Legs, hands, arms, feet: the Ali Abad Orthopaedic Centre in Kabul produces more than 15,000 prosthetic limbs each year. Outside, snaking around the corner of University Road at 8 a.m. every weekday morning, is a queue of limbless Afghans hobbling in to receive new legs or have their old body parts serviced.
On the inside, doctors and technicians shuffle around wielding disembodied plastic limbs. Above the screeching of fret saws and scraping of chisels, the workers shout, enjoying the camaraderie of the factory floor.
The loose-fitting lab wear of one of the technicians rides up to reveal a silver screw and the shiny veneer of polypropylene. All of the workers seem to have the awkward gait of men with false legs. This is because everyone that works here is a former patient, from the gatekeeper to the cleaner to the doctors.
The International Committee of the Red Cross founded the Ali Abad Orthopaedic Centre in 1988 to provide artificial legs to Afghans who had lost their own in war. In 1994 its doors were opened to anyone with a mobility handicap. While accurate figures are not available, the ICRC estimate that there are about 500,000 people with a mobility handicap in Afghanistan, of whom approximately 40,000 are limb amputees.
Across the courtyard from the factory floor is the physiotherapy unit, where patients have their new limbs attached. Spanners, hammers and hacksaws hang from the walls. There are victims of polio, congenital disorders, leprosy and road accidents here. There are also many injured by fighting and landmine incidents.
An old man, supported by crutches, stares in a mirror at his new leg with curiosity and wonder. A boy grimaces with determination as he heaves himself along between two parallel bars. Another young man peddles furiously on a cycling machine. His plastic foot is in a trainer that looks like it was from an aid package.
The recent history of Afghan conflict is told on the faces in this room; lost limbs the legacy of the Soviet invasion, the ensuing Civil War, internecine fighting between the Mujahideen, the Northern Alliance’s struggle against the Taliban and, of course, their current strife.
Dr Alberto Cairo has managed the Centre since 1990. He is a greying Milanese with wire-rimmed glasses and a trimmed goatee. He is one of very few ex-patriots to have stayed in Afghanistan through the Civil War and Taliban eras. Rushing from room to room, he chats fluently in Dari and Pashto with his staff and patients. One patient hugs him. He makes a joke with another.
Dr. Alberto was once a lawyer in Milan. ‘Then one day I wanted to do something different,’ he says, ‘I arrived in Afghanistan nineteen years ago, by chance. I just applied to the Red Cross. I wanted a mission, wherever in the world. They sent me to Afghanistan. I think it was love at first sight. Since the very beginning I felt at home here, with a lot of problems, of course, but every home has its problems!’ He is now in his fifth political regime here.
‘I am so nervous today!’ he says with lavish Italian cadence, ‘we have to go faster. We have to be in a hurry to make the patients happy and at the same time achieve a good quality!’ Matching supply to demand for false legs in Afghanistan is hard work.
They used to manufacture the false limbs at the Centre using the rubber from Soviet military hardware. The tyres from a MiG jet, for example, had the perfect consistency for a foot. Dr. Alberto points out the sweet irony of this: ‘I like very much the idea – to use weapons of war for peaceful purposes!’ This was before the arrival of certain prosthetic technology in Afghanistan, but producing enough false feet is still a bit of a problem. They are forced to import lots of feet in order to ensure high quality and durability.
Dr Alberto runs one of the largest orthopaedic operations in the world: they receive up to three hundred and fifty patients here each day. Adult patients need to have their prosthetics changed every three years and children every six months. Each limb is custom-made and fitted to the patient.
In the physiotherapy unit, disabled doctors fine-tune plastic limbs for their disabled patients. There are small crowds of onlookers as is custom for any object of intrigue in Afghanistan.
Patients are practicing the lost art of mobility. There is lots of banging and crashing. Abdul Aziz sits resting for a moment. He was a Mujahideen who lost his leg twenty three years ago fighting against the Russians. On the other side of the room is Omar Angin, who lost his leg fighting against the Mujahideen in the Civil War. Mahmood, who wears the black turban fashionable amongst Taliban, was returning from a trip to Pakistan twelve years ago when he stood on a landmine.
‘Sometimes they come wearing military uniforms, sometimes they come dressed like Mujahideen, or dressed like Taliban with long beards and turbans’ says Dr Alberto, ‘we know that some of them are Taliban, or former Taliban, or former Mujahideen, or former Communist. But who cares? Patients are patients. We never ask questions. The important this is that they come to us so we can help them.’
‘When we came there was nothing for the disabled. Now at least there is something,’ says Dr. Alberto modestly. The truth is that all over the city of Kabul one sees people with prosthetic limbs courtesy of the Orthopaedic Centre.
The following day after my visit to the Centre, as I walked through the Shar-e Naw district of Kabul, I felt a tap on the shoulder and turned around. It was one of the patients from the clinic with outstretched palms requesting baksheesh. He had two legs.
‘I know that people come here and they are shocked by what they see and they find it a very sad place,’ says Dr. Alberto, taking in his work and surroundings. ‘It is a sad place because so many people have suffered. But at the same time it is a place of hope, where disabled people work for disabled people, to rebuild their own lives and the life of someone else. This is the spirit of the place.’
