.
Presentazione del caso studio:
Problemi
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Il ritorno massiccio in Afghanistan mette a dura
prova la capacità di assistenza delle strutture
governative, delle agenzie umanitarie e delle
ONG.
Come primo risultato dell’eccessivo rientro
rispetto alle previsioni, gli aiuti promessi sono
diminuiti drammaticamente.
Si distribuisce dai 5 ai 40 USD a persona, un kit
di soccorso, coperte, grano, con il rischio che i
fondi a disposizione terminino in qualche mese,
molto prima del previsto.
Presentazione del caso studio:
Il campo profughi di Kabul
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Sono migliaia le persone che transitano
quotidianamente attraverso il campo profughi
alle porte di Kabul, per la registrazione e
l’ufficializzazione del loro rientro.
Con il coordinamento dell’UNHCR si sta
organizzando, alle porte della città di Kabul,
vicino la strada che porta a Jalalabad, un campo
profughi temporaneo, che assicuri assistenza di
base, registrazione dei profughi, fornitura di cibo
e beni di prima necessità, smistamento nelle
regioni di origine, evitando l’accumulo di famiglie
nelle aree periferiche e malsane della città di
Kabul.
Presentazione del caso studio:
Situazione attuale

L’UNHCR stima che i rifugiati di ritorno dal
Pakistan in Afghanistan, al momento siano circa
100.000, che necessitano di una sosta transitoria
(massimo 3 mesi), nel campo profughi di Kabul,
in attesa di rientrare nelle loro città di origine,
forniti di un aiuto economico minimo con il quale
ricominciare piccole attività di sostentamento
della famiglia.
Presentazione del caso studio:
Situazione in Pakistan.1

A seguito degli attacchi terroristici dell’11
Settembre 2001 il flusso di rifugiati
dall’Afghanistan è nuovamente aumentato.
Sebbene le frontiere siano state chiuse
ufficialmente sin da Novembre 2000, i
rifugiati raggiungono il Pakistan attraverso
strade poco conosciute. Alla fine di
Ottobre 2001 è stato stimato l’arrivo di
circa 100.000 rifugiati.
Presentazione del caso studio:
Situazione in Pakistan. 2

I rifugiati che arrivano in Pakistan, nonostante la
situazione, sono accolti in campi allestiti da
UNHCR vicino alle frontiere. Il Governo del
Pakistan ha accolto, nelle ultime 2 decadi una
delle più larghe popolazioni di rifugiati del
mondo. Più di 1,2 milioni di afgani vivono in
villaggi di rifugiati e, secondo le fonti
governative, oltre 2 milioni di rifugiati vivono nei
centri urbani.
Presentazione del caso studio:
Problemi in Pakistan

A seguito del deterioramento della
situazione economica del Pakistan, il
Governo ha gradualmente ridotto il
supporto ai profughi tranne nei casi in cui
esso
sia
sostenuto
pressochè
integralmente dagli aiuti internazionali.
Tale situazione ha ulteriormente spinto il
graduale rientro in Afghanistan dei
profughi.
Selected indicators
World Health Organization
Demographic Indicators
Afghanistan
Pakistan
Cina
1,292,378
Tajikistan
Iran
6,135
71,368
Total population (000), 2001
22,473
144,971
Annual population growth rate (%),
1991 to 2001
4.5
2.6
0.9
1.3
1.8
Dependency ratio (per 100), 2001
86
83
45
76
66
Dependency ratio (per 100), 1991
88
84
49
89
89
% of population > 60 years, 2001
4.7
5.8
10.0
6.8
5.3
% of population > 60 years, 1991
4.7
5.6
8.6
6.3
4.7
Total fertility rate, 2001
6.8
5.2
1.8
3.1
2.9
Total fertility rate, 1991
7.1
5.9
2.1
4.7
48
Alcuni indicatori demografici
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Dependency ratio (per 100), 2001. Indicator used in population
studies to measure the portion of the population which is
economically dependent on the active age group. It is calculated as
the sum of 0-14 year olds and over 60 or 65 year olds, depending on
the working age limit considered, divided by the number of people
aged between 15 and 59 or 64, respectively. For the purpose of the
World Health Report, it is calculated as the sum of 0-14 year olds and
over 65 year olds divided by the number of people aged between 15
and 64.
Total fertility rate, 2001. The average number of children a
hypothetical cohort of women would have at the end of their
reproductive period if they were subject during their whole lives to
the fertility rates of a given period and if they were not subject to
mortality. It is expressed as children per woman.
