Afghan Refugees

Afghan doctor volunteers as a lifeline for new arrivals

After a hellish first night in Sacramento, Nazir Ahmad Ahmadi was ready to return to Afghanistan with his wife and 5-month-old son despite the danger of being killed by the Taliban.

He took his family to the Sacramento refugee health clinic. There, a tall, well-groomed interpreter listened patiently to his story.

Ahmadi told Dr. Fahim Pirzada about the roaches and bedbugs that besieged his family that first night, leaving them with irritating bites and rashes days later. Their refugee resettlement worker had picked them up at midnight March 16 at Sacramento International Airport and delivered them to an apartment at the Balmoral Arms apartment complex in Arden Arcade. Ahmadi said the apartment was stocked with some food, furniture and a fly swatter. But the fly swatter was overmatched. Ahmadi begged his case worker to get him some bug spray, which also failed to stop the assault.

Ahmadi, 31, said he never cried in Afghanistan, but was reduced to tears after his first day in Sacramento. “I’m homeless right now,” he said. “If you don’t have an apartment, nobody gives you a job. My life in Afghanistan was not easy, but not harder than here.”

In Afghanistan, Ahmadi said, he supervised apartments on U.S. bases for the Army Corps of Engineers for nine years. He made $1,600 a month, a healthy sum by Afghan standards.

Pirzada nodded in recognition. He’d heard variations of this story dozens of times. He told Ahmadi not to return to Afghanistan – both for his safety and his baby’s future. “He told me, ‘Don’t worry, you stay here, go nowhere. Day by day we will solve your problems,” Ahmadi recalled in an interview.

Pirzada, 39, arrived from Afghanistan two years ago after working as an emergency room doctor, community health executive and protocol officer at the U.S. Embassy in Kabul. He has emerged as a linchpin of Sacramento’s Afghan refugee community.

Lacking a U.S. license to practice medicine, Pirzada earns $20 an hour as a part-time medical interpreter. He devotes most of his time to his volunteer work – responding to one crisis after another in the population of newly arrived refugees. More than 2,000 of them, including Pirzada, came on Special Immigrant Visas granted for their work alongside U.S. forces in Afghanistan, work that put them in grave danger of being killed by the Taliban if they stayed in the country.

Pirzada has become the person to call for Afghans dealing with medical problems, suicidal thoughts, discrimination and financial issues. He created a cellphone app, Afghan Community Newsroom, which has been downloaded by several hundred Afghan refugees. He also heads a nonprofit, VIRTIS, that provides mental health care to refugees. It has no funding and relies on a volunteer network. Pirzada pays $600 a month – more than half his salary – for a small office and insurance.

He and his wife and three children scrape by with the help of $940 a month in welfare and food stamps. They live in an apartment on Franklin Boulevard in south Sacramento.

“Dr. Pirzada is a peacemaker, a bridge builder, a cultural broker,” said Dr. Patrick Marius Koga, director of Refugee Health Research for the UC Davis School of Medicine. …“He’s working day and night for the community.”

Ahmadi’s situation was similar to others Pirzada had encountered. After that unbearable night in their new apartment, Ahmadi said he and his wife and child fled to his younger brother Noori Ahmadi’s one-bedroom apartment about a mile away. He told his resettlement agency he wanted to find a new, bug-free apartment. The reply: He had little choice but to stay in the unit he had been assigned because $2,000 of his government “welcome money” had already been spent on the rent – and it was unrefundable.

Nazir Ahmad Ahmadi is reflected in one of many certificates of commendation from nine years of work in Afghanistan with the U.S. Army Corps of Engineers. With him are his brother, Nasir Ahmad Noori, and nephew Basat, 3. Ahmadi sought help from Dr. Fahim Pirzada about his bug-infested Sacramento apartment.

“They told me, ‘If you stay, we’ll give you $700 more.’ I have a 5-month old child. I can’t stay here; it’s bad for him.”

Pirzada called the head of the refugee agency and learned Ahmadi could get a partial rent refund if another family was moved in. He also made Ahmadi, 29, feel he wasn’t alone.

“I am very, very thankful to him,” Ahmadi said. “He helped me a lot. I’m OK for now.”

‘Helpless and hopeless’

The need among newly arrived Afghan refugees is overwhelming.

They have spent years in direct combat situations – far longer than most U.S. troops. Once here, they’re no longer well-paid translators, engineers, architects and doctors, revered for their loyalty and savvy by the U.S. forces that relied so heavily on them. Many say they get little help from their resettlement agencies and government offices, and don’t know how to start over. As their refugee cash assistance and other temporary services run out, they often find themselves stuck in dangerous neighborhoods without jobs, cars or advocates.

They struggle to find medical care and get their children enrolled in schools.

Women forbidden to attend school during the Taliban years often feel trapped in their apartments, unable to drive or speak English.

One recent call for Pirzada’s help came from Opening Doors, a refugee resettlement agency. An architect who had just arrived two weeks earlier sent the agency an email threatening to kill himself and his family if he didn’t receive help.

