This is How The Afghans Walk in Kabul Prosthetic City

 adamfoxie*

In Kabul, where I lived on and off as a journalist for eight years, disabled men are a ubiquitous sight in the streets, begging alongside women and children at busy intersections, where traffic slows to a crawl. With sleeves or pant legs rolled up to show naked stumps or withered limbs, they weave between the cars on crutches or hand-cranked wheelchairs, navigating the unpaved streets and open gutters that, when rain or snow comes, turn into rivers of mud and sewage. Warlords and Taliban commanders sometimes have Noms de Guerre (which tend to be things like Mullah Rauf or Commander Ibrahim) with a peculiar suffix: “lang,” or “the Lame,” a testament to the injuries accumulated over decades of war. Whenever I visited a trauma hospital, the sight of patients resting quietly with their white-bandaged stumps — many of them children — made me think that what is most difficult for us to imagine is not a tragedy but the prospect of living in its aftermath. Life after suffering a permanent injury is particularly harsh for people in Afghanistan, where agriculture still employs nearly two-thirds of the working population and many of the few jobs available in the cities involve manual labor.

As with American soldiers who lost limbs in the country, these Afghan victims were often casualties of explosive devices. In the days when they still went on joint patrols, international medevac crews would routinely fly wounded Afghans to a coalition military base, where they would receive state-of-the-art trauma care. Eventually, though, their fates would diverge from the foreign soldiers in the beds beside them, who would be sent back home to receive rehabilitation and follow-up treatment.

In the United States, the number of service members who lost limbs in the wars in Iraq and Afghanistan, roughly 1,720, has driven advancements in prosthetic technology. Researchers are developing artificial limbs that can be controlled by the brain and that restore a sense of touch through neural feedback. Prosthetics that simulate the balancing motions of regular appendages using small motors controlled by microprocessors are becoming more available. With them, patients can regain their ability to do things like walk backward or jog up a flight of stairs. Like conventional prosthetics, they have to be replaced every three or four years, though they can be 10 times more expensive. The cost to the Department of Veterans Affairs to provide a cutting-edge artificial knee starts at $30,000.

Photographs of prosthetics made by Afghans who had to
rely on their own ingenuity when they were wounded in war.

Photographs by ROSS MCDONNELL Text by MATTHIEU AIKINS

By contrast, the limbs seen in this series of photos taken in 2012 by Ross McDonnell would have seemed primitive 100 years ago. Left behind by patients who received new prosthetics from the International Committee of the Red Cross after it opened its center in Jalalabad, a city in eastern Afghanistan, in 1995, many of the limbs bear signs of having been painstakingly repaired in order to extend their life. Others have been fashioned from scrap metal and clothing. They hang on the clinic’s walls as remnants of a time when Afghans had to travel to Pakistan or Iran to receive medical care — a trip that many could not afford. In that sense, they are part of the patchwork ingenuity on display throughout the country, where discarded Western goods from ancient Toyotas to castoff T-shirts are given long second lives. “In the beginning, I remember people going to blacksmiths and making limbs out of stovepipes, or wood,” Najmuddin Helal, who has worked for the I.C.R.C.’s physical-rehabilitation program in Afghanistan since it began in 1988, told me. “Sometimes I’ve even seen them made from shell casings.”

Today the limbs that patients receive from the I.C.R.C. are made with deliberately simple technology, as the program is meant to be largely self-sufficient. An above-the-knee prosthetic costs the I.C.R.C. $420, on average. All of its prosthetics are provided free of charge to the patients. Most of the components are manufactured in Kabul, by an entirely Afghan staff, using a polypropylene-based technology designed by the I.C.R.C. that is now in widespread use in developing countries around the world. First, a technician makes a “negative” cast of the patient’s stump, which is then used as a mold to create a white plaster model. A sheet of polypropylene plastic, baked until soft in an oven, is draped over the plaster cast and suctioned onto it with a vacuum, forming a custom-fit socket to which the rest of the prosthetic is attached. Patients usually spend a week or so doing rehab and adjusting to their limbs at the center before returning home with them.

Since the start of its program, the I.C.R.C. has supplied 109,303 prosthetics to replace limbs — some lost in the fight against the Soviets, others during the civil war that destroyed Kabul in the 1990s, some during the subsequent war between the Taliban and the Northern Alliance, others during the current conflict, whose end remains nowhere in sight. Many of the patients lost their limbs to roadside bombs, airstrikes, old land mines or stray American cluster munitions, as well as to other injuries and diseases like diabetes. With more than 10,000 Afghan civilians — a third of them children — killed or injured by the war in 2017 alone, the demand for the I.C.R.C.’s humanitarian programs continues unabated, as it does in dozens of other conflicts around the world. The I.C.R.C.’s work is not without its own risks. The organization reduced its footprint in Afghanistan after seven staff members were killed in three different incidents in 2017.

McDonnell’s photographs are moving for what they do not show. Looking at these prosthetics, we can envision the hands that made them and the bodies that they joined. On each, we see the traces of a person, the nicks and scars of their daily struggles, the decorative flourishes that perhaps remain engraved in memory to this day. We imagine the crinkle of cellophane tape as it enters a shoe, or the strain of laces against flesh each morning, the way that leather becomes damp with sweat by midday, and the sudden weightlessness, at once a relief and a pang, each night before bed. They testify at once to a world radically different from our own and to the common form that we all share.

Posted Previously on The New York Times (1/27/2019)