Selected indicators
World Health Organization
Health indicators, 2001
Afghanistan
Pakistan
Cina
Tajikistan
Iran
Life expectancy at birth (years)
Total population
Males
Females
42.3
41.1
43.7
61.3
61.0
61.5
71.2
69.8
72.7
63.3
59.9
66.9
68.6
66.4
71.1
Child mortality (probability of
dying <5 y) (per 1000)
Males
Females
252
249
105
115
34
40
93
79
45
39
Adult mortality (probability of
dying 15 -59y) (per 1000)
Males
Females
527
418
229
203
157
106
300
197
209
137
Healthy life expectancy
at birth (years)
Total population
Males
Females
33.4
31.1
35.7
50.9
50.4
51.5
63.2
62.0
64.3
50.1
47.0
53.2
56.7
55.5
57.9
Alcuni indicatori sanitari
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Life expectancy at birth (years), total population, 2001. Life expectancy (LEX)
is the average number of years of life that a person can expect to live if they
experience the current mortality rate of the population at each age.
Child mortality (per 1000), 2001. This refers to child mortality risk, which is
defined as the probability of dying before age 5 (5q0).
Adult mortality (per 1000), 2001. This refers to adult mortality risk, which is
defined as the probability of dying between 15 and 59 years (45q15).
Healthy life expectancy at birth (years), total population, 2001. Healthy life
expectancy (HALE) is based on life expectancy (LEX), but includes an adjustment
for time spent in poor health. This indicator measures the equivalent number of
years in full health that a newborn child can expect to live based on the current
mortality rates and prevalence distribution of health states in the population.
Selected indicators
World Health Organization
Health accounts indicators, 2000
Per capita GDP in dollars, 2000
Total health expenditure
As % of GDP
Per capita at average
exchange rate (US$)
Public health expenditure
% of total expenditure on health
Sources:
Social security %
External resources for health as %
Private health expenditure
Private expenditure %
Sources:
Prepaid plans as %
Out-of-pocket expenditure %
Afghanistan
Pakistan
Cina
Tajikistan
Iran
820
1,834
3,852
1,154
1.0
4.1
5.3
2.5
5.5
9
76
205
29
336
63.5
22.9
36.6
80.8
46.3
0.0
5.9
50.0
8.2
50.7
0.6
0.0
19.5
93.3
1.0
36.5
77.1
63.4
19.2
53.7
0.0
36.5
0.0
77.1
0.4
60.4
0.0
19.2
1.9
50.9
6,120
Alcuni indicatori economici
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Per capita GDP in international dollars, 2000. Gross domestic product (GDP) per
capita is the per capita market value of the total final output of goods and services
produced in a country over a specific period. The international dollar is a common
currency unit that takes into account differences in the relative purchasing power of
various currencies. Figures expressed in international dollars are calculated using
purchasing power parities (PPP), which are rates of currency conversion constructed
to account for differences in price level between countries.
General Government expenditure on health as % of total expenditure on health,
2000. Public Health Expenditure (PHE) is the sum of outlays on health paid for by
taxes, social security contributions and external resources (without double-counting
the government transfers to social security and extra-budgetary funds).
Per capita government expenditure on health in international dollars, 2000.
Public Health Expenditure (PHE) per capita is the per capita amount of the sum of
outlays on health paid for by taxes, social security contributions and external
resources (without double-counting the government transfers to social security and
extra-budgetary funds). The international dollar is a common currency unit that
takes into account differences in the relative purchasing power of various currencies.
Figures expressed in international dollars are calculated using purchasing power
parities (PPP), which are rates of currency conversion constructed to account for
differences in price level between countries.
Alcuni indicatori economici
Public expenditure
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Social security expenditure on health as % of general government expenditure
on health, 2000. Social Security and Extrabudgetary Funds on Health is the
expenditure by these schemes to purchase health goods and services. Includes all
compulsory schemes for a sizeable segment of the population.
External resources for health as % of general government expenditure on
health, 2000. External Resources are loans and grants for medical care and
medical goods channelled through the Ministry of Health or other public agencies.
Grants in-kind (capital equipment, pharmaceutical supplies and vaccines, technical
assistance such as experts) should be estimated at their monetary values. Grants to
non-governmental organisations should be accounted for as private (in practice,
this is difficult).
Private expenditure on health as % of total expenditure on health, 2000.
Private Expenditure on Health (PvtHE) comprises the outlays of insurers and thirdparty payers other than social security, mandated employer health services and
other enterprise provided health services, non-profit institutions and nongovernmental organisations financed health care, private investments in medical
care facilities and household out-of-pocket spending.
