* Civilian casualties rise, access to health care shrinks
* Afghanistan is ICRC&${esc.hash}39;s largest aid operation worldwide
By Stephanie Nebehay
GENEVA, Dec 2 (Reuters) - The dire humanitarian situation in Afghanistan is likely to deteriorate further in 2011 unless the Kabul government and Taliban insurgents reach a political settlement, the Red Cross warned on Thursday.
Intensified fighting has led to rising civilian casualties and kept millions of Afghans in rural areas from reaching basic health care this year, it said, citing "acute medical needs".
"This year the humanitarian situation (in Afghanistan) has worsened, frankly," Jakob Kellenberger, president of the International Committee of the Red Cross (ICRC), told reporters.
"I cannot speculate what would happen on a political level next year but seen from now, in our analysis, they (needs) will not decrease, if anything they will increase," he said.
U.S. President Barack Obama reviews his Afghanistan war strategy this month, more than nine years after U.S.-led forces drove the Taliban from power in retaliation for the Sept. 11, 2001 attacks on America.
Afghan President Hamid Karzai has asked U.S. and NATO leaders, who have propped up his government with billions of dollars in aid, equipment and cash since 2001, to start drawing down their troops and end combat operations by 2014.
But by insisting NATO troops end combat missions, Karzai may be weakening his own grip on power and also his negotiating position in tentative peace talks with the Taliban. [ID:nSGE6AT050]
The ICRC, in a record 1.2 billion Swiss franc (${esc.dollar}1.2 billion) annual appeal for 2011 launched on Thursday, is seeking 89 million francs for Afghanistan, its largest humanitarian operation worldwide for the