Good afternoon, ladies and gentlemen. I am honoured to be here to talk to you today. Thank you very much for the opportunity.

The title of "Transcending Ethnicity, Religion and Politics towards Peace" is so big that it tends to end with abstract arguments. Hence, I would like to talk about it using concrete examples of what I have seen and what I have done practically, by briefing you about our activities at Peshawar and Afghanistan for 20 years.

As you know, the Taliban regime fell by US attack two years ago. And, soon after the collapse of the Taliban, Afghanistan became a land of lawlessness and anarchy instead of becoming a better place. The current situation in Kabul can be compared to a small boat floating aimlessly on a sea of magma in a crater. Many international aid organizations rushed into Kabul, protected by the international troops. So most of the information about Afghanistan you hear overseas is coming just from Kabul City, which is quite a specific area in that country. What we actually see and feel in the rural areas of the country, however, is the opposite of what foreign people are informed of.

A "Tokyo Conference" was held for rehabilitation of Afghanistan just one and a half years ago. However, more than half of the organizations and the media which attended said conference shifted their activities to Iraq. I hope that you can gain something from my story.

We are based in Peshawar, a north-western city of Pakistan, and we operate in both Pakistan and Afghanistan. As of now, we have three clinics inside Afghanistan which have been operating for over 10 years. We also run a clinic in northern Pakistan besides our main hospital in Peshawar. We have a total medical staff of 140. Last year, we treated 150,000 patients in total. In addition to medical work, we have 150 other staff members at a Branch Office in Jalalabad, Afghanistan working for a water supply programme. We are now struggling against serious drought conditions which hit Afghanistan during the past three years, keeping us busy trying to find water sources.

Now, let me mention some points about Afghanistan which are not well-known. The area of Afghanistan is 2.1 times larger than that of the Philippines. The country’s population is approximately 20 million. The majority of the land are of the Hindu Khush ranges that are 6,000 to 7,000 meters high. The view of massive mountain ranges is spectacular. What we do there, in contrast, looks like work of troops of ants crawling through the valleys between these towering mountains, trying to extend their territory little by little. Clearly, it takes a long, long time for us to cover a wide area. For example, it could take a week on horse back from our clinic to visit a patient in a remote place. As you can imagine from this example, it takes a lot of time to do anything there. In Afghanistan, regions and districts are physically isolated from one another by those massive mountains, and different ethnic groups live together to lead self-sufficient lives.

Afghanistan is a part of Central Asia and an arid region. More than 90% of the population depends on farming and cattle breeding for a living. Snow plays a crucial role here. In Afghanistan, there is a saying, "One can live without money, but not without snow." It is true. Snowfall during the winter, along with water from ten thousand year old glaciers, produce water streams when they melt in summer, promising a good harvest in areas along the rivers. Humans, animals and plants around the Hindu Khush mountains have enjoyed the benefit of this water for a long, long time. However, in recent years, snow has been disappearing from these mountains, presenting serious problems. Global warming is a major factor that is causing the drought there. Snow is really a lifeline for the people.

Most Afghans are devout Muslims. Mosques can be seen everywhere in towns and villages throughout the country. Islam is not only their belief but also their source of morale, the basis for their life-style and culture. Every person belongs to his own local community, bound to each other by mosques. Often times, troubles are solved at a mosque by a local elders’ council called Jirga. It is a completely self-sufficient and self-governing society sharing common unwritten laws as Afghans have no police force, nor any psychiatric hospitals; they can live together with any power unless it invades their cosmos. The people are bound together by blood and by a shared territorial bond. They are quite an independent and brave people. This is a difficult part of Afghan society for foreigners to understand.

The Afghans place higher priority on their own traditions than new rules that come from the capital. This part of the Afghan way of thinking is totally different from that of Westerners. Huge gaps between the rich and the poor are also a headache, similar to other countries. For example, wealthy Afghans could easily fly to London, Tokyo or New York to seek medical treatment, while poor Afghans die just because they cannot afford medicines costing a few dollars. Now you may understand why simply bringing in advanced medical formulations wouldn’t work there. Our challenge is how to benefit the maximum number of the local populace with the minimum amount of money. Therefore, we are obliged to come up with carefully planned programs to be truly helpful.