Afghanistan:
Population estimates
(Source WHO, 2003)
Indicator
Total population (000), 2001
Annual population growth rate (%), 1991 to 2001
Dependency ratio (per 100), 2001
Dependency ratio (per 100), 1991
Percentage of population aged 60+ years, 2001
Percentage of population aged 60+ years, 1991
Total fertility rate, 2001
Total fertility rate, 1991
Health indicators, 2001
Indicator
Value
Life expectancy at birth (years)
Total population
42.3
Males
41.1
Females
43.7
Child mortality (probability of dying under age 5 years) (per 1000)
Males
252
Females
249
Adult mortality (probability of dying between 15 and 59) (per 1000)
Males
527
Females
418
Healthy life expectancy at birth (years)
Total population
33.4
Males
31.1
Females
35.7
Healthy life expectancy at age 60 (years)
Males at age 60
4.9
Females at age 60
8.7
Expectation of lost healthy years at birth due to poor health (years)
Males
10.0
Females
8.1
Percentage of total life expectancy lost due to poor health (%)
Males
24.4
Females
18.4
Value
22,473
4.5
86
88
4.7
4.7
6.8
7.1
Uncertainty Interval
33.1 - 48.6
34.8 - 52.6
205 - 298
195 - 298
331 - 772
215 - 645
24.9 - 37.6
27.4 - 44.6
3.2 - 6.8
6.9 - 10.7
Afghanistan:
Selected national health accounts indicators
YEAR 2000 (Source WHO, 2003)
Indicator
Value
Per capita GDP in international dollars
Total health expenditure
Total expenditure on health as % of GDP, 2000
Per capita total expenditure on health at average exchange rate (US$)
Per capita total expenditure on health in international dollars
Public health expenditure
Government expenditure on health as % of total expenditure on health
Government expenditure on health as % of total general government expenditure
Per capita government expenditure on health at average exchange rate (US$)
Per capita government expenditure on health in international dollars
Sources of public health expenditure
Social security expenditure on health as % of government expenditure on health
External resources for health as % of general government expenditure on health
Private health expenditure
Private expenditure on health as % of total expenditure on health
Sources of private health expenditure
Prepaid plans as % of private expenditure on health
Out-of-pocket expenditure on health as % of total expenditure on health
820
8
1.0
9
63.5
2.9
5
5
5.9
.0
36.5
.0
36.50
Pakistan:
Population estimates
(Source WHO, 2003)
Indicator
Total population (000), 2001
Annual population growth rate (%), 1991 to 2001
Dependency ratio (per 100), 2001
Dependency ratio (per 100), 1991
Percentage of population aged 60+ years, 2001
Percentage of population aged 60+ years, 1991
Total fertility rate, 2001
Total fertility rate, 1991
Health indicators, 2001
Indicator
Value
Life expectancy at birth (years)
Total population
61.3
Males
61.0
Females
61.5
Child mortality (probability of dying under age 5 years) (per 1000)
Males
105
Females
115
Adult mortality (probability of dying between 15 and 59) (per 1000)
Males
229
Females
203
Healthy life expectancy at birth (years)
Total population
50.9
Males
50.4
Females
51.5
Healthy life expectancy at age 60 (years)
Males at age 60
9.3
Females at age 60
10.8
Expectation of lost healthy years at birth due to poor health (years)
Males
10.7
Females
10.0
Percentage of total life expectancy lost due to poor health (%)
Males
17.5
Females
16.3
Value
144,971
2.6
83
84
5.8
5.6
5.2
5.9
Uncertainty Interval
59.4 - 62.5
59.7 - 63.2
91 - 123
97 - 134
202 - 254
176 - 231
48.9 - 53.3
50.0 - 53.9
8.6 - 10.3
10.0 - 12.3
Pakistan: Selected national health accounts indicators (Source WHO 2003)
Indicator
Per capita GDP in international dollars, 2000
Value
1,834
Total health expenditure
Total expenditure on health as % of GDP, 2000
Per capita total expenditure on health at average exchange rate (US$), 2000
Per capita total expenditure on health in international dollars, 2000
4.1
18
76
Public health expenditure
Government expenditure on health as % of total expenditure on health, 2000 22.9
Government expenditure on health as % of total general government expenditure, 2000
Per capita government expenditure on health at average exchange rate (US$), 2000
Per capita government expenditure on health in international dollars, 2000
4.0
4
17
Sources of public health expenditure
Social security expenditure on health as % of general government expenditure on health 50.0
External resources for health as % of general government expenditure on health, 2000
8.2
Private health expenditure
Private expenditure on health as % of total expenditure on health, 2000
Sources of private health expenditure
Prepaid plans as % of private expenditure on health, 2000
Out-of-pocket expenditure on health as % of total expenditure on health, 2000
77.1
.0
77.10