Medical doctor (Executive Director of the Peace Japan Medical Services [PMS], Representative of Peshawar-kai in Pakistan and Afghanistan)

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1 th Grand Prize Tetsu NAKAMURA Born on September 15, 1946 *Winning the prize at the age of 66 Japan / Others Medical doctor (Executive Director of the Peace Japan Medical Services [PMS], Representative of Peshawar-kai in Pakistan and Afghanistan) (Dr. Nakamura at Sekifusha, publisher in Chuo-ku, Fukuoka City, on July 29th, 2014) For about 10 years after the invasion by the Soviet army in December 1979, people in Afghanistan continued struggling with the difficulties caused by the war. Approximately 6 million people, that is, one in every four citizens, escaped from the country as refugees. Of them, approximately 3 million people took refuge in neighboring Pakistan. Dr. Tetsu Nakamura, a medical doctor from Fukuoka City, visited Pakistan for the first time in 1978, accompanying a mountaineering party as a doctor. It was at this time

2 that he observed the severe reality of poor people living in the mountainous region. Even though he was asked for help, he could not do anything. The remorse that he felt at that time made him later work together with people in Pakistan and Afghanistan, and provide them with continuous support for 30 years. In 1983, Dr. Nakamura s support group, Peshawar-kai, was founded in Fukuoka, Japan. In 1984, while working at a medical ward for people with Hansen s disease in Peshawar, Pakistan, he began to provide medical treatment at a refugee camp. Afterwards, he also began to go to the mountainous region, where many people with Hansen s disease and refugees lived. In 1991, he also established a clinic in a medically underserved area in Afghanistan. He strongly felt that nothing would change without support for poor people. In those days, the political situation of Afghanistan was becoming more and more complex. The country served as home not only to a wide variety of Islamic fundamentalist groups organized at refugee camps in Pakistan, but also to the terrorist organization, Al Qaeda, which had been originally formed as a volunteer army to fight against the Soviet Union in cooperation with the U.S. and other countries. Changing its course to anti-americanism in 1991, when the Gulf War broke out, the volunteer army became more and more hardline. The coordinated simultaneous terror attacks in the U.S. in 2001 caused the allied forces to launch military attacks on the Taliban regime based on suspicions that it was sheltering Al Qaeda, ultimately leading to the collapse of the regime. Despite the establishment of an interim government and the introduction of a new constitution under President Hamid Karzai, the situation in the country is still far from a complete reconstruction. Dr. Nakamura insists that the policy that the U.S. has selected is like using one poison to drive out another. He believes that the U.S. has destroyed the Taliban regime by sheer force, even though the country could have worked on the problem through dialogue. According to him, people in Afghanistan are saying that even though Al Qaeda is performing various activities in Afghanistan, the allied forces are still foreigners to them, and ever since their arrival, the situation of the country has worsened. (In 1984, Dr. Nakamura began to provide medical treatment for people with Hansen s disease at Mission Hospital in Peshawar, Pakistan.) Although many people might imagine Afghanistan as a country of conflict, it is actually an agricultural country where farmers account for approximately 80% of the entire population. Dr. Nakamura says that it is totally wrong to regard the country as the main battlefield for terrorists.

3 At the same time, he indicates that the situation is becoming worse and worse every year, and that almost all areas other than the capital Kabul have fallen into total anarchy. He explains that antigovernment groups are engaged in secret maneuvers, and moreover, various crimes, especially related to drugs, are rampant. He believes that public order is somehow maintained in some farming areas based on long-established regional ties and blood relationships. Major media agencies report this chaos only from the perspectives of the military situation and the political situation, asking when U.S. forces will pull out from Afghanistan, and what will become after the end of the Karzai government. Dr. Nakamura indicates that there is almost no reporting on how ordinary lives of citizens are trifled with and destroyed in the flow of international politics. He says that as far as rural agricultural areas are concerned, he is worried that the country will be ruined not by war, but rather by droughts, although neither international society nor journalists recognize this reality. According to the United Nations World Food Programme (WFP), Afghanistan s food self-sufficiency rate as of 2007 fell short of 60%. In fact the country s self-sufficiency ratio in terms of food follows the course of the drop for the past few decades. While indicating a gradual decrease in the number of farmers, Dr. Nakamura states that although this is partly due to the reduced law and order after the inflow of foreign forces, the phenomenon is actually being accelerated by droughts, which prevent farmers from earning their living. He explains that to support their families, they have no choice but to go to urban areas in order to work as police officers, soldiers, or mercenaries for anti-government groups. He continues, however, that it is never easy to find jobs or secure living places, causing public order to further deteriorate as a consequence. Dr. Nakamura also states that the reality of farmers facing starvation has not been regarded as problematic even within the country. The reason lies, ironically, in a large amount of financial support from foreign countries to fight the war. Dr. Nakamura explains that a large sum of cash has begun to circulate and move around in Afghanistan, generating a finance-oriented economy, which can also be seen as a global trend. He feels that by making every effort to increase the amount of cash earnings, more and more people believe that they can live as long as they have cash, turning food from something that they produce into something they sell or buy. He says that one conspicuous example is the surge in food imports. However, foreign forces will leave Afghanistan someday, just as if nothing had happened. Dr. Nakamura emphasizes that the problem lies there. Indicating that what will be left in the country is, of course, the citizens of Afghanistan, he is worried that a lack of consideration on how to ensure they can support themselves. This will lead to the collapse of the country.