I was assigned to the leprosy department of a Christian Hospital in Peshawar in Pakistan 19 years ago in May 1984. At that time, 2,400 patients were registered at the hospital. However, patients could only be admitted to the hospital when they developed serious complications. The leprosy ward had only 16 beds for admission. Treatment of leprosy requires various medical skills, reconstructive surgery, plastic surgery, neurosurgery, dermatology, social care and so on. However, what they had at the hospital 19 years ago was one broken trolley, one gauze kettle, several broken pairs of forceps, one stethoscope that would hurt my ears when wearing it and some syringes. Their method of disinfecting gauzes was to place them in a metal bowl and put the bowl in an oven toaster. When the gauzes started to smoke, we used to take them out of the oven quickly. If the gauzes were brown, they were disinfected. If they were still white, they were not. That’s where I started. Those who visited me at the hospital at that time were shocked to see the situation.

I want to point out here that some people say that medicine is not about material things or money. It is true. But on the other hand, it is also a fact that medicine requires materials and money, at least to some extent. For this reason, the Peshawar-kai Head Office has been activated for fund-raising and a continuing constant supply of finances for the long run. Helped by their activities, I was able to extend our medical services, benefiting many more patients. Now, we have a well-furnished hospital where essential treatment of leprosy complications is available, including reconstructive surgery. With the cooperation of public institutions, our mere presence is reassuring 7,000 registered cases throughout Afghanistan and North-Western Pakistan.

You may think we have been busy just for medical works, though it may not be an exaggeration to say that our past 20 years has been spent in the effort to understand a different culture and people. According to their custom, for example, young women are supposed to hide their faces from male strangers. It made my work especially difficult because the early signs of leprosy appear on the patient’s skin. In the case of male patients, it is easy because we can simply ask them to take off their clothes to examine their skin. If we start the treatment at this stage, we can cure the disease completely. On the contrary, chances for cures are very low in female cases, because they never expose their skin to male strangers, even to a doctor.

However inconvenient it is, we have to be careful because foreign workers tend to make mistakes here. Foreigners tend to impose their own value system on these local customs and culture, categorizing them as right and wrong or superior and inferior. Naturally, such an attitude is not appreciated by the locals, unnecessarily creating conflicts.

Frankly speaking, we are not as free as we may think. We are bound to many things in our lives that limit or control what we can do. Social relations, acquired natures, the times, nationality, sex, place of birth, and so many other constrictions exist. This is the reality of all ages and of all places. It is important for a clinical doctor to know what is limited at that situation and what would be the happiest condition for each patient, while doing what I can do for them practically. But whenever I do that, I also keep it in mind that I should never impose my values on local people or be judgmental about their customs, culture or tradition. This is the toughest rule of PMS (Peshawar-kai Medical Services). Instead of criticising others, we have been sending female workers from Japan in order to improve our services for female patients.

Other than the effort of adjusting ourselves to the locals, we faced various other difficulties. Then, the Afghan turmoil added to our problems. In 1979, 100,000-strong Soviet troops invaded Afghanistan. During my first three years in Peshawar, from 1984 through 1986, the Afghan civil war was fought most fiercely. Peshawar is a border city and is also called, "the city of Pashtuns," because the Pashtuns are the largest ethnic group in and around Peshawar. There are about 20 million Pashtuns, half living on the North-West Frontier Province on the Pakistan side and another half on the Afghan side. They are the majority group on both sides. The border between the two countries was drawn during colonial times. Before that, they would freely travel back and forth between the two regions. When there was no border, their passage was just a domestic migration and nobody was called a refugee. Anyhow, the civil war generated six million Afghan refugees and half of them flooded into Peshawar and its surrounding areas. At least two million people, including 600,000 combatants, are said to have been killed during the civil war. This is the figure released at that time, so the actual number could be bigger now. Our medical activities, of course, were greatly affected by the war.

