The effects of calamities on water resources
and consumption in Afghanistan
Sayed Sharif SHOBAIR1 and Abdul Khabir ALIM2
Foreword
The current droughts and turmoil in Afghanistan have imposed negative impacts on water
resources and has caused considerable reduction on agricultural production and drinking
water as well has ended with the environmental degradation. Regional long-terms data
indicate that the entire region has experienced four wide droughts, beside of other zonal
droughts, during the last century: 1898-1905; 1944-45; 1970-72, and 1998-2004 (FAOand WFP, 2003). In the recent drought although precipitation increased in 2003 withgood distribution, it reduced significantly again in 2004. The available data show thatcomparing to normal years, irrigation water availability from surface water resource has
decreased up to 70% in canals and this has caused the irrigated land to shrink up to 60%
all over the country. Similarly more than 36% of the Kanats(Karezes) have dried up andthe discharge of the remaining has reduced up to 83% of their water production. This hascaused 81% decrease in the irrigated land under these systems. As a consequent, the crop
production has reduced and more important that around 300,000 families who aredependent on this water source for their drinking purpose have suffered and now are
struggling for finding other source; or to move to areas where drinking water is available.
Still more than 500,000 families are dependant to the remaining active Kanats that areunder the danger of drying by the effects of the current drought and unregulated usage ofdeep wells (FAO, 2003a).
This paper focuses mainly on the impact of the recent drought and the armed conflict onwater availability for different users; as considerable negative impact on drinking water,
agricultural outputs, in number of livestock, local people displacement, environment
degradation and socio-economy in the country have been imposed.
1. BACKGROUND
Afghanistan, with an area of 652,000 sq km, is a landlocked mountainous country locatedbetween Central and South Asia, strategically located cross-road of three main regions:the Indian sub-continent in the east, central Asia in the north and the Middle East in thewest. Afghanistan is divided into 34 administrative divisions, 40 watersheds and 5 mainriver basins. Map 1 shows the location of Afghanistan. The topography, climate, andother geographical features of Afghanistan are highlighted by others (Alim and Shobair,
2002, Naimi, 2003 and Shobair 2001).
Total estimated population of Afghanistan is 22.23 million, of which 85% are directly
dependent on agriculture (FAO and WFP, 2003). Population annual growth rate is around
3.8%, population density 34.1 person per square km, life expectancy at birth is 41.9 years
for male and 43.4 years for female (WHO, 2004), urban population is 21.9% of total. A
number of 2,000,000 refugees are still in Pakistan and another 1,500,000 in Iran.
Numbers of population killed in War reaches to about 2,000,000.
1. Eng. Sayed Sharif Shobair, FAO, Afghanistan
2. Dr. A. Khabir Alim, WHO, Afghanistan1Map 1. Location of Afghanistan
Around 10 million mines planted in
55,000 sq km areas still threaten the life of
Afghans.
Before 1978 Afghanistan was self
sufficient in food production andsignificant exporter of agricultural
products.
2. AGRICULTURE AND
IRRIGATION
12% of Afghanistan’s total land is arable,with 4% under forest cover and about 72%
rangeland and bare land. Agriculture ispracticed between 300m up to 3,500m
above sea level (asl) in the central highlands. Considerable differences in agricultural
practices and cropping exist in localities. Agriculture varies from sub-tropical areas;such as Jalalabad (315 frost free days), where citrus and sugar cane grows, totemperate cool areas where only barley and wheat are cultivated (less than 180 frost
days/year) (Raphy, 2004). 3.2 million hectares (ha) or 5% of Afghanistan’s area was
the irrigated agriculture, including intensive and intermittent irrigation in 1993.
However, according to another FAO study (FAO, 2003a), only 1.9 million ha was
irrigated in 2002. Northern, Hilmand and western Basins contain 33% of the one-crop
intensively irrigated areas. 85% of agricultural production is wheat, forming thestaple of diets of Afghans.
Map 2. River Basins in Afghanistan
3. HYDROLOGY OF
AFGHANISTAN
V
3. 1 River Basins in Afghanistan
IV
Hydrologically Afghanistan is divided in
to 5 following major river basins (map
I
2):
III
River Basin I - Kabul/ Indus RiverII
Basin: This basin is located in easternpart of the country, including the south –eastern river sub-basin. The outflow ofRiver Basin 1 is in Pakistan. The total
catchment area of this basin is 143,000
km2. The main direction of flow is fromwest to east. Run-off generated in this basin is discharged by Kabul river fromAfghanistan and Indus rivers from Pakistan to Indian Ocean.
River Basin II - Hilmand River Basin: This basin is located in the southern part of
Afghanistan, with a total catchment area of 166,000 km2. The discharging river mainly
flows from east to the west. The run off of upper parts of this basin is collected in Kajaki
reservoir. Due to the current drought the amount of water stored in this reservoir has been2

