Small's Great Contribution

By Metta Spencer (interviewer) | 2002-10-01 12:00:00

If you are hunting for Ian Small, just look for his yurt. This past summer he and his pregnant wife Michelle set up their huge round felt tent in various local parks, hung tapestries inside, put carpets down, and invited Canada to explore the nomadic society of desert Uzbekistan. Unfortunately, it rains in Toronto. When I visited, the dwelling smelled like wet fur, but Ian covered it with a tarp and continued his enthusiastic hospitality.

He had just returned from four years in Central Asia, where he had worked with Médecins sans frontires (MSF) on one of the planet's worst environmental catastrophes, and then helped victims of the War on Terror. Initially he administered a tuberculosis treatment project around the Aral Sea and after September 11, he directed the MSF mission for western Afghanistan, providing humanitarian aid inside the country and to refugees.

Tuberculosis, Wind, and a Dried-up Sea

The Aral Sea (or, more accurately, what soon will have been the Aral Sea) is located between Kazakhstan and Uzbekistan. Formerly the world's fourth largest lake fed by two rivers, it sustained a major fishing industry. Soviet policy-makers decided to use the river water to irrigate cotton fields (initially to provide for soldiers' uniforms), knowing this would dry up the sea. Today the sea is only the world's eighth largest lake, and it will vanish entirely soon after 2010. Shoreline salt has accumulated, and is blown by the wind, degrading agricultural lands and causing health problems throughout a large part of Central Asia.

Technologically, it is still possible to save the Aral Sea, though the measures would be so costly that the required political will is absent. To do so would require relocating some 50 million people over a period of ten years, and allowing the rivers to flow back into the sea instead of being diverted for irrigation. Such a program will not happen, and the best that can be done realistically is to ameliorate the catastrophe. Thus MSF set up a tuberculosis care program to make up for the loss of the good treatment that had been provided under the Soviet government.

Tuberculosis is endemic in the area -- not basically because of the environmental catastrophe, but because of poverty and the breakdown of the health infrastructure. (This same explanation applies to high TB rates wherever they are found in the world.) However, the Aral Sea area has the worst dust storms in the world, and dust is debilitating. MSF is studying its impact on respiratory infections and eye diseases. The most promising solution may be to plant trees, which will help reduce the dust, improve water quality, and improve soil quality. "Reforestation has economic value. You can't go wrong with trees," Small said.

The Uzbekistan project was a unique venture for MSF and required considerable innovation. Most of the organization's projects are straight medical interventions, often in areas of political strife, but requiring conventional programs. He explained, "In the typical MSF environment, you just pull down the cholera manual and see how to set up a camp to treat cholera. There were guidelines for TB, of course, but even those were largely underdeveloped, so we had to innovate our own tools and our own approach to the complex environmental disaster."

Having worked effectively in meeting this challenge for four years, he was ready to come home. His family had already returned to Canada ahead of him, and he was awaiting the arrival of a doctor who would replace him in the administration of the tuberculosis project.

September 11, 2001

"The new doctor arrived to take over my job," said Small. "He had been working in Nigeria, in Brazzaville, in Congo, and some other nasty places and he chose Uzbekistan purely because it was a 'quiet' medical program. He had been there three days when 9-11 happened. Immediately I became the head of mission and he became the project coordinator for western Afghanistan. We used to kid him that he might never see a TB patient, but would be dealing with Afghan refugees for the rest of his mission.

"MSF didn't evacuate personnel from Afghanistan for the first three or four days," Small said. "We went to Ashkabad, Turkmenistan, which became my responsibility because we were running our western Afghanistan operations out of Ashkabad. Our national staff were still inside Afghanistan and they kept the programs going on a maintenance level. It was tremendously heart-warming to see them continuing there, against all odds. Imagine! The whole world is wanting to raze your country to the level of a parking lot and you're still slogging it out, trying to keep those programs going. Fantastic! We were in contact with them daily by radio until a certain time when we knew we had to take down the radio. It was terrible to order the national staff to end it, but the Taliban had issued an edict that if anyone was caught in Afghanistan using a radio or any form of communication equipment, they would be hanged. That was in the middle of September. Until that point we were in contact with them every day, coaching them, providing solidarity, getting details about the status of the feeding programs that we were running, and getting information on their needs. Then we had to cut them off from the world. We feared being on the radio and hearing it go dead and knowing that the guy on the other end is actually dead.

"But we kept getting material back into the country, across the border," Small continued. "Even if we couldn't go in, we were still able to get trucks across the border. We were developing contingency plans for when we would be able to get access and become really operational again. "

The refugees went in a number of directions when they left Afghanistan. Some went to Peshawar, Pakistan, but that place became unstable, so others went to Islamabad or, if they were coming from the eastern part of the country, to Kandahar or Qweta. On the west, some went to Ashkabad. It was possible to get across the Uzbek border. Others went to Mashat in Iran. Ian himself visited Mashat.

Small said, "The blessing is that the international community was able to get back into Afghanistan fairly quickly. If the bombing had lasted longer, there would have been vast suffering over the winter months -- particularly in the remote areas. A humanitarian disaster had already been going on in Afghanistan before the bombing because of the prolonged civil war and two years of drought. The country was on its knees. But the western press under-reported the suffering because they concentrated on the bombing. Once it started, that was the story. If the bombing had gone on much longer, a lot more people would have died from exposure and starvation. But fortunately, in December the international NGOs were able to start going back in -- just before the winter.

"It was an extraordinarily challenging time for us all. But even in hindsight it feels good actually to have been involved. I would have felt tormented if I had come home, say, at the end of July or August before all this started happening, after becoming so familiar with the region. When I came back in November it was a let-down, in a sense, but also uplifting to feel that power of being there and knowing that you can do something, fighting against the odds."

A New Hybrid NGO?

Since his return to Toronto, Ian Small has been working at an international health institute and considering various options for further work. He acquired skills in the Aral Sea region that could be usefully applied in other settings. His notion now is that there is need for a new kind of non-governmental organization -- one that would respond to the combination of environmental/ health/peace issues, just as the tuberculosis project that he recently headed.

"We had to innovate," said Small. "It wasn't like a typical MSF campaign. Is what we did applicable to other areas in the world? If the answer is yes, then there is a potential need for a hybrid -- MSF and Greenpeace. Those two organizations started in the exact same year. One clearly chose health and the other one chose the environment. They both have been extremely effective at putting their issues on international agenda, but today we see more situations like the Aral Sea. A new NGO would look at the environmental impact on human health. It should have a research focus, but also do advocacy (just as Greenpeace does) and would bring the humanitarian action service component in, whereby we would also try to improve people's lives on an individual level."

How about just getting Greenpeace and MSF to work together on the same projects? Would that not be easier than founding a new organization?

"Never in a million years would they do that," said Small. "I can't speak for Greenpeace, but MSF culture just wouldn't allow it. MSF is very careful about safeguarding its independence. They truly do work alone."

How, then, could such a new "hybrid" organization be created?

"You'd have to get a critical mass of motivated people who think the same way you do," explained Small. "You need a bit of luck. You need something to jump start you. One paradox of development work and humanitarian assistance is the problem of funding. You can't get funding unless you've proven yourself. You can't prove yourself unless you get funding. Some somehow you have to get over that paradox."

But Ian Small is not easily daunted. When we last spoke, he was seriously planning to go ahead with his idea. To discuss it further, contact him at <ibprivate@yahoo.com>.

Metta Spencer is editor of Peace.