It was around this time that we made a big change in the way we operate, after running a small-scale mobile clinic to refugee camps for a while. We thought refugees would eventually go back to their own villages. Most Afghan villages with a high incidence of leprosy are located in deep mountainous areas. Where leprosy is common, we can see many other infectious diseases frequently occurring, diseases such as typhoid fever, malaria, dysentery and tuberculosis. Moreover, patients with these diseases are very poor and have no access to medical institutions. In such areas, you cannot open a clinic and say you will only treat leprosy. On top of that, leprosy itself is of a much lower incidence than other infectious diseases. Anyway, that is why we decided to establish a model case of medical care in the rural areas where no medical facilities are available. This way, operating in rural areas became one of our important projects.

Statistics in Afghanistan is often unreliable. When we started this project, we had no idea about the demography of our target areas or what diseases were common there. At that time, it was almost impossible to walk around the areas freely because of the ongoing war, but that was the only option we had. So we walked up and down the mountains to learn about our target areas.

When we reached an area called Nuristan, situated at 2,800 meters high half way up the country’s highest mountain, local men came up to me and said, "Welcome from France." And, they asked me if I was French. I had been asked if I was Chinese or Korean before, but never French. I didn’t know how to respond. Later I was told that they had never seen foreigners before, so they randomly picked up a name of a foreign country. The interesting thing was that, once I told them that I was Japanese, their attitude completely changed. They became very friendly. I later learned why. The name of Japan associated in their mind with the Russo-Japanese War a century ago. They also knew about Hiroshima and Nagasaki. Everywhere I went, even in deep mountainous areas, villagers knew these three things. Other than that, they had almost no knowledge about Japan. It means that their respect for Japan must have come from their own miseries from domination by western super-powers and being deprived of a peaceful life.

A tiny, vulnerable nation defended herself against a Western superpower in the Russo-Japanese War, which encouraged these people. Also, they have much sympathy for the victims of massive slaughter by nuclear bombs. Fortunately for me, however, they did not know that Japan had followed her Western teachers and behaved as an advanced guard against them, invading neighbouring countries.

It was in 1988 that the Soviet troops started to withdraw from Afghanistan. Before that, we used to go to Afghan refugee camps to offer medical services. When the withdrawal was completed in 1989, Afghanistan remained in the world’s major news. A host of journalists gathered from all over the world assuming that three million Afghan refugees would go home en mass. Contrary to their assumptions, however, no one went home.

During this time, there were a lot of discussions about the reconstruction of Afghanistan. Between 200 and 300 aid organizations rushed to Peshawar from all over the world, spending several billion dollars in two years. However, no refugee returned home despite all this international support. Instead, the civil war intensified and the Gulf war broke out. Most of the projects wound up abruptly, and this discouraged Afghan refugees. After a while, the then Afghan communist government collapsed, and various political kingpins flooded into Kabul, hoping to control the capital. Meanwhile, the traditional system of autonomous rule made a comeback in rural areas. When the Afghans became aware of this transformation, they started to return on a massive scale. In only seven months from May through December 1992, two million of the 2.7 million refugees made their trip home on their own almost without any foreign assistance. Seeing the refugees coming back, we started to open our clinics one after another in mountainous areas. These clinics are still functioning well.

Now I would like to touch upon our rehabilitation program intended for rural areas. After all, agriculture is the most important activity to sustain man’s life. In a country like Afghanistan, if you don’t have anything to eat, you have no way to survive. Modern tools such as electric appliances won’t help you at a time of starvation. Even bank notes would only be useful when you burn them for firewood. If you lived in Afghanistan, you would be immediately convinced that agriculture is the most fundamental enterprise for human life. Based on this belief, we expanded our scope of operation to assist farmers from the medical project.

Five years ago, after 15 years of commitment, we became aware that the problems we were tackling would not be solved even in the next 10 or 20 years. Therefore, we opened our base hospital with 70 beds in Peshawar to settle down there. The hospital can also function as a command centre to support and supervise our fieldwork in rural areas both in Afghanistan and Pakistan. This way, we can keep our foundation there more definite and stable.

There was another reason that we set up the core hospital. We learnt from our experience that media attention could shift from one place to another very quickly. When there is news value, they pay you a lot of attention. If not, no one pays any attention to you. And your activity could be badly affected by that. For example, when the media focuses on tuberculosis, TB specialists swarm the area. When leprosy becomes the topic, many projects rush in. Then, once the media attention shifts to something else, those aid will leave soon. In the case of leprosy, we need to keep looking after the same patients for decades. We didn’t want to be disturbed by the world’s trends and simply wanted to focus on what we were doing. To be able to do so, we had to take deep roots in the place we operate. In Japan, we are a voluntary organization. But in Pakistan, we obtained the status of a social welfare organization.

