Eight-month-old Gulmina was the first to die. Her tiny chest heaved with every breath for more than a week in November, until her uncle Nasrullah Niazai realized she needed medicine and bundled her into a battered car for the two-hour drive to the nearest doctor. But relief came too late, and the baby died soon after they returned home.
Next, in late January, Nasrullah's 18-month-old daughter, Shirina, fell ill. This time he quickly recognized the signs of pneumonia and wanted to fetch help right away. But by then, snowdrifts as high as 14 feet had completely sealed off this alpine village in Logar province, just 50 miles south of the capital, Kabul. A second child was lost.
By last week, when the men managed to dig a path out of Altamur, Nasrullah had buried another relative: his uncle, Nawab Khan, a former anti-Soviet fighter in his late nineties who died of untreated respiratory illness.
"I walked eight hours through the snow to find a doctor for him," Nasrullah said. "But no one would come back with me."
As Afghanistan struggles to cope with its harshest winter in years, more than 300 people have been reported dead from cold-related causes, while hundreds of thousands of people in villages across the mountainous central region remain cut off from help after weeks of freezing temperatures and steady snowfall. Once the villagers are reached, Afghan and relief officials said, the death toll could rise substantially.
According to the Health Ministry, 226 children under the age of 5 have died of infectious diseases such as whooping cough and pneumonia this winter, and 29 people either froze to death or were killed by avalanches. In some provinces, governors are reporting higher numbers of deaths, but they have not been confirmed.
According to the United Nations, even in warm weather, more than 700 children under 5 die from disease in Afghanistan every day. But the unusually severe winter has brought a new level of hardship to a country where most people live in mud houses with no central heating or plumbing, and many live miles from the nearest clinic.
'It was very shocking'
In Logar, most of the 60 villages surrounding Altamur are still snowbound. Late last month, a Red Crescent Society representative, Mohammed Zaman Asir, hiked to about 20 of those villages and gathered news about 20 more.
In that tiny corner of the country, Asir said he learned of 25 children who had perished from cold and disease, 19 pregnant women who had died during unassisted deliveries, six people who had disappeared, and two teenage boys who were attacked by wolves as they trekked toward a neighboring village in search of food.
"Everyone was coming up to me and saying, 'Help us,' " Asir said. "It was very shocking."
In remote Ghowr province, one of the worst affected of Afghanistan's 32 provinces, a survey team from Catholic Relief Services recently visited 50 villages that had been cut off intermittently and learned of 173 children under age 5 who had died.
Afghan and international officials say they have responded aggressively to the potential humanitarian crisis. The World Food Program, which had already stored 21,000 tons of food in remote areas in anticipation of winter, is working with the Afghan government and aid groups to clear roads and distribute food to tens of thousands of people. U.S. and NATO forces have sent truck convoys and helicopters to deliver supplies.
The U.S. Embassy has freed up $100,000 in disaster relief funds on top of $600,000 that the U.S. government had already spent to provide blankets and cooking oil. The United States has also contributed $126 million to the World Food Program's operations. Much of the relief effort, however, has been organized by the Afghan government, earning praise from international officials.
"This is really significant," said Manoel de Almeida e Silva, the U.N. spokesman here. "Three years ago, the government of Afghanistan would have had zero capacity to bring all its ministries, as well as the international side, together under such close coordination. I'm not saying the effort is perfect, or that they don't need a lot of assistance. But they are clearly taking the lead."
Still vulnerable
While it has not reached crisis proportions, the suffering caused by this winter's weather underscores how vulnerable Afghanistan remains, three years after U.S.-led forces toppled the extremist Taliban government and launched a multibillion-dollar international effort to rebuild the war-ravaged nation.
According to a report released by the U.N. Development Program last week, Afghanistan ranked a dismal 173rd out of 178 countries in human development during 2004. The report said 29 percent of Afghans have access to health services, less than 40 percent of children receive vaccinations and 29 percent of adults can read and write.
That combination has made the harsh winter a particular challenge for families such as Logar's Niazai clan, which includes three brothers, their five wives and fifteen children. The relatives share a three-room, mud-walled compound with a breathtaking view of jagged mountain peaks.
The beauty of the surroundings masks the difficulty of life here. The land, never especially fertile, has been rendered virtually useless by a seven-year drought.
"Just soil and rocks, that's all there is here," said Sher Ahmad Khan Niazai, 43, the eldest brother.
To support the family, Nasrullah, 40, and the youngest brother have spent the last 20 years working in Saudi Arabia -- first as construction laborers, and more recently as owners of an auto mechanic shop. The two take turns visiting Altamur, staying for six-month stretches every two years.
When 8-month-old Gulmina, whose father is currently in Saudi Arabia, began coughing and breathing with difficulty, Nasrullah felt responsible but not especially worried. Unschooled and unfamiliar with respiratory diseases, he knew only that some of the children had suffered the same sickness last winter and come through it fine.
In retrospect, Nasrullah said last week, he should not have waited so long before taking Gulmina to the doctor. He also said he wondered whether the medicine he ultimately obtained without charge at a provincial clinic was what she needed. "I don't know what it was -- some syrup and an injection," he said. "But you get what you pay for."
Not long after Gulmina died, a three-day storm blanketed Altamur with snow. Like Afghans across the country, Nasrullah was overjoyed at first. "I thought, 'Finally we will have water in the well,' " he said.
But then little Shirina began to develop the same symptoms as Gulmina. It took six days before the snow had melted enough to allow Nasrullah to drive Shirina to the same clinic that had treated Gulmina. By then, Shirina was gravely ill.
Soon, the family's car broke down and it began to snow again. Twice, Nasrullah said, he and Shirina's mother carried her on foot to the doctor, walking eight hours through the snow each way. Their efforts proved futile -- as did Nasrullah's attempt a week later to bring a doctor to his ailing uncle, Nawab Khan.
Nasrullah and his brother, Sher Ahmad Khan, recounted those events in the casual tone of men who have become accustomed to seeing loved ones die. In 1983, their father and one of Sher Ahmad Khan's sons were killed during a Soviet bombing raid. After the family fled to Pakistan, three of Sher Ahmad Khan's children died of polio in a refugee camp. In 2003, polio claimed three more of the clan's children.
"We accept that this is the order of God," Sher Ahmad Khan said. Nevertheless, the Niazai men have taken pains to keep Gulmina's death from her father in Saudi Arabia. When he calls the family's mobile phone and asks to speak to her, they put one of the other children on the line.
"It's better for him to find out when he comes here. He will be very sad, but at least his wives and family will be around to comfort him," Nasrullah said.
As for his daughter Shirina, Nasrullah said: "She already knew so many words. She could ask for tea and for candies and for her uncles. And she had such a smiling face. I will never forget it."
It was not possible to speak to Shirina's mother. In keeping with conservative tradition, she spends most days in the inner rooms of the compound, shielding her face from even her brothers-in-law. Nasrullah would not allow her to be photographed or interviewed in the presence of a male interpreter. Instead, he spoke for her.
"Yes, of course she is very sad. Every mother is sad to lose a child," he said. "But I tell her, 'Don't worry. We will have more children. Then, in two years, I will come back and visit them.' "