reduced significantly and in at least 2 years the water has not been spilled out from thespillways. The water released currently fulfills the needs of upper parts of the basin;
while the demand for water in the lower parts remains unmet. Originally the discharge ofthis basin was drained to Hamoon-e Helmand; partly situated in Iran. The root for thechange is accounted to the rainfall reduction and improper management of irrigationwater in the middle parts of the river. Some ephemeral rivers also exist in this basin thathave outflow to Baluchistan/Pakistan.
River Basin III -Western Rivers Basin: This refers to the western watershed of thecountry. The watershed size of this basin is about 131,000 km2. Hari Rod, Farah Rod andother smaller streams drain the run off from the area. Harirod defines partially theboundary with Iran. The southwestern river of this basin drains into depressions situatedalong the Iranian border.
River Basin IV - Northern Rivers Basin: Several watershed of the northern part of thecountry are classified as basin IV. The area of this drainage basin is 116,000 km2. The
runoff is discharged by Murghab, Kashan, Kushk and Gulran rivers out from the basin to
Turkmenistan by Amu (Oxus) River. The other rivers, such as Samangan, Balkhab,
Saripul and Shirin Tagab however do not reach Amu River.
River Basin V - Northeastern Rivers Basin: Basin V is the northeastern river basin of
Afghanistan. The size of this watershed is 86,000 km2. Runoff generated here is rooted to
Amu river by Kunduz and Kokcha rivers. Amu River is finally drained to Aral sea.
Most of the rivers in Afghanistan are perennial although many of them fall dry at theirlower reaches during late summer due to the diversion of water for irrigation purposes.
Discharges are rising continuously from March onward originated by snow melt endingin June/July before diminishing to a minimum in Dec. /Jan. A large amount of the river
flow (over 80%) occurs from April to September. Most disastrous floods occur after
heavy rainfall in March/April, especially when snow melt is already well advanced.
Over 80 per cent of the country’s water resources have their origin in the Hindu Kush
mountain ranges at altitudes above 2,000 m asl which function as a natural storage ofwater in form of snow. The gradual snowmelt supports perennial flow in all major rivers
during summer.
The hydrological data of the rivers were collected regularly through 167 hydrologic
stations before the war (Shobair, 2000). Presently most of these recording stations aredestroyed; their measurement equipment looted and hence none is operational. The
absence of hydro metrological stations has introduced a gap in the availability ofhydrological data. Attempts are going on for rehabilitation of these stations.
Regarding to groundwater situation in Afghanistan, although no reliable data on annual
groundwater recharge exists, an estimation of 15 bcm is made however (Sheladia, 2001).
In a same manner, the total amount of water extracted annually from groundwater isestimated to 3 bcm.
3.2 Precipitation and Evapotranspiration (ET) Rates in Afghanistan
Afghanistan is receiving irregular precipitation over the year; which varies from a low of
75 mm in Zaranj to 1,170 mm in south Salang (Walter, Shobair et. all. 1997). Mainly
precipitation occurs in winter; particularly from December to April. The wet season is

3

concentrated in winter and spring when the vegetative cover and crop water requirements
are low. In higher elevations, precipitation falls in the form of snow that is highly critical
for river flow and agricultural demand in summer. From June to October, Afghanistan
receives hardly any precipitation. The southern part of Afghanistan receives less than 300
mm of rain per year; while, the region south of Bust and Farah receives less than 100 mm.
The Central Highland and Northern Afghanistan receive between 300-400 mm and thehighest mountains in these areas may receive some more. Chart 1 shows the average
rainfall of different river basins in Afghanistan during the year.
Chart 1. Average monthly rainfall in different basins during the year (mm)
140
122
120