Afghanistan is really an unfortunate country. On top of what has happened in the past, the worst drought ever is hitting this country. According to the World Health Organization’s estimate in June 2000, this drought in the middle of the Eurasian Continent was going to develop into an unprecedented disaster. The drought has spread from Central Asia to China, India, Pakistan, Iran and Iraq. Afghanistan is most badly hit. Approximately 60 million people have fallen victim to the calamity. More than half of Afghanistan’s 20 million people have suffered from it. There is an estimate that 4 million Afghans are on the verge of starvation and one million might starve to death in the not too distant future.

In some areas of Afghanistan, we have seen people walk several kilometres for water, sometimes for a whole day. Outbreaks of gastro-intestinal infections such as dysentery, amoebiasis and typhoid hit the area too. So many children died. Farmers’ only assets in their villages are livestock, but the situation was so bad that they had to sell their cattle before they died. It is said that 90% of livestock in Afghan villages died two years ago. This tells you how seriously the country’s agriculture has been hit by the drought.

As I mentioned already, snow continues to disappear from the Afghan mountains. The Kabul River, one of the largest rivers in Afghanistan, became so shallow that we were able to cross it easily on foot. Due to the shortage of water, children drink contaminated water and develop dysentery as a result. Most of the drought victims were children. We have seen many children expiring in their mothers’ arms in outpatients’ waiting rooms at our clinics. It was very difficult for us to witness such a disheartening scene so many times. It may not be appropriate for a doctor to say this, but, at one point, I couldn’t care less about treating diseases, because the situation had become so desperate that simply staying alive itself became very difficult. In other words, we had to feed and keep them alive first before worrying about treating their illnesses.

So in July 2000, we mobilized a whole village and started digging a well to get clean water. This was the beginning of our new project. The locals already had a technique for digging a well, but did not know what to do when they hit a large rock. The area was very dry and the water level was going down. We had to keep digging to catch up with the descending water level in the beginning. We removed land mines for this project. When we hit huge stones as we dug, we drilled a hole in them and placed gunpowder in the hole. It is so powerful that it breaks solid rocks. Most of our staff are former guerrillas, so they know how to handle explosives. This was our peaceful method of using land mines. The project is still in progress. As of June 2003, we have worked on a total of 1,000 sites (as of June, 2003) and, currently, over 900 sites provide local populations with water. Thanks to this project, nearly 300,000 villagers are still able to remain in their villages.

However, people cannot survive with just drinking water. We were challenged to get water for agriculture. Afghans have a special irrigation system called karez which bring underground-water to the cultivated field. We reactivated 38 karezes, which had dried up. In villages, along the rivers, we also dug large-size irrigation wells with a diameter of five meters. These karezes and wells have produced green fields, and they continue to do so. In this area, green fields continue to expand around these wells.

In January 2001, UN sanctions were imposed on Afghanistan during an already difficult time. Ordinary Afghans could not understand why they had to be punished this way. Just before the sanctions, I though the world would not ignore the devastation which no Afghan has ever seen. Contrary to my expectations, the U.N. instituted sanctions, instead of providing international aid. To make matters worse, they tried to impose a sanction on food in the beginning. Imagine the feeling of those starving people in Afghanistan. International aid organizations started leaving from the country. The sanction definitely isolated Afghanistan from other parts of the world. Distrust of foreigners spread. In the past, we had never tried to target major cities for our medical activities. However, after the UN sanctions were imposed, the capital city, Kabul, which had already harboured over a million internally-displaced people, had no access to medical services. Fear made us take an exceptional step and go to Kabul. We opened temporary clinics there in March 2001 and they remained open for 14 months until June 2002.

