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22 DRC / DANISH REFUGEE COUNCILoverlooked in the KIS context, it will be considered in the light of its effects on health and security.On the other hand, several studies have underlined the potential impact of cash programming onchildren’s wellbeing through conditional programmes for education and health 22 . Low schoolattendance, child labour and high health concerns were observed as central both in the quantitativeand qualitative data. These three protection concerns will therefore be addressed in the light of thesituation in the KIS – taking into account factors preventing households from correctly addressingthem, and the diversity of situations according to camps and communities.Health: One of the main findings of this study was the high exposure to health problems ofinhabitants in the surveyed KIS, and increased vulnerability due to economic barriers to access toquality health care. High levels of debts were identified both as a consequence of necessaryexpenses for health care, and an aggravating factor further impeding improvement of healthconditions. Insalubrious living conditions causing recurrent health complications, limited access toquality health services, and high levels of indebtedness aggravating both factors, were found to bevulnerabilities specific to the KIS sites visited. Out of the surveyed sampling for this study, 81%respondents correspond to the extremely vulnerable individuals (EVI) standards developed byUNHCR. The higher degree of vulnerability of IDPs in Afghanistan, and in urban settings in particular,has already been underlined in previous research, and IDPs households in Kabul identified as morelikely to fall in the EVI category. This is notably the case for chronicle illness, physical disabilities andmental illness (respectively 18%, 14% and 5% of the members of the households in the sample forthis study).Affordability: The study found that the issue is less one of access to health services than thatof the quality and affordability of services. Most respondents to the survey and participants inFGDs in the KIS sites visited had access to either public health facilities, or free medicalhealthcare and medicines provided by the WeltHungerHilfe. However qualitative data foundmost families interviewed are more likely to seek medical care in private clinics, withsubsequent indebtedness and distress sales to provide for medical expenses.Consequences are household’s resort to health care only as a last option, with potentialnegative impacts on validity, morbidity, and capacity of household members to activelycontribute to the family’s income.“If it's a serious matter, then I go to the hospital. I borrow the money from relatives. But if thesickness is not that serious I treat it myself. I use traditional medicines. The clinic used to give usgood medicines, but nowadays they only give really bad quality medicines. I borrow the money, sellmy blankets or even sometimes sell some food items. I am obligated to do that because I don't haveenough money”- (Female participant FGD Parwan 2, 50 years old)Health and Debts: One of the main running themes of this study is the relationship betweenlevels of indebtedness and seeking health care. A recurrent statement in focus groupdiscussions was that households primarily resort to loans from relatives or neighbours forhealth purposes, mainly due to their incapacity to put aside money for health needs or toplan for external shocks such as sudden illness. Participants in FGDs also reported thatselling in-kind assistance provided by aid agencies was a common way to pay for theirmedical bills. Likewise, in the quantitative survey, 33 % of the surveyed respondentsmentioned systematically seeking health facilities when faced with a problem, 17% reporteddoing so often, and 39% seeking medical care only if they had enough money. Overallapproximately 89% of our respondents therefore indicated a strong interest in medical care.However, quantitative data collected showed an inverse correlation between the level ofindebtedness of households and their attendance of health facilities in case of unexpectedillness: 47% of the indebted respondents surveyed mentioned seeking health care facilities22 cf, among pthers: World Bank (2012) Can Cash Transfers Help Children Stay Healthy? The Human Development Network ;MACOURS K., SCHADY N., VAKIS R. (2011) Cahs Transfers, Behavioral Changes and Cognitive Development in EarlyChildhood: Evidence From a Readmozed Experiment, Human Capital and Economic Opportunity Working Group,EconomicReserach Center, University of Chicago. ; CONWAY, A., and GREENSLADE, M. (2011), Cash Transfers: Literature Review,DFID Policy Division.
CASH PROGRAMME REVIEW FOR IDPs IN KABUL INFORMAL SETTLEMENTS 23only if they have enough money for medical expenses, and 28 % whenever they are facedwith unexpected illness. For households who stated not being indebted, the proportions arerespectively 8% and 55%.Graph 4: Seeking medical care for health issues (%)We never go to hospitals or clinics for medicalcare.1%We rarely go to hospitals or clinics fortreatment.10%Sometimes: Only when we have enoughmoney for medical expens39%Usually: Most of the time when we fall ill.17%Always: Every time when we fall ill.33%,0 10,0 20,0 30,0 40,0 50,0Our findings therefore suggest levels of indebtedness have an impact on household’s behaviourtowards seeking health facilities. Furthermore, when asked about their spending preferences if theywere to be provided with cash assistance, 33% of indebted respondents stated they intended tospend cash assistance directly on health care, underlining the potential role of cash-approach inhelping indebted households to overcome economical barriers to access health facilities. Amongmany other cases, a female respondent in Rahman-Mina Qala-e Barqi underlined the potentialimpact of cash to overcome economic barriers to access to health services: “If I received cashassistance,it would be better. I could purchase everything I wanted with that money, and I could alsopay off my debts for the money I borrowed for my medical treatment”.Health and Hygiene: Lack of proper housing in the KIS induce poor health conditions. FGDparticipants reported repeated child illnesses due to cold weather in the winter and exposureto high temperatures in the summer. High mortality of children and women during the harshwinter of 2011-2012 was also repeatedly brought up in FGDs, and directly related to poorhousing conditions.“I had food in the last winter, but I didn’t have fuel, so the winter was very cold, and my childrenwere crying all the night because of the cold rooms, and my children were sick the entire winter”- Female FGD Sharak- e Police, 30 years oldHousing: Given the informal and irregular nature of the settlements, the issue of access to land andthe right to settle is particularly sensitive in KIS. According to both quantitative and qualitative datagathered for this study, temporary land/space acquisition was mentioned as a serious year-roundneed and inadequate housing as a source of difficulties, with repercussions on access to drinkingwater, sanitation, and overcrowding of cramped housing space. More than 70% of respondentsmentioned additional space, proper infrastructure and land as their preferred form of assistance toimprove their shelter, aside from cash. As shown by a recent NRC/IDMC/JIPS/Samuel Hall study onthe challenges of IDP Protection in Afghanistan 23 , which identified housing land and property (HLP)as one of the three top protection priorities for IDPs, HLP issues are related to broader durable23 NRC/IDMC/JIPS/SAMUEL HALL CONSULTING (2012), Challenges of IDP protection in Afghanistan: Research study on theprotection of internally displaced persons in Afghanistan.
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