120

100
81

86

85

80
mm

75
69

67

64

60

46
42

48

54

43

43

40

30
38

40

37

37

20

36

37

17
24

39

6

13

5

5

8

6

1
1

5

2

3

2

1

19
8

0

Basin II

Basin III

Basin IV

1

0

MonthsBasin I

7
Dec

-

13

13

5

Oct

0

24

18

Nov

0

Sept

0

Aug

2

July

9

June

May

Apr

Mar

Feb

Jan

15

31

19

6
-

34

Basin VThe annual ET rates are relatively low in Hindu Kush (900-1,200 mm) mountain ranges;
because of severe and long winters. The ET rates vary between 1,200 mm and 1,400 mm
in the northern plains and can reaches up to 1,800 mm in the southern and southwestern
plains. However, summer ET rates are high all over the country; showing a daily peak of
5-8 mm in June/July/August (Shobair, 2000). Due to strong winds occurring particularly
in Herat and in the southern-western plains, maximum daily ET rates are over 10 mm inthis period (max 11 mm in July).
Chart 2. Annual Rainfall, Evapotranspiration
In chart 2 the annul rainfall, ET and
the deficit to fulfill the potential
and Water Deficit by River Basins.
ET is presented.
1,370

1,400

1,314

1,308

1,209
1,200

1,156

1,135
1,057

3.3 Water Consumption
Presently the major water consumer in
Afghanistan is the agriculture sector; withmore than 21.9 bcm (98% of total). 19.1 bcm(87%) of this amount is met by surface
sources and 2.8bcm (13%) from groundwater[1.74 bcm (8%) from Kanats; 0.98 bcm (4%)
from springs and 0.17 bcm (1%) from deep
wells] (FAO, 2003a). The available statistics (FAO, 2003b) show that in 1995
(hydrologically a normal year) there were a number of 21.93 million sheep; 11.56 million
1,034

1,000

815

800

600

600

457

394

400

280

214

173

200

-

Basin III

Basin II

Basin IV

Rainfall mm

4

ETP mmBasin I

Dificit mm

Basin V

poultry; 9.4 million goat; 1.09 million donkeys; 3.66 million cattle and 0.41 million
camels in Afghanistan (FAO, 2003a), but in 2003 the number has decreased considerable
to 2.88 million sheep; 4.0 million poultry; 2.4 million goat; 0.52 million donkeys; 1.22
million cattle and 0.06 million camels in Afghanistan. Considering the consumption rates
for livestock given by Davis and Lambert (1995), the annual water consumption for thecurrent number of livestock in Afghanistan reached to about 0.05 billion m3, which is
1.07% of total consumption. The required water for livestock is provided from different
sources including surface water (canals) and ground water (Kanats, springs and wells).
At present, almost there is no major industrial production in Afghanistan to be considered
as industrial water consumer. Table 1 shows a water balance from surface andgroundwater in Afghanistan. This estimation is based on available data at national level(FAO, 2003b) and other assumptions.
Table 1. Estimated Surface and Groundwater potential Consumers (bcm per year)
Type of water
resources

Poten
tial

Present used in billion cubic meter
Agric
Live
Water
Industulture stock
supply
ry
bcm
bcm
bcm
bcm
19.07
0.14
0.05
0

Total

Balan
ce

Futureuse*

Balance/en
vironment

bcm
bcm
bcm
bcm
bcm
Surface57
19.25 37.75
30
27
Water/canals
GroundKanats
1.74
0.03
15
3.04
11.96
5
10
water
Springs
0.93
0.01
Wells**
0.17
0.17
72
21.9
0.05
0.35
0
22.29 49.71
35
37
Total
Note:
* All existing irrigation schemes are assumed rehabilitated and managed efficiently,** It is assumed that out 0.34 bcm extracted water form shallow and deep wells, partly half of it is used for
irrigation and half for water supply (Potable water) .