After the September 11 terrorist attack in New York, news about Osama Bin Laden, the Taliban and other Afghan matters suddenly started to flood the media all over the world. If you know anything about Afghanistan, you would agree that bombing the country before the onset of winter is criminal. It was feared that over 10% of the population might not be able to survive the severe winter that year. This fear led us to start the "Fund for Life." Under this program, we originally planned to dispatch 4,500 tons of wheat and cooking oil, but we could only send 1,800 tons. Still, the goods we distributed saved the lives of over 100,000 people. This programme was carried out by our brave Afghan and Pakistani staff under heavy bombardment by the US.

Soon after the Taliban government collapsed, we started to see the revival of lawlessness, opium production, fighting between rival warlords and starvation. If you come across a field of pretty flowers in Afghanistan, it is a poppy farm. During the Taliban rule, it was a rare thing to see because they strictly banned growing poppies. I wonder if we can call this revival of freedom to grow poppies a good result of liberation from the Taliban regime.

However, the locals around our clinics did not start growing poppies, even if they could have. We have known these people for over ten years through our medical services. They know that we do not like poppies. The local residents promised us at a Jirga, a local council of elders, that they would not grow poppies. It seems that the only way to eradicate poppy cultivation is to provide welfare to the people. Just forcing them not to grow poppies without doing anything about their poverty cannot succeed.

In addition to what we have done so far, we are now trying to help the locals increase their agricultural production. We are making slow but steady progress in the fields, including improvement of soil conditioning and further irrigation. I assume this will be our long-term project. The aim of this project is to help the local population to become self-sufficient. Our task has just begun. We have no concern for political matters at all.

In March 2003, we started constructing a 16 km canal in eastern Afghanistan. Within two years, it is supposed to irrigate 1,500-2,000 hectares of agricultural fields, which had been turned into desert by the drought, enabling 150,000 farmers to stay alive. This is the beginning of our new 15- year scheme against drought. Many local villagers are busy working with pickaxes and shovels for their own lives every day. It may be surprising for foreigners to see all the party members, the former soldiers of pro-Taliban, anti-Taliban, northern alliance and sometimes local employees of the US army working together. It seems ridiculous from the viewpoint of political dynamism. However, the matter seems quite simple once the idea enters your mind without any prejudice. Life itself has the highest priority than anything else.

Whenever I give a lecture about Afghanistan, I always show some slides to tell my audience that the Afghan people don’t always look depressed or gloomy. To me, the people in developed countries like Japan often look more depressed or gloomy. The Afghans have such great smiles that those who help them get inspired and encouraged. But, it does not mean that they are not suffering. Of course, you encounter heartbreaking sights, but in general, children in Afghanistan are very cheerful and exuberant.

To think of it, I wonder if it is the optimism of those who possess nothing. We tend to think that we could do better if we had more. I learned from them that having nothing could liberate us and make us optimistic. The more you possess, the more despondent you become. Back in Japan, I hear people say that we are facing a serious recession. When I first heard it, I asked the person how many people had starved to death because of the recession. Their answer was that nobody died of starvation, but over 30,000 people had committed suicide.

By following the track of our activity there in the past 20 years, yes, I do not deny my original "humanitarian motivation" to save the people, although I now realize the more important fact that we, ourselves, have been helped by this activity. At least, I am free from the world-wide belief that violence and money can solve all the problems of human beings, even if it is claimed under the name of modernization or the righteousness of so-called democracy. Real happiness of humans does exist somewhere else.

I feel fortunate to be able to see the truth and speak the truth, while the whole world seems to be confused by the campaign of the war against terrorism. My experience in Afghanistan helps me see the matter more clearly. To me, it is time we seriously contemplate and find out what is truly needed for mankind and what is not. "Afghanistan" tells us a lot about itself. It also discloses that our civilization is nothing more than a thin overlay on barbarism since ancient times.

I don’t mean to play the prophet, but I see the bombing against Afghanistan as the beginning of an end. I don’t know what it is that will end or when it will end. But, I just sense that the world is approaching a catastrophe. It may not be completely wrong to say that, after the catastrophe, something new will arise. We need to learn what we should give up in our lives and what we should not. When we stand on common ground in this regard, it is the beginning of transcending ethnicity, religion and politics towards peace. Our real enemy is in our minds, not outside.

With this, I would like to conclude my presentation. Thank you very much for your attention.