4 What motivated Dr. Nakamura not only to provide medical support, but also to squarely tackle this self-support problem of farmers was the great drought in The ensuing large-scale famine forced 12 million people to leave their land, with millions living on the verge of starvation. This disaster made him aware that medical treatment was not sufficient to save people s lives, and that with clean water and food, he could save many more people s lives. Accordingly, he decided to dig wells for drinking and irrigation purposes. He immediately dug the first well in the same year, followed by 1,600 wells in subsequent years. He also restored 39 karez (traditional underground waterways) in order to ensure water supplies reaching an even wider area of land. (To tackle with a problem of droughts in Afghanistan, Dr. Nakamura started to dig wells for drinking and irrigation purposes in 2000 along with his medical activities. This photo shows the water taken from an irrigation well.) However, the water soon ceased. The progress of the desertification was faster than expected. Actually, droughts had already rendered some villages around these wells ruins. Fathers, the main earners in most households, left their families to find jobs in other places. Almost no hope was observed in the villages where only mothers, children, and the elderly people were left. To irrigate the fields and ensure water supplies to these villages, there was no option but to try to construct an irrigation canal to take water from one of the major rivers. He insists that although he will not try things that are impossible, he must try things that are possible. In 2003, he began to work on the design of an irrigation canal. What should be done to make a sustainable irrigation canal in Afghanistan, where neither concrete nor heavy equipment is available? While continuing trials and errors there, he visited many irrigation canals in Japan that had been constructed in the Edo period, when people had likewise suffered from famines.

5 He says that even if he had asked for advice from experts, the modern construction methods would not have worked in Afghanistan. He also says that even if an advanced water control system is introduced, it will be useless if local people cannot maintain the system, and if the running costs are too high. According to him, currently, in Japan, the annual maintenance cost for the water-intake equipment and related river construction is nearly 800 billion yen, which a poor country such as Afghanistan could never afford to pay. In this regard, he thought that it would be better to follow examples of water-intake techniques and models established in the Edo period, and gradually adapt them to the local environment. On seeing the Yamada Dam in Asakura City, Fukuoka Prefecture, Dr. Nakamura intuitively felt that it would fit the settings of Afghanistan. For the several hundred years since its construction, the dam has been used to ensure a water supply from the Chikugo River to an irrigation canal. He indicates that the concepts upheld by developed countries are based on those for an urbanized society. He states that although he does not mean to say that urbanization is unfavorable, it will be totally impossible to introduce those concepts to the reestablishment of Afghanistan as a new country. He also indicates that Afghanistan is not a country where electric power is available 24 hours a day and water comes every time a faucet is turned on. In addition, according to him, since self-governance is focused on in this country, it will remain almost impossible in the future to establish a system like the one in Japan, where the central government assumes full responsibility for collecting taxes from across the country and taking care of social services for the citizens of the country. In this regard, he says that an irrigation canal that cannot be managed by local people themselves will end up purely as a show. He emphasizes that the important thing is to consider the problem from the perspective of how to sustain farmers, who account for 80% of the entire population in the country. Without this perspective, he says, nothing will work. The total length of the irrigation canals constructed by 2014 under the leadership of Dr. Nakamura, including the Marwarid irrigation canal (25 km, with an irrigation area of approximately 3,000 ha), as well as water-intake facilities in the neighboring areas, is 30 km, with the total irrigation and cultivation area being 16,500 ha, equivalent to about 2,400 Fukuoka Domes. This means that it has become possible to cultivate land enough to sustain approximately 650,000 people. Currently, the local Peace Japan Medical Services (PMS) and the Japan International Cooperation Agency (JICA) are working with each other to establish a village reconstruction model in Jalalabad, a city in eastern Afghanistan once called the grain belt in the country and possessing the most fertile land. If even half of the grain belt in Afghanistan is restored, it will enable people in the country to sustain themselves, even after the foreign forces withdrew. Added to this there are plans to grow wheat, rice and vegetables, and to restore the once-thriving cultivation of oranges and other citruses. With this as the background, PMS and the JICA are now focusing on developing village leaders, although this is

