KABUL - Mohammed Ibrahim thought life would be easier in Kabul after leaving Helmand's insecurity behind. But a new range of challenges, including health, face he and his family as they cling to the fringes of the crowded capital.

We are getting sick because of poor nutrition. We can't buy any meat, fresh fruit and vegetables," says 49-year-old Ibrahim from Helmand's Greshk district, who moved to Kabul with a cousin and their 14 family members more than one year ago. "And the bad hygiene and sanitation is causing our children to get sick with fever, diarrhea and tuberculosis."

To respond to these health needs, WHO, as Afghanistan Health Cluster lead, is working with local NGO, Serve Health Relief and Development Organization, to run health centers at five temporary informal settlements in Kabul province, where 26,000 people live. Doctors give patients check-ups, midwives provide essential obstetric services and counseling to pregnant women, and vaccinators immunize children.

"These are very vulnerable people," says Dr Maria-Luiza Galer, coordinator of the Health Cluster network of healthcare providers which is co-chaired by the Ministry of Public Health and includes NGOs and UN agencies. "Displacement, poverty and poor living conditions impact on their health."

But the WHO-supported health centres provide the only access such people have to essential health services and hospital referrals, including pregnant women for deliveries. Disease outbreaks are also being prevented in both the settlement and neighboring communities.

Since Ibrahim and his relatives arrived in Kabul, they have been sharing a squalid mud-brick dwelling at the Bagrami settlement, home to 390 families. Clouds of flies hover around a small dark room used as a kitchen. Some crawl over cooking utensils. The smell from the open sewer just outside wafts into the dwelling's compound, where young children sit on the dusty ground.

WHO is working with several NGOs to assess the health needs of the larger of a remaining 23 settlements that have sprung up around the city's edges to house people who have fled the conflict in southern Afghanistan. Most have no or insufficient access to health services and are not serviced by electricity, running water or sewerage systems. NGO water tankers deliver supplies of drinking water just twice a week to same camps.

WHO is advocating with Afghan authorities to consider the health consequences and needs linked to urban planning in general. WHO has also dedicated its 2010 World Health Day theme to this issue, under the banner of "Urban Health Matters."

More than one year ago as conflict raged in parts of southern Afghanistan, Ibrahim telephoned his 38-year-old cousin, Mohammed Wali Khan, from neighboring Kandahar province, and they decided to gather their relatives and belongings and move to the relative safety of Kabul.

"The main reason we left was the insecurity and to have a good life here. But we did not expect to be living this way," Wali Khan said. "Nothing was available. We expected our children to be able to find work, but each day 50-60 of our young people from this settlement go to the bazaar looking for daily work. However they rarely find any. If they did manage to get some money, they would be bringing only bread and we would be eating it only with water."

But the health facility, located in a white tent with areas for male and female patients, has provided some ray of hope.

"We are very happy this NGO came here and we hope they will remain here to help us," Ibrahim said. "Please give them good medicines and more of them so they can keep treating us."

By Paul Garwood, WHO