The man was frustrated and fearful, in pain from an ear infection. He had no doctor, no car, no furniture, no money and didn’t know how to get his two children into school.

Pirzada persuaded the agency not to call 911, knowing it would fracture the architect’s already fragile family. As he had done many times before, he climbed in his 2010 Honda Civic and headed out to help.

“He called himself useless, a burden, helpless and hopeless,” Pirzada said of the architect. “Filled with anxiety and depression, he woke up and his hands and legs had no feeling and couldn’t move. I found it was because of the level of pain, distress and sleepless nights.”

Pirzada said he learned Opening Doors had selected a health plan for the architect and his family, but hadn’t told him which one.

The doctor said he assured the architect that people cared about him, and then got him a medical appointment along with counseling sessions with a counselor who speaks Dari, one of the main Afghan languages. “The next step was to get his children enrolled in school, complete their immunizations and get the man his welcome money and some furniture for his apartment,” Pirzada said.

He didn’t get home until after 8 p.m. that night. When he finally pulled into his gated apartment complex, his wife, Suman, asked him: “Why do you do this for free? Nobody in America does anything for free.”

Pirzada shrugged.

The demands on his time are exhausting. “I know many people in Sacramento who are disabled, mentally ill, speak no English, no car, and are left with this bunch of problems and I’m their only point of contact,” he said. “I want to help them, but not 24/7.”

‘Just fixing iPhones’

One of the services Pirzada performs for newly arrived Afghans is to help them navigate the U.S. refugee resettlement process. Most refugees are placed by the government with one of four nonprofit resettlement agencies in Sacramento that distribute government aid and secure apartments. These groups have been criticized by Afghan immigrants who object to having their government “welcome money” – currently between $925 and $1,125 for each member of a household – spent for them on rent, furniture and other supplies rather than given to them directly.

Working with new arrivals, Pirzada has begun viewing the refugee assistance system with a critical eye.

He said the U.S. government lacks a coordinated strategy for helping Afghan refugees succeed in America. Resettlement services last for just 90 days, and the refugee agencies often rely on volunteers or young staff members who have little experience as caseworkers and who aren’t themselves adept at navigating the systems of welfare, school enrollment, tenancy and obtaining Social Security numbers.

“Most of the (aid) workers, they even do not understand the concept of refugees,” Pirzada said.

He said he also doesn’t understand why experience gained in Afghanistan counts for nothing in the United States, even if the person worked for a U.S. corporation or the U.S. government.

“We have very skilled SIV holders who were in great positions back in their country, especially working for the U.S. government, but they are now just fixing iPhones,” Pirzada said. “Why is a project manager who managed multibillion-dollar projects in Afghanistan not considered a project manager here? Why is an architect not considered an architect when he or she served for five or 10 years developing U.S. construction projects in Afghanistan?”


Back in Kabul, Pirzada was a protocol officer in the U.S. Embassy for six years. He advised four different U.S. ambassadors on culture, politics, economics and national security. He said he helped translate for George W. Bush, Colin Powell, Condoleezza Rice, Donald Rumsfeld, John Kerry, Jeb Bush and numerous other U.S. dignitaries. Once, he had to stop U.S. officials from using dogs and metal detectors on tribal leaders entering the embassy.

“That’s terribly disrespectful in our culture and religion – they hate dogs to sniff them,” he said. “They asked me, ‘We have fought with U.S. on the ground in the war against Taliban and al-Qaida; why are they not trusting us?’ 

Pirzada, the son of a farmer and a housewife, said he believes strongly in the American ideals of freedom, justice and equal opportunity.

Despite continued turmoil and fighting in his home country, he said the United States left a positive legacy in Afghanistan, building schools, hospitals and roads.

“Over 1 million boys and girls have been enrolled in school; 85 percent of the nation has basic access to health care; our justice system is reformed,” he said. “We have a national security force of 350,000 with advanced technology.”

Afghanistan now enjoys freedom of speech, he said. “There are over 50 private channels free to criticize the government.”

Women forgotten?

Pirzada has plenty of experience in helping to address poverty. In Afghanistan, he led a community development partnership between private Tanweer Investments and the government of the United Arab Emirates that employed 5,000 Afghan women in carpet factories and provided meals, education and health care to members of the wider community.

“The majority of Afghans are suffering on a daily basis, and it is no exaggeration to say they are starving to death,” he was quoted as saying in a 2013 article about the food distribution program. The article described women – dressed in head-to-toe blue burqas – walking for many miles with their children to get free meals to break the daily fast during the holy month of Ramadan.

Here in Sacramento, Pirzada remains concerned about the plight of women in particular. “Afghan women in Northern California are largely unemployed and in poor health, despite the ideal of egalitarian gender roles here,” he said. “I’m very concerned these refugee women are forgotten.”

Afghan women who didn’t want their faces photographed, participate in an English class created and taught by Fahim Pirzada in December.

The pressures of starting a life in America often boil over into marital discord and problems at home and school, he said. These are exacerbated by anti-Muslim sentiment in the larger community, fanned by terrorist attacks in the U.S. and Europe.

