With the US military currently engaged in Afghanistan, humanitarian relief organizations are concerned about the welfare of civilians. Jennifer Leaning, professor of international health in the Department of Population and International Health, and director, Program on Humanitarian Crises and Human Rights, François-Xavier Bagnoud Center for Health and Human Rights, offers insights and opinion:

As we have learned in humanitarian response efforts throughout the decade of the 90s, there is a significant, though narrow role, for humanitarian relief in the midst of war," said Leaning.

Afghanistan has experienced more than two decades of steady war. This conflict, along with severe drought in the last three to four years, has left approximately one-third of the population, or seven million people, at high risk of famine this winter, according to humanitarian organizations.

The situation became more dangerous for civilians in the country when the United States launched a war against terrorism following the September 11th attacks on America, targeting the leaders of the Al Qaeda terrorist network in Afghanistan.

"As public health professionals, our biggest responsibility is the protection and support of civilian populations," said Leaning.

There are fears that US air strikes might lead to a mass exodus from Afghanistan, adding to more than three million Afghans who are refugees in surrounding countries or internally displaced within the borders of Afghanistan. So far, these large numbers of new people in flight have not been observed crossing Afghan borders.

"If there were widespread panic and vast movements, we’d be hearing about it by now," said Leaning. "The situation is fragile but has not turned into outright catastrophe."

Within the context of aerial bombardment and potential use of ground troops, the options facing both the people of Afghanistan and the international relief community are limited, said Leaning.

"From the perspective of the relief community," said Leaning, "it would be best if the population were to stay in place, near the existing medical and food stations that have already been set up by international relief agencies during these past years of crisis."

The challenge for the relief community will be to resupply these stations by bringing in food and supplies across the mountainous borders without getting harmed by ongoing military action.

According to Leaning, this challenge has led many in the international relief community to call upon the US and the warring parties within the country to establish safe corridors for the movement of crucial humanitarian aid.

Reducing the likelihood of population flight will also relieve pressure at the borders of Afghanistan, where poor and politically charged countries such as Pakistan and Iran already are dealing with refugee populations from Afghanistan.

There is another concrete reason for urging the population in Afghanistan to stay in place. The country is one of the most heavily landmined regions in the world, remnants of the conflict between Afghanistan and the Soviet Union. According to Leaning, it is well established that when civilian populations move into new territory within a country littered by landmines, there is a sharp rise in new landmine casualties.

"Consequently, what the humanitarian community is trying to do is to keep conditions inside Afghanistan from deteriorating further, so that people do not feel compelled to move and ultimately leave," said Leaning.

The continued delivery of food will help. According to experts, 50 to 55 thousand tons of food will need to go into Afghanistan over the next several months to stave off severe hunger or frank starvation. This amount cannot be met by the food air drops of the US military, said Leaning. Afghanistan’s transportation network, including roads and bridges, was virtually destroyed during the last 20 years of continual fighting. The relief community is now using all possible means, including donkey caravans, to cope with the problem, she said. And getting the food to those in need will be made increasingly more difficult as winter descends in the mountains, with expected onset of heavy snows in November and December.

"It is clear to all involved," said Leaning, "that the sooner the military phase of US action can be brought to a conclusion, the better it will be for the safety of civilians in Afghanistan and the prospects for resupplying them with food, medicines and other materials needed for survival through this winter."

Continued Leaning, "The conclusion of the military phase will herald an expanded, urgent agenda for the humanitarian community. At the geopolitical level, a new and widely representative government will need to be reconstituted and supported through a broad international coalition, with the UN playing an active role. The task of helping the Afghan people rebuild their country and community will require humanitarian efforts far beyond the scale seen in Kosovo. We should expect that, as with Kosovo, relief efforts during war lead to great responsibilities for relief and development efforts in the peace that hopefully follows."