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Roundtable discussion: Policy Engagement in Conflict Settings

Watch as Ahmad Omid Rahimi tells Svea Closser about the complexities of policy engagement in Afghanistan.
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SPEAKER 1: Hi. My name is Svea Closser, and I’m an associate professor here at the Johns Hopkins School of Public Health. Today, I’m really lucky to have with me Dr. Omid Rahimi. He’s going to talk with us about policy engagement strategies in Afghanistan, which have been particularly complex because of ongoing conflict in Afghanistan. So Omid, thank you so much for being with us today. And it would be great if you could start by just talking a little bit about your background and your work in Afghanistan.
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OMID RAHIMI: Thank you, Svea. Hello. My name is Omid Rahimi. I am working at Global Innovations Consultancy Services in Afghanistan. And I am a part of the consortium working under the guidance of Johns Hopkins University on polio and eradication activities and lessons learned from eradication activities from seven countries.
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SPEAKER 1: So let’s get into some of those lessons learned in Afghanistan, particularly in terms of policy engagement, because usually when we think about global policy engagement, we think, OK, the international organizations, like WHO, are going to speak to a country government.
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OMID RAHIMI: Yes.
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SPEAKER 1: So they did that, of course, in Afghanistan. But can you talk a little bit about why things were more complicated there?
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OMID RAHIMI: Absolutely. As you know, Afghanistan, together with Pakistan and Nigeria, are the three endemic countries with regards to polio. And unfortunately, Afghanistan is a war-torn country, having been affected for more than 40 years by war. It’s a war-ravaged country, and the setting in Afghanistan is totally different with regards or comparing to other nations. In Afghanistan overall, we have the government of Afghanistan responsible for polio eradication activities, WHO, UNICEF, run by GPEI, and other small NGOs working at the field for coordinating the eradication activities overall.
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The problem with Afghanistan is that WHO and UNICEF have the experience of working on polio eradication activities since the start of the GPEI.
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SPEAKER 1: Right.
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OMID RAHIMI: And now, the government, by establishing the emergency operations center, wants to take over the responsibility and wants to control the health service overall, including the polio eradication. So there is some sort of soft struggle between engagement and involvement of foreign and international organizations and local organizations–
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SPEAKER 1: Sure.
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OMID RAHIMI: –which is a bit problematic.
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SPEAKER 1: So it’s a complicated negotiation–
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OMID RAHIMI: Yes, yes.
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SPEAKER 1: –between the government and the international partners–
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OMID RAHIMI: Yes, yes.
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SPEAKER 1: –and it doesn’t always work smoothly.
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OMID RAHIMI: Doesn’t always. Sometimes, it works, sometimes it doesn’t.
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SPEAKER 1: Sure, yeah. Do you think that that’s affected by the larger geopolitical context of, obviously, American and other armed involvement in Afghanistan, or do you think that’s specific to polio?
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OMID RAHIMI: In a broad way, it’s not specific to polio. We have too many players in Afghanistan.
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SPEAKER 1: Yeah.
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OMID RAHIMI: We have Taliban, we have insurgents, we have ISI, we have– I mean, ISIS, Daesh.
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SPEAKER 1: Right, yeah.
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OMID RAHIMI: I meant Daesh and other insurgents actively fighting against American troops, against international aids and assistance, and against the government of Afghanistan.
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SPEAKER 1: Yeah.
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OMID RAHIMI: So this directly and indirectly affects all the health system in Afghanistan, including polio.
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SPEAKER 1: Yeah.
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OMID RAHIMI: Yeah.
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SPEAKER 1: So let’s talk a little bit more about how that works. So there’s this engagement that the GPEI has to have with the government of Afghanistan, which, as you mentioned, is complicated. But then what about the areas that the government doesn’t control? What are some other players that you might have to work with? So Taliban, I would assume, is one. Are there others, too?
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OMID RAHIMI: Other insurgent groups are not that much powerful to have influence all over Afghanistan. They are local insurgent groups–
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SPEAKER 1: OK.
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OMID RAHIMI: –that, in order to conduct all activities in a smoother way, each organization or the government have to–
