Fixing lives and limbs through decades of war in Afghanistan

After the 9/11 attacks in 2001, the United States and its allies invaded Afghanistan – a campaign that lasted 20 years and took the greatest toll on Afghan civilians. Photojournalist Ricardo Garcia Vilanova covered Afghanistan between 2007 and 2011. He writes about photographing those trying to help amidst the conflict.

The first memory I have of Afghanistan is arriving in the capital Kabul before dawn on a flight via Frankfurt. It was 2007 and I had been working for several years in Haiti before I decided to go to Afghanistan as a freelancer, without any real assignment. Once in the country, I was lucky to get work with American publications, which allowed me to continue travelling back and forth.

That first day, I left the terminal in darkness, watching as several soldiers stood guard on the periphery of the airport between barbed wire fences and concrete blast walls set up to protect the airport from car bombs. Unlike other airports, there were no taxis or any alternative means of transportation. It seemed I had no option but to sleep there until the next morning. But then a fellow passenger from my flight, an NGO worker, offered me a lift to my guesthouse in a convoy of two armoured cars.

It was winter, the night was cold and there was no electricity. As we drove, the streets were dark and deserted and several checkpoints manned by Afghan Forces marked the different access points to the city.

The outlook seemed bleak. Even though there was no active war in Kabul, there was elsewhere in the country, so the atmosphere in the capital was one of latent war. For many Afghans, this was a feeling they seemed to have normalised.

For decades, even before the so-called “war on terror”, Afghans had known conflict. Twenty years prior, the country was embroiled in a civil war between the forces of the National Army, supported by Russia, and the Mujahideen rebels.

Then, as in later conflicts, humanitarians arrived to help with aid and medical care.

In 1988, the International Committee of the Red Cross (ICRC) set up the Ali Abad Orthopaedic Centre in the capital, to provide physical rehabilitation and artificial limbs for the war wounded who had been victims of fighting, landmines and bombs.

Two years after that, in 1990, Italian physiotherapist Alberto Cairo arrived to work at the centre. More than three decades later, he has not left, deciding to spend his life helping those affected by Afghanistan’s decades-long conflicts.

Three decades of care

I met Alberto on my first trip to Kabul. The then-55-year-old director of the orthopaedic centre was personable, outgoing, courteous and attentive as he went about his work.

My first thought upon meeting him was to wonder how someone could dedicate themselves to helping others without expecting anything in return, living cut off from everything he once considered a normal part of his life in the West. But he is part of that nucleus of people who altruistically try to help others, and that is his mission and legacy in life.

Alberto told me that it was in 1992 when he met the man who changed his life – and whose example would go on to change the lives of thousands of others, people who have passed through the ICRC centres for treatment and those who have worked there.

The man Alberto met was called Mahmood. He had no legs and one arm. He was in the middle of the street in a wheelchair, trying to escape a nearby explosion with his youngest son.

Although fighting had ravaged the capital, causing the orthopaedic centre to close, Alberto invited Mahmood in for treatment. After a while, Mahmood was up and about with the help of his new prosthetics.

Once Alberto was able to reopen the centre, Mahmood started working there too.

Since then, it has been Alberto’s policy to hire people who had been rehabilitated at the centre.

A crucial service

The Ali Abad Orthopaedic Centre is in downtown Kabul and has a view of the mountains that frame the city.

Its main entrance opens onto a closed deck, where people wait when it is cold or raining. On sunny days when the temperature allows it, people sit on large benches or in a yard that surrounds it. There they wait their turn for treatment, which is offered completely free of charge.

Inside the building, there are large rehabilitation rooms, some like a gym where physiotherapists do exercises with patients who already have some mobility, and others where patients go through an initial phase of care. Depending on the type of disability, a specific treatment is designed for each patient.

Over the decades, the orthopaedic centre expanded its operations, opening new locations to help even more patients – there are now seven specialised centres across the country. Each year, some 10,000 Afghans enrol with the ICRC for prosthetics and physical rehabilitation and the centres have supported more than 178,000 patients with care, the NGO says.

Since the mid-1990s, they have not only helped the war-wounded but expanded their work to cover anyone with a mobility issue. Ninety percent of the patients they treat suffer from disability due to congenital conditions, illnesses or accidents. In some cases, the treatment can last for years.

Every day, year in and year out, long lines of people seeking care pass through the doors of the centre. Then there are the teams who make home visits to reach those patients who cannot move or travel to the centre.

It is a crucial service in a country like Afghanistan, where many people do not have the logistical or economic resources to be able to travel far for medical care or to access a four-wheel-drive that can take them to a treatment centre from an area where standard cars or taxis often cannot reach.

Taking care of patients

One day, I accompanied several physiotherapists on their home visits to the areas surrounding the Kabul orthopaedic centre.

The team started out early in the morning, travelling with a driver in a four-wheel-drive, with a plan to visit several houses that day.

Even though the distances between the centre and its patients may not be that far, some live in areas that are difficult to reach; or in houses built on streets with great slopes that on rainy days would turn to mud, making things more complicated. Only a four-wheel-drive, inching forward at a snail’s pace, could make the journey.

In the car that day was Bashir, a physiotherapist working at the centre in Kabul. He is one of the former-patients-turned-staff-members who make up 90 percent of those working at the ICRC centres. He was injured in a landmine blast and now uses prosthetics to walk.

After circumventing several checkpoints that morning, our vehicle finally arrived in one of the poorest areas of Kabul. In a modest house, we met Ashma, who lived with her father and brother (her mother had passed away). Bashir tended to her with great attention and patience while her family observed from a distance. As the physiotherapist and his patient worked, Ashma’s gratitude was palpable.

We made another stop that day, at a small clothes-making workshop, also located in one of the poorest parts of the city. Bashir followed up with a patient who worked there. Thanks to a prosthesis the centre had provided, he is now able to stand up.

The prosthetics the ICRC team uses are all produced on-site in artisanal workshops housed within the seven orthopaedic centres. The staff members – nearly all of them former patients with disabilities – hand-make the prostheses and adapt them to the needs of each patient.

More than 19,000 artificial legs, arms and other orthopaedic devices are manufactured every year, the ICRC says. Alberto has estimated that there are no fewer than 200,000 people in Afghanistan who are in need of prosthetic limbs.

More than 30 years ago, war created the need for an orthopaedic centre like this one. In the decades since, the conflict shifted, the players changed, and the conditions on the ground altered.

But those who have always needed help still do.

So the centre, and its satellite projects in other cities, stands. And Alberto and his committed team continue their daily work of ensuring Afghans who are most in need get the care they seek.