The drainage area of each basin with mean annual volume, estimated volume used in
2002 which more or less is the same in 2004 and percentage of usage out of existing
resource is shown in table 2.
Table 2. Estimated water volume in billion m3 used for irrigation in each river basin
Name river BasinRiver basin IV- Northern
River basin III- WesternRiver basin I- Kabul
River basin II- Helmand
River basin V- North-eastern
Total All Basins

Catchment
Area (km2)
11600013100014300016600086000
642000Mean Annual
Volume (bmc)
3.34
3.33
21.74
7.50
48.12
84.03

Estimated volume
used in 2002
19.99
0.96
4.15
7.86
4.12
19.07

% of available
or used in 2002
59%
29%
19%
105%
9%
23%

4. EFFECT OF CALAMITY ON IRRIGATION/AGRICULTURE
4.1 The reduction of Agricultural production
Afghanistan is a drought prone country. Sever droughts are generally linked to low winterrainfall in two consecutive years here. Rainfall records suggest that low winter rainfall in5two successive years occurs at least once every 10 to 15 years (Shobair, 2001).
During the current drought, which is almost in its seventh year (1998 to 2004), although
there were signs of recovery in 2003 with good rainfall and good distribution, the amountof cereal production has dropped to around 3 million metric ton (FAO, and WFP, 2004).
A recent crop and food assessment survey conducted by FAO and WFP (FAO, and WFP,
2003) shows that in 2003 Afghanistan's agriculture has suffered from widespread crop
failure; caused by below average rains and loss of animals due to diseases. The reportadds that drought conditions are particularly acute in the west, southwest and south of thecountry, where more than half of the crops have failed. In areas north of Hindu Kush
Mountains, pests and diseases as well as untimely rains were mainly responsible for the
low harvest. The above report also mentions the lower harvests resulted from severe
water shortages in some areas; where the water table has dropped by up to four meters.
Ironically, seasonal flash floods in the same areas have also been reported; indicating asevere lack of irrigation infrastructure to store and distribute water temporally andspatially. Wheat prices on average are nearly 30 % higher than prices at the same months
last year (Kamal, Shobair et. al., 2004).
Chart 3 shows the total amount of crop production (wheat, rice, barley and maize) for
different years, from 1964 to 2003. Cereal production in Afghanistan has not been
sufficient to meet consumption requirements since 1976.
Civil unrest since 1978 has contributed to a steady decline in production throughout
1980s. The agricultural recovery of the 1990s was halted by severe drought for threeconsecutive years between 1999 and 2001 and again in 2004.
Chart 3. Total crop production (wheat, rice, barley and maize)
from 1964 to 2004 (FAO, 2004)
Total Cereal production
6000
5521

5000
4624

4000

3876

Thousand

3732
3319

3000
3050
2420

2000
1837

Total Cereal

Wheat

Rice

Barley

2004

02

2003

01

99

2000

98

97

96

95

94

93

92

91

89

1990

88

87

86

85

84

83

82

81

79

1980

78

77

76

75

74

73

72

71

69

1970

68

67

66

65

0

1964

1000

Maize

Chart 4 shows a direct relation between the total amount of crop production in the
country and the annual rainfall distribution in Kabul (used as an indicator) for years 1964
to 2003. It can be seen that there is high sensitivities between the frequency of rainfall
during different years and crop production.

6

Chart 4. Long term rainfall distribution and crop production
552

471

462
448

446
427

425

373 379
349

426

421
407

395

392

358 363

438
415

404
383

435

389
372 372

351
332

388

339
308

270
253

332

324

282
252

283
264

310 305305

290
271 272

251

250

326

325

304

303
300

278
262

373
353

342

330

368

367

359

349

242

236
220
206

205
193

189

184

177

156

151

2004

02

2003

01

99

2000

98

97

96

95

94

93

92

91

89

1990

88

87

86

85

84

83

82

81

79

1980

78

77

76

75

74

73

72

71

69

1970

68

67

66

65

1964

125

Years
Avearge Rainfall mm

Cereal production 10000 MT

Note: in the chart there is a gap of rainfall data from 1992 to 2000. This is due to destruction (by war) ofalmost all of meteorological stations in the country. The chart shows that the crop production depends bothon the amount of rainfall available and on the effects of war and recovery.