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how can I say it– negotiate with them separately.
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SPEAKER 1: OK.
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OMID RAHIMI: But with the Taliban, it’s a bit different. So they have their own commanding power, their central commanding power. So the type of negotiation with Taliban is totally different with type of negotiation with other small insurgent groups.
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SPEAKER 1: OK.
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OMID RAHIMI: So this makes it more complicated.
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SPEAKER 1: Even more complicated.
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OMID RAHIMI: Even more complicated.
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SPEAKER 1: So how do you negotiate with the Taliban to do polio eradication?
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OMID RAHIMI: Actually, comparing to Pakistan, Taliban in Afghanistan are not that much against polio activities. One is that these activities were not stopped during the time the Taliban controlled almost totally areas of Afghanistan. At that time, it was not a very big issue. And we have local Talibans who are pro all health activities, and the small group of insurgents who belong to some foreign terrorist organizations.
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SPEAKER 1: OK.
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OMID RAHIMI: So generally, Taliban are not against it. And besides, there is a good strategy of the WHO, UNICEF, and other implementing partners who are focusing on recruiting people from the community, including Taliban. So Taliban somehow are involved in eradication activities, and they do not pose too much difficulties and smooth implementation of polio eradication activities. However, while there is active fighting, no matter who is responsible for it, between Taliban and other insurgent groups, between government of Afghanistan and other insurgent groups, or between the foreign troops and the Daesh, we know that, due to active fighting, there will be pockets of people isolated and unprotected, let’s say, against polio virus.
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SPEAKER 1: Yeah.
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OMID RAHIMI: So this is the main cause of low coverage and low accessibility with regards to polio.
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SPEAKER 1: Yeah. So the WHO, UNICEF, other GPEI partners have been able to work with Taliban leadership and with local communities who may be Taliban-affiliated–
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OMID RAHIMI: Yes, yes–
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SPEAKER 1: –to implement.
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OMID RAHIMI: –they have.
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SPEAKER 1: How have they tried to work with an organization like Daesh, or has that not been successful?
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OMID RAHIMI: Organizations like Daesh and other foreign terrorist organizations, they don’t have any interest in public health, and it’s very difficult to convince them. And they do not have a physical presence–
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SPEAKER 1: So it’s hard to know who to negotiate with.
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OMID RAHIMI: So it’s hard to know who to negotiate with.
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SPEAKER 1: Yeah.
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OMID RAHIMI: While the Taliban have their–
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SPEAKER 1: They have a designated leader–
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OMID RAHIMI: –a presence–
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SPEAKER 1: –so you know who–
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OMID RAHIMI: –they have a designated leader–
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SPEAKER 1: –to contact, yeah.
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OMID RAHIMI: –but contacting with Daesh and other terrorist groups is very difficult.
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SPEAKER 1: Difficult.
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OMID RAHIMI: Yes.
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SPEAKER 1: So those are the areas maybe that they control that are particularly difficult to access.
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OMID RAHIMI: Yes, yes.
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SPEAKER 1: Yeah. Wow. Well, thank you so much. I really appreciate you giving us an overview of some of the challenges involved with policy–
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OMID RAHIMI: Yeah, some of the–
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SPEAKER 1: –engagement in–
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OMID RAHIMI: –challenges, exactly.
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SPEAKER 1: –Afghanistan. Thank you.
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OMID RAHIMI: Thank you. Thank you.
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SPEAKER 1: Thank you.

Experts discuss challenges in conducting consistent and effective policy engagement in conflict settings.

Presenter
Ahmad Omid Rahimi, MD, MPH Global Innovations Consultancy Services, Afghanistan

Moderator
Svea Closser, DrPH, MPH, PhD, Bloomberg School of Public Health, Johns Hopkins University, USA

Which of the community engagement strategy types mentioned in this discussion might work in your context? How would you want to implement it?

Post your thoughts in the discussion.

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