9/11 at 20: after war, what?

Two decades after the terrorist attacks that initiated a US-led “war on terror”, what are implications and prospects for global health wellbeing? From an American—indeed, western—perspective, dangers to security today diverse complex. The US intelligence community's annual threat assessment report, published in April, 2021, highlights risks from individual nations destabilising transnational concerns, conflict climate crisis cyberattacks. emergency is today's Afghanistan was already cited as cause anxiety. report anticipated Afghan Government would struggle hold Taliban at bay if coalition forces withdrew, although pass without mention. Indeed, within 2 weeks of withdrawal, controlled most commentators now fear return cells country. It reasonable ask: have 20 years simply been wasted? No. people live very different circumstances those existed before USA deposed 2001. According World Bank estimates, population has almost doubled—to 38·9 million 2020—making one youngest countries world. Two-thirds younger than 25 years. In education, major investments provided unparalleled opportunities many young Afghans. UNESCO, nearly all children were enrolled primary school 2018, compared with 21% 2001, when girls prohibited attending. Major challenges remain, course. School attendance often much lower enrolment and, literacy increased, attainment (43% 2020) still too low. Despite important improvements gender equity visible increases number women working, including prominent roles, ranks worst equality globally. Some dramatic shifts health. Life expectancy increased by 10 years, up 65 2019. Remarkable gains seen maternal child data Lancet Global Health, had 29% decline under-5 mortality between 2003 2015 (from 127·8 91·0 per 1000 livebirths). Maternal 2001 among highest world, but since halved. 2019 GBD Study reports substantial decreases respiratory tract infections, diarrhoeal diseases, measles 2009, deaths conflict, road injuries, interpersonal violence, non-communicable diseases. system sustained these heavily dependent aid, importantly Bank, which financed 2500 clinics across country suspended funding. suspension contracts led non-governmental organisations reassess care services they can provide. This uncertainty destroying nascent service resiliently throughout three waves COVID-19 escalation conflict. Wahid Majrooh, minister public Afghanistan, told that, aside damage morale trust, lack financial assurance leading suppliers default their contractual commitments. He says sector stayed deliberately impartial withdrawal international aid could precipitate humanitarian emergency. responsibility protect advance progress made during past But community also reciprocal urgent continue support be fatal blow. Although few agencies remain committed, failure others plan provide continuity face this eventuality, despite clear indications need do so, appalling unjustifiable. uneven, achieved small dedicated group workers. Supporting doctors, nurses, midwives through intensified collaboration essential. Coalitions strengthen Afghanistan's brittle must new regime. status valuable squandered delay. experience, Iraq well surely tell us real lesson 9/11 not war. remains demand peace, cooperation, attention basic human needs—of foundational. For more see https://www.dni.gov/files/ODNI/documents/assessments/ATA-2021-Unclassified-Report.pdfFor growth, life expectancy, education https://data.worldbank.org/country/afghanistan https://reliefweb.int/report/afghanistan/afghanistan-unesco-highlights-key-challenges-education-science-and-cultureFor inequality http://hdr.undp.org/en/indicators/137906For https://data.worldbank.org/indicator/SH.STA.MMRT?locations=AF https://www.dni.gov/files/ODNI/documents/assessments/ATA-2021-Unclassified-Report.pdf https://reliefweb.int/report/afghanistan/afghanistan-unesco-highlights-key-challenges-education-science-and-culture http://hdr.undp.org/en/indicators/137906 Progress inequities (RAMOS-II): retrospective observational studyRemarkable other reductions occurred disparity urban rural sites alarming, indicators significantly higher Ragh Kabul. Customised delivery needed ensure parity geographic settings. Full-Text PDF Open AccessAchieving Afghanistan: Countdown case studyDespite poverty, its reproductive, maternal, newborn, over last decade based contributions factors outside sector. However, equitable access challenge present models high transactional costs, affecting sustainability. To maintain further accelerate development gains, future strategies will focus improving social determinants targeted cost-effective interventions address causes newborn mortality. AccessMaternal setting achievable targetsIn 2002, soon NATO-led overthrow regime, survey done, commissioned Ministry Public Centers Disease Control Prevention, UNICEF. results 2005 estimated ratio (MMR) 1600 100 000 livebirths (95% CI 1100–2000),1,2 world consistent UN estimates.1 remote district, Ragh, mountainous Badakhshan Province, estimate 6507 livebirths,1 MMRs recorded burden 369 diseases injuries 204 territories, 1990–2019: systematic analysis Burden 2019As disability becomes increasingly large component disease larger expenditure, greater research investment identify new, effective intervention strategies. With rapidly ageing population, demands deal disabling outcomes, increase age, require policy makers anticipate changes. mix universal geographically specific influences reinforces regular reporting detail underlying help decision success stories control emulate, improve. AccessAfghanistan: perilWith recent collapse Taliban's takeover, previous building resilient jeopardy. 35 people, 7 under 5, danger losing right essential services.1 Malnutrition rampant mental trauma due exacerbated. national provision care, largely independent (NGOs), supported donors pooled fund. Aid needs takeoverHealth following takeover Sharmila Devi reports.