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14 June 2016

Evaluationreport: The work of Medica Afghanistan has an impact

Stress- and trauma-sensitive counselling in a fragile and insecure social context: “All in all, the evaluation demonstrated that the project activities had a pronounced impact ... .” That is the very positive result of an evaluation of three projects carried out by Medica Afghanistan (MA) between 2012 and 2015. In the Afghan cities of Kabul, Mazar-e-Sharif and Herat, Medica Afghanistan offers counselling to women who were (or are still) subjected to physical or psychological violence (including wartime violence).

Furthermore, Medica Afghanistan provides assistance to self-help groups for women with experience of violence. Through these offers of support, Medica Afghanistan was able to reach more than 1300 women within the three years studied.

Support of traumatized women has an impact

A comprehensive evaluation was carried out by the experts Marie Huber and Mateja Zupancic from the Thousand Plateaus consultancy, for which they surveyed over 280 former and current clients of Medica Afghanistan. The ratings for average or above average self-efficacy and self-confidence were 83% and 78% respectively. At the same time, almost all clients (98%) whose data was collected demonstrated evidence of symptoms of a post-traumatic stress disorder (PTSD). This might seem paradoxical, but accords with the result of the evaluative study in Bosnia (“We are still alive”, 2014) which revealed how symptoms of PTSD persist despite increased feelings of well-being where the survivor experiences their social and societal contexts as being insecure, fragile, stigmatising and/or unsupportive.

Women, who are conscious of their rights

The impact of legal counselling is revealed by the wide and sophisticated knowledge the surveyed women had regarding their rights and the institutions they can turn to. Many of the women interviewed by the evaluation team indicated how receiving advice from Medica Afghanistan was a turning point in their lives. “I feel better now. I used to avoid going to celebrations, but now I attend them. The more we go to Medica Afghanistan, the less pain we have (...). The female psychologists there are good and they understand us.” In particular, the evaluation report praises Medica Afghanistan for the self-help groups it established and supports. According to the report, these groups enable the women to help each other. They also anchor the organisation’s work in the communities. For the women, the self-help groups offer a special safe space where they can share their experiences and support each other.

Only organisation in Afghanistan offering psychosocial and trauma-sensitive counselling

One outstanding point revealed by the evaluation was the fact that Medica Afghanistan is the only organisation in Afghanistan which offers psychosocial and trauma-sensitive counselling for women who have experienced violence. A representative from another women’s organisation reported: “In our country we have laws for women but we have nobody who helps to ensure their psychosocial health (...). Medica Afghanistan strengthens their psychosocial health and gives them equal rights.” This further underlines the great relevance of the projects and work of Medica Afghanistan. The evaluation expressly emphasised the high level of recognition which Medica Afghanistan enjoys from civil society and government bodies. The independent Afghan Independent Human Rights Commission (AIHRC) reported on its experiences with Medica Afghanistan in political advocacy work, for example with regard to family law: “Medica Afghanistan is always active. They are friendly people and its members contribute clear proposals. Their work is not symbolic.” The external consultants stress how the work of MA takes place in an exceedingly difficult context. The security situation is extremely fragile, many people are living in conditions of ongoing conflict and great poverty. Additionally, most people in Afghanistan are unaware of the significance of psychosocial counselling and there are great inhibitions towards seeking psychological help. In spite of improved legislation, women’s rights are widely flouted and women are very dependent on male family members, both economically and socially. Extricating themselves from violent relationships is therefore a particular challenge for women since they generally have very little choice. There are some women’s houses where some can find shelter, but in many cases this shelter would mean living in poverty and losing any contact to their children. This is why many are seeking assistance from Medica Afghanistan to improve the situation at hand, to recognise and enhance their own strengths and resources in order to take any opportunity to live a life of more dignity and give their children the best care possible.

A mindful women rights organisation

The working conditions for Medica Afghanistan staff are very challenging and potentially debilitating. So the external consultants offered particular praise for the culture of organisational mindfulness in place at the organisation. The proportion of staff suffering from exhaustion was astonishingly low. 90% of the staff indicated they experienced their work as ‘fulfilling’ and were ‘very satisfied’ with it. The evaluators trace this success back to the further training provided by the organisation.

Decreasing violence against women contributes to a peaceful society

In spite of this overall very positive evaluation of the work of Medica Afghanistan, the consultants also revealed challenges. For example, they propose formalising the need for confidentiality and discretion in counselling. They also indicated a necessity to improve the feedback opportunities for clients. Nonetheless, after stating these and other critical comments, the evaluation comes to the following conclusion: The work of Medica Afghanistan is making a decisive contribution to the stabilisation and pacification of Afghan society. A decrease in violence against women and within families also helps to make it possible for societal conflicts to be resolved more peacefully. The external consultants also recommend expanding the work of Medica Afghanistan to other regions and cities in the country.

Download here the evaluation report (summary)