4.2 Reduction of Surface Water for Irrigation and the Arable Land
The FAO study of 2002-2003 (FAO, 2003b) shows a decline of 66% of water flow incanals. This has caused a reduction by 58% of the irrigated land area. Main reasons forthe reduction in irrigation schemes are as follows:i.
Severity of the droughts and reduction of water in the main sources,ii.
Effect of war and improper operation and maintenance of canals (siltation in
the canals, damaged regulating systems in the canals etc…) - including
improper irrigation water management which causes low water use efficiency,iii.
Lack of sound irrigation structures (mainly 90% of irrigation systems in the
country are the traditional schemes; and additionally water conservation
appropriate technologies are not yet introduced widely).
The available discharge in canals in 2002, the percentage of decline and the commandarea and its percentage of decline for surface water in all river basins are shown in tab. 3.
Table 3 Available discharge in the canals and command area in 2002-3 and its
percentage of decline
Command% decline
River basins
Accumulated % declineofArea inof irrigatedDischarge in2002 (ha)area2002 (m3/sec) discharge
River basin I- Kabul
400
72%
328,434
48%
River basin II- Helmand
758
62%
734,088
61%
River basins III- Western
92
69%
68,14867%
River basins IV- Northern
19269%
241,891
61%
River basins V- North-eastern
397
60%
266,425
49%
Total all basins
1839
66%
1,638,986
58%

7

4.3 Decrease of available water in Kanats/Karezes and arable land irrigated
The impacts of droughts and war in Afghanistan are apparent in the discharge of Kanats
and as a consequent on agricultural productivity, human settlement and on livestock
condition. During the war many of Kanats were destroyed intentionally or damaged due
to lack of maintenance. This is examined on the available discharge in the Kanats and thesize of command area in 2002-2003 and its percentage of decline in table 4 (Please see
next page). The table shows that the Kanats in river basin I have reduced their waterflow by up to 90% and this has caused a reduction of 88% of irrigated land. In river basin
II the Kanats have reduced their water flow and land under irrigation by 88% and 85%
respectively and in river basin III the Kanats have reduced their water flow and land
under irrigation by 80% and 78% respectively. From this analysis it can be visualized thatin these 3 river basins where the Kanats exist, the groundwater level has depleted
significantly. The main reasons for the decline are accounted to the following causes:i.
the severity of the drought and reduction in the recharging of groundwater,ii.
effect of war (bombing/mining) and improper operation and maintenance ofKanats,iii.
drilling of deep wells close to the Kanats (Shobair, 2000)
iv.
non technical and non-scientific use of groundwater.
Table 4. Discharge in Kanats in 2002-2003 andpercentage of decline in discharge and in command area.
River basins
No ofDischar- % reduction Comma % reduction
surveyed
ge inof discharge nd Area in command(m3/s)in (ha)area
KanatsRiver basin I- Kabul
4,669
30.0
90%
31,226
88%
River basin II- Hel.
4,116
21.0
88%
26,322
85%
River basins III- West.
585
5.0
80%
5,380
78%
Total all basins*
9,370
56.0
89%
62,92787%
Note:* The Kanats/Karezes are only found in three above mentioned river basins

Chart 5. Number of Active and dry Kanats
In a same manner, the result of a survey on
6781
the functionality of Kanats in Afghanistan 8000
7000
shown in the above table reveals that froma total number of 9370 Kanats in 6000
4077
5000
Afghanistan, a number of 3400 (36%) are 4000
2704
dried. Nevertheless, the lack of supervision 3000
2004
1423
and maintenance must also be considered 2000
581
585 464121
for the non-functionality of these Kanats. It 10000
is worthy to mention that recently some12
3
displacements of the local population has
taken place because of drying up of these
Water Basin
Total
ActiveDry
Kanats ; as they are usually the source ofdrinking water of villagers. Chart 5 shows the number of dried and active Kanats in
2002-3 in Afghanistan.

84.4 Decreases in Availability of Water for Livestock Consumption and in Number ofLivestock
Livestock play important role in providing foodstuff for Afghan people. Pastoral land is
the main source of feeding for some of the livestock. This land covers about 45% of total
area of the country. The total number of livestock declined in 1980s. Although thisrecovered to the pre-war level in the 1990, the current drought imposed negative impact
on the number of livestock, mainly because of shrinkage of pastoral land and shortage ofconsumption water to them. Comparing the results of studies conducted on this regard in2003 (FAO, 2003b) and a census made in 1995 show a reduction of 80% in the numberof sheep and 70% in the number of camel. In Afghanistan, mainly sheep and camels are
grazing in the pastoral lands. The overall reduction in the number of livestock from 1995
to 2003 is estimated 63%. Chart 6 presents the percentage of reduction in the number ofdifferent types of livestock in 2002 compared with the number of same livestock in 1995.
Chart 6. Percentage of Decline of Numberof Livestock in 2002 Compared with 1995
The impact of water shortage forlivestock during the drought period
can be examined by estimation ofwater consumption for different
species for years 1995, 1998 and2003. The data shows the decrease of
fodder and the consumption water for
livestock in recent years. The result isshown in chart 7.

90%
80%
80%

74%

70%

63%
58%

60%

51%
50%
42%
40%
27%

30%
20%
10%
0%
sheep

CamelsGoats

CattlePoultry

DonkeyTotal

Chart 7. Decline in the amount of water consumption in (bcm) by livestock indifferent years
0.24

0.30

0.25

0.16

0.16

0.20

0.10

0.15

0.05
0.001

FAO 95
Sheep

FAO 98CattleGoats

Donkey9

FAO 03
CamelsPoultry

Total

0.0003

0.01

0.00

0.02

0.01

0.003

0.0005

0.02

0.01

0.02

0.004

0.0008

0.03
0.01

0.05

0.03

0.10

5. Conclusions and Recommendations
1. National water security for national food security: For fulfilling the timely demandsof agricultural and other water consumers, construction of small and medium sizestorage reservoirs, and completion of all reservoirs under construction in the country
including rehabilitation of existing schemes in all regions is highly necessary,
2. Watershed management is highly essential for appropriate water utilization andenhancement of agricultural production,
3. Drought assessment, preparedness and mitigation planning plays important role forsecurely living environment of the ecosystem,
4. Improvement of the on-farm and out-farm water management through rehabilitationand modernization of existing irrigation schemes is highly essential for a friendly
water source utilization and achieving maximum efficiency,
5. Introducing appropriate and simple water conservation technologies along with acapacity building of the farmers are critically needed for efficient water utilization,
6. Introducing new rainwater harvesting techniques to harvest water for drinking andirrigation usage and ground water recharge should be enhanced in all river basins;
considering the existing traditional water harvesting techniques,
7. Awareness of the communities/farmers about efficient use of water and the inverse
affects of over/improper usage of surface and groundwater resources through country
wide extension service.

References
Alim, A. K. and Shobair S. S., 2002.
“Drought and Human Suffering in Afghanistan.”
TAEAS2002 Proceedings, Agricultural and Forestry Research Center, p. 119 – 127.
University of Tsukuba, Japan.
Davis Jan and R. Lambert, 1995.
“Engineering in Emergencies – A Practical Guide for Relief Workers”.
IT Publication, London, 717 pp.
Food and Agriculture Organization/World Food Program, (2004).
“Crop and Food Supply Assessment Mission to Afghanistan”, FAO, Afghanistan
Food and Agriculture Organization, 2003a.
Countrywide assessment/ inventory survey of traditional irrigation schemes, Afghanistan,
FAO, Afghanistan
Food and Agriculture Organization, 2003b.
“Afghanistan: Livestock census”, FAO, Afghanistan
Kamal B., P. M. Azizi, Shobair S. S. and M. Y. Mohsini, 2004.
Drought in Afghanistan and its potential mitigation,
Presentation on International Workshop on Drought Mitigation and Assessment in SouthAsia, IWMI, Colombo, Seri Lanka.

10Naimi, M. Q., 2003.
“Vision of the Integrated Water Resources Development in Afghanistan”.
TAEAS2003 Proceedings, Agricultural and Forestry Research Center, p. 11 – 17.
University of Tsukuba, Japan.
Raphy F., 2004.
“Watershed atlas, working document for planner”, Kabul,
FAO, Afghanistan (in printing)
Sheladia Associates, (2004),“Final Report for Framework of Water Resources Management & Draft Report on
Proposed Water Resources Development Strategy, Afghanistan,”. FAO, Afghanistan.
Shobair S. S., 1997.
“Manual on water harvesting”, FAO, Afghanistan
Shobair S. S., 2001.
“Effects of Deep Wells on Groundwater Resources in Afghanistan”, FAO Afghanistan
Shobair S. S., 2001
“Current Drought Situation in Afghanistan” FAO Afghanistan,
Walter Klemm, Shobair S. S. et. all. 1997.
“Promotion of Agricultural Rehabilitation and Development Programs in Afghanistan.
Water Resources and Irrigation”, Agricultural Strategy”, FAO, Rome,
WHO, 2004“The World Health Report :2004 - changing the history” . World Health Organization,
Geneva, 169 pp.

11