6 extremely difficult. Local people cannot read drawing plans, and because of the lack of power, they cannot do weight calculations or draw elaborate designs as people in Japan do in comfortable rooms with air-conditioners. Moreover, the introduction of new methods is always met with opposition. Even if admirable advice is presented to local farmers, who live on land handed down for generations from their ancestors, they simply say I see and take no action. Even if the organizations explain that water will become available in several years, no one trusts them until they see the actual result. In this regard, there is no alternative but to implement on-the-job training, which has begun to generate some benefits. According to Dr. Nakamura, hundreds of workers and nearly 100 foremen have been trained over the past dozen years. He states that if what they are doing is something necessary for their lives, they will make desperate efforts, and if they are able to see water actually flowing to irrigate their land, they will feel that they should work harder. He says that although the on-the-job training is challenging, he has been convinced that the knowledge and skills obtained through experience are strong. (An irrigation canal was constructed to take water from Kunar River, one of the major rivers fed by melting glaciers. Another canal reaching 25.5km in length was opened in This photo was taken at a construction site.) While appropriate approaches and skills are becoming accepted by the local communities, a new concern has arisen. His experience as a former member of a mountaineering club has made Dr. Nakamura aware that the summer snowline has now risen to 4,000 m from anywhere between 3,200 m

7 and 3,300 m in The snowline has ascended by approximately 700 m over almost 30 years, even though there has been no decrease in the absolute amount of rain or snow. Dr. Nakamura suggests that this is partially due to global warming. According to him, the permanent snow has gone and sudden thawing has begun to occur, releasing the meltwater as large-scale flooding into the irrigation canals, and destroying all the canal intakes. He says that added to this problem is an unstable rain pattern, and that terrible flooding is sometimes followed by a continuous drought, making the irrigation canals run dry. He also suspects that the land is losing its power to retain water, and that this is why the water levels in some rivers frequently fall suddenly, with the amount of underground water also decreasing. He indicates that the extreme weather pattern of flooding and drought is being repeated. Dr. Nakamura is the only Japanese pioneer in Afghanistan. No matter what has happened there, he has consistently continued to provide support for local people. Asked what has made him so, he comments in line with the following: Hundreds of thousands of people are on the verge of starvation. An irrigation canal can be used for hundreds of years, and the water from the canal can save a countless number of people. If I left nothing despite having attracted great attention from the public by asking people for donations and gathering a few billion yen, it would be totally insufficient even to commit hara-kiri. Without doing my best, I could not say that although I have worked very hard, things have not gone well. I m allowed to say so only if I have done my best, although there might be some unavoidable events that will prevent me from doing so. If I say so without making sufficient efforts, I will end up simply as a swindler or an empty boaster. That s why I m working very seriously. My organization s basic policy is to do what others will not do. I feel that the projects that we are working on now should be actually promoted by a country with sufficient financing and technical resources. However, in general, a country tends to select themes that will appeal to its citizens. Dr. Nakamura frequently feels that things are becoming less and less comfortable to human beings than before. He also feels that while fewer people have wisdom, more people believe that they know a lot. He is worried that the focus is shifting towards superficial knowledge, and that some people believe they can do everything without actually doing anything. He says that although the Japanese government currently refers to the right of collective selfdefense, this phrase was the one used to decide whether Japan should participate in the allied forces or not. He indicates that while the official English title of Jiei-tai is the Self-Defense Forces of Japan, it is often referred to as the Japanese Army by speakers of English, and that it is useless to play such a word game. According to him, people in Afghanistan regard Japan as a country with great pride as indicated by its having fought against and defeated the Russian Empire, and also respect Japan as a

