The killing in Afghanistan is not winding down:  in fact the annual death toll has risen since the war began in October 2001, and according to the United Nations, more civilians died there in May 2011 than in any month since 2007.  More lives are being lost as a result of war than when the Taliban was in control. The first half of 2011 has seen the most intense fighting since the early part of the war.

Civilians are being killed by crossfire, improvised explosive devices, assassination, bombing, and night raids into houses of suspected insurgents.  Unexploded ordnance from previous wars and from U.S. cluster bombs continue to kill after the fighting stops. 

The hospitals in Afghanistan are also treating increasing numbers of war wounded, including amputees and burn patients.  The war has also caused invisible wounds.  In 2009, the Afghan Ministry of Public Health said fully two-thirds of Afghans suffer mental health problems.

Afghanistan was poor and vulnerable before the war that began in 2001; its population remains poor and vulnerable. The general immiseration of the Afghan population is in part due to and exacerbated by past conflict.  The prior wars and civil conflict in the country have made Afghan society extremely vulnerable to the indirect effects of the current war. 

The war related indirect deaths in Afghanistan, as with any war, are caused by many factors, including disease due to lack of clean drinking water, malnutrition, and reduced access to health care.  Environmental disasters, such as drought and floods, make living in war zones more difficult, and create what the humanitarian relief community calls "complex emergencies." 

Nearly every factor that is associated with premature death — poverty, malnutrition, poor sanitation, lack of access to health care, environmental degradation — is exacerbated by the current war.  On the other hand, Afghanistan has benefited from investments in health care that may ameliorate some of the effects of war.

For a time, many -- except Afghans and aid workers -- seem to have stopped recording the toll of death and injury in Afghanistan. NATO ISAF has recently released some figures, but comparisons to other data, specifically from the United Nations, shows that the NATO ISAF data is an undercount.