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After a 20-year US military campaign in Afghanistan that was marked by sacrifice and frustration, it is understandable that exhaustion has drained interest in the fate of that country. However, America needs to think about Afghanistan again. The humanitarian crisis there threatens to be overwhelming; its contagion will disrupt the South Asian region; and without a change of course, America will get the blame.

In August, there were desperate stories of the 70,000 Afghans who were flown out of the country, bound for America, and of those left behind. The lucky few are now being processed at US government facilities, en route to building new lives in this country.

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But for the 38 million Afghans left in the country, their 40-year trauma of conflict and poverty — to say nothing of new threats from COVID-19 and climate change — has them entering a new and more desperate phase. Their new normal is marked by four factors.

There is norm-setting by the new regime. Many are fearful of the consequences. The International Rescue Committee has worked in the country for over three decades and has 1,700 Afghan staff delivering humanitarian services, including education. We are committed to continue our work in nine provinces, including employment of women and education of girls, and are currently being allowed to do so.

There is faction-fighting within the new Taliban regime, and score-settling across the country, with harrowing reports of persecution of former human rights defenders. And then there is economic meltdown. It is this last factor that is precipitating an alarming crisis, with the head of the World Food Programme telling the BBC that 9 million people in Afghanistan are marching toward famine. Last year, 1 in 5 was threatened by food insecurity, but this year the figure is more than 1 in 2 (about 23 million people in total). IRC anticipates that the number of people in need in Afghanistan has increased by 50 percent this year alone.

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Afghanistan has been subject to an unprecedented economic shock in the last three months. The end of the war has meant the end of employment for millions of Afghan contractors engaged in the war economy. The suspension of foreign development aid flows to government coffers — worth 75 percent of the government budget — has sapped the government’s ability to pay salaries to public servants and deliver desperately needed services to millions of Afghans. The impact on ordinary Afghans has been immediate and widespread — especially in the health care sector, where 90 percent of primary health facilities are at risk of closure, potentially ending the provision in 31 of Afghanistan’s 34 provinces.

Meanwhile, the freezing of Afghanistan’s financial assets and suspension of its International Monetary Fund support has sent the country’s ability to pay for basic goods — medicines, fuel, food — into a tailspin. And continued uncertainty about sanctions regimes, despite a welcome US carve-out for humanitarian efforts, has frozen trade and created risk for aid agencies.

The result is disastrous. Afghans don’t have money. The banking system is not functioning. Inflation is rampant following a 14 percent devaluation of the afghani since mid-August, while the cost of basic cooking staples, like flour and cooking oil, has risen by 35 percent in recent weeks. According to the International Monetary Fund, Afghanistan’s GDP could contract by up to 30 percent under Taliban rule, a forewarning of a new refugee crisis.

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Increases in humanitarian aid to feed people and keep them warm is essential but not sufficient. Without a functioning economy and functioning banking system, lives and livelihoods are at risk; humanitarian suffering is on the rise as is migration. The Norwegian Refugee Council reports that 300,000 people have fled into Iran since August.

A true plan to relieve the suffering in the country needs to be economic not just humanitarian. That means facing some hard truths.

The public sector needs to be refloated, with a massive expansion of international aid mechanisms (such as the United Nations or World Bank) to directly pay salaries to teachers and nurses. Citizens need to be able to buy food, fuel, and medicines; markets need to be restarted with a stable currency; the banking system needs to be resurrected. Sanctions regimes, including UN Security Council sanctions, need to have clear and clearly communicated exceptions for humanitarian agencies and the commercial activities and actors (suppliers, banks, etc.) they rely on.

A recent report of a meeting of the Center for Global Development made the necessary if unpalatable point that support will be required from Western countries. As the report points out, it is in the power of the US government to unfreeze national financial assets for specified purposes, as has been done with Venezuela, to help combat the spread of COVID-19.

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This is not about supporting the regime. It is about saving the people and the country from further disaster. As the Center for Global Development put it: “Tying the use of funds to the purchase of essential imports — particularly food, fuel, and health commodities — and/or to the facilitation of dollar auctions to prop up the value of the afghani could help meet the needs of ordinary Afghans facing food insecurity without giving the Taliban discretionary control.”

There are bound to be accusations that such measures will help the regime. There is an obvious moral rebuttal to letting people starve in an effort to deny political credit to a regime. But there is also a political one. Who can believe that America and its allies won’t get the blame for the unfolding disaster when its policy decisions are clearly so central, and who honestly believes that a successor regime would be better? The answers are obvious.

The war in Afghanistan is over, but the peace carries perils. They need to be addressed. The sunk costs of the longest war are good reason for action, not inaction. And by virtue of its recent history in the country, only the United States can enable the financial flows to help the Afghan people.

David Miliband is president and CEO of the International Rescue Committee and a former foreign secretary of the United Kingdom.