8 country that has maintained its peace constitution since the end of the Second World War and has decided not to use weapons. He continues to say that, however, this recognition is becoming a thing of the past. He also indicates that unlike the U.S. and European countries, which dispatch troops to battlefields causing some of their citizens to experience the reality of losing their families, Japan today is free from such a sense of crisis. He emphasizes that this is a point that people in Japan need to think about deeply. He hopes that people in Japan will deeply consider why the war started in Afghanistan, and what has become of the allied forces and Afghanistan. He feels that it is natural that Japanese people, many of whom idle away their time simply watching variety shows on TV, cannot do anything when they visit Afghanistan as international cooperation volunteer staff. He thinks that this is because they mistakenly believe that they can do everything without actually doing anything. He honestly admits that he accepts such Japanese volunteer staff for the sake of their education. He says that Japanese government s explanation on the right of collective self-defense makes him feel that the government is not facing reality, and this is why he feels relieved when he comes back to Afghanistan, where people know from their experience what is truly necessary in their lives. He emphasizes that in Afghanistan, each individual is mature. Since being children, people in the country have been engaged in farm work and have lived in nature, which makes them keenly aware that without water, they could not live, he says. Is there really no problem with the idea of holding an event such as the Olympics Games before fully solving the issue of Fukushima? The labor shortage due to the current construction boom is leading to the relaxation of regulations in order to facilitate the inflow of labor from foreign countries. At the same time, young people in Japan tend to seek for more comfortable jobs. Is there really no problem with this trend? Dr. Nakamura laments that even though it has been only 70 years since Japanese people ceased to kill, or be killed by enemies at war, Japan has changed. He feels that people in Japan need to consider more deeply the significance of living together with nature. Asked whether the world might not last so long, as suggested by the wars occurring not only in Afghanistan, but also in Syria, Palestine, and Israel, Dr. Nakamura answers in the following way: I hope at least that the world will not come to an end as the result of violence. We must avoid the world s end being caused by nuclear power or war. I feel that it will be OK as long as there are people who are worried whether there are any measures to stop wars. However, if people shamelessly believe that it is natural in this world for the weak to become the victims of the strong, the world will come to a miserable and destructive end.

9 Turning to territorial issues, I feel that people would like to have black-and-white decisions. Can you imagine how long the national border extends between Pakistan and Afghanistan? Divided into two groups, the same race lives along the 2,400 km border. However, this situation does not lead to a war. A national border should be vague and unclear, although since Japan is an island country, this notion is difficult to understand. I believe that human beings should focus not on territorial issues that cannot be solved, but rather on the on-going global environmental problems, and share their wisdom to solve them. What is going on in Afghanistan now is simply the tip of the iceberg and the essence of the on-going global problems. Certainly, we cannot solve the problem of climate change straight away. Actually, I was once told that it was unavoidable for Afghanistan, a country located in a dry region, to become unlivable. If so, why do people in Japan continue to live on the islands frequently hit by earthquakes? Human beings can survive at most for several hundreds of thousands of years. I believe that human beings are required to demonstrate some prudence to live this short period of time in harmony with nature. The issue of Fukushima tells us a lot. After being hit by a 16 m wave, some people may insist constructing a 20 m seawall. But does this really work to ensure safety? Although human beings think that way, the law of nature operates regardlessly. I feel this so strongly especially when I m engaged in river construction. Some theories regarding the construction of water-intake gates insist that safety will be ensured if the height of the relevant gate is set as that of the highest flooding ever in the area. Nobody knows whether such a flooding will occur once every 100 years, 300 years, or 1,000 years. I believe that the damage from the accident of the Fukushima Nuclear Power Plant at the Great East Japan Earthquake was magnified due to people s overconfidence in technology. The economic growth period has reached its limit. Many people believe that money makes the world richer, but this is totally wrong. The gross domestic product (GDP) of each country does not necessarily represent how rich people in the country are. The time has come when we need to consider what is truly necessary and what is unnecessary. Even though Afghanistan is suffering from a drought, this is not treated as a problem in the world, and I keenly feel that this represents the limits of civilization. People do not regard the drought as an urgent problem that they need to address. Now, it is time to look at nature very carefully and to reconfirm the connection between nature and human beings so that we can see the world from this perspective.