Pirzada was recently called upon to help an Afghan mother of four who was suffering from PTSD and depression. Her husband, a Special Immigrant Visa holder, had moved in with a girlfriend and kicked his wife and children out. She was despondent over the loss of her marriage, and she missed two of her children who remained in Afghanistan. She and her teenage son and daughter were staying at a women’s shelter, My Sister’s House.

“She was homeless and in a terrible situation and needed help, big time,” Pirzada said.

He arranged for her medical benefits and connected her with a counselor and a psychiatrist. Then he helped her enroll in welfare, moved her and her children into a new apartment and helped her apply for visas for the two sons she was forced to leave behind in Afghanistan. He found her an informal job taking care of a mentally disabled African refugee for $5 an hour – the best he could do.

The family’s stress intensified when the woman’s 18-year-old daughter, a high school senior 5 feet tall and barely 90 pounds, was beaten by another girl at Encina High School in Arden Arcade last October.

The girl recounted her story in an interview with The Sacramento Bee, but neither she nor her mother would agree to be identified for fear of retaliation.

That Friday afternoon, the girl said, another girl ripped off her hijab, dragged her by her hair and beat her so badly she was hospitalized for two days. “For 37 minutes they hit my head, and no one came to help me until a teacher called 911,” the girl said. “ I think it was because I was wearing a hijab.”

The UC Davis medical report said the girl suffered a scalp hematoma. The attacker was expelled, but the school’s internal investigation determined it wasn’t a hate crime.

The girl’s mother recounted her family’s story in December, in the living room of their new apartment. Bottles containing medication for depression and stress sat on the cabinet behind her. The woman picked up a framed photograph of a handsome young man – one of the two older sons she’d had to leave behind in Afghanistan – and clutched it to her chest. She sank to her knees in tears.

A refugee who has attempted suicide and does not want to be identified clutches a portrait of one of two sons she had to leave behind in Afghanistan when she and her husband came to the U.S. with two younger children. Her daughter was beaten by another girl in high school.

“I don’t have any support,” she said. “I have a very bad life.

“Not only am I and my two children broke, we lost our confidence,” she said. “We are very, very fearful living in the United States. … My daughter is so traumatized. … I’m afraid they will hurt my daughter.”

Sometimes, Pirzada has helped refugees in court. In one case, an Afghan woman in Sacramento called 911 after a fight with her husband. She did not expect the phone call would result in him being locked up, with bail set at $50,000, and that her kids would be taken from her by Child Protective Services until she finished anger management classes. Pirzada wrote a letter to the judge explaining how such fights are cultural, and are never resolved by police in Afghanistan. The father was released from jail and the family was reunited.

Local health care providers, including UC Davis Medical Center, have asked Pirzada to give workshops on how Sacramento agencies and Child Protective Services can provide culturally appropriate services for Afghan refugees suffering from PTSD and depression.

UC Davis’ Koga, his mentor, said it’s a shame that Pirzada’s medical credentials do not qualify him to practice in the United States, considering his potential value to Afghan patients. Pirzada had just arrived from Afghanistan and was translating for his wife in the county refugee clinic when Koga noticed him and asked if he was a doctor.

“This man is a diamond – humane, compassionate, pragmatic and responsible,” Koga said. “Gold is washing up on our shores, and though we cry that we do not have enough primary care physicians for refugees, we do nothing to change that.”

Pirzada typically works 12 hours a day, most of it for free. He dreams of one day being able to practice medicine in Sacramento and of obtaining greater resources to help his struggling community.

When he finally returns home at night, Pirzada retreats to the living room in his family’s Franklin Boulevard apartment – a little piece of Afghanistan in Sacramento. There is no Western-style furniture here. The floor is covered with a richly patterned carpet, and long cushions for sitting line the walls.

Here he sheds his suit and tie and dons the Perahan tunban, the tunic worn by Afghan men. He sinks into the red cushions his wife sewed by hand, under the protection of the same Muslim prayer that hung in his home in Kabul.

“We’ve worn it for centuries; our president wears it,” he said, his fingers stroking the delicate embroidery stitched into a star on his chest. “The needlework takes a month to hand sew, thread by thread.”

The Bee’s Phillip Reese and Renée C. Byer contributed to this report.

Stephen Magagnini: 916-321-1072, @SteveMagagnini

How you can help

These organizations are involved with providing services to Afghan refugees:

1. 1. Refugee Integration & Health Azimuth. Provides mental health counseling and other assistance to new refugees. Used to be called VIRTIS – the Veteran, Immigrant and Refugee Trauma Institute of Sacramento, and was run by Dr. Fahim Pirzada until he was hired by the state Department of Refugee Health. Dr. Ali Alazzawi, an Iraqi refugee, is the new CEO and can be reached at or 916-459-0693. Dr. Malikah Popal, an Afghan doctor from Kabul, is the new president and can be reached at

Needs: Money and volunteers

2. Refugee resettlement agencies. There are four non-profit organizations in Sacramento that receive federal money to resettle refugees: World Relief , Opening Doors, International Rescue Committee (IRC), and Sacramento Church World Service. Contact them to find out how to give and to see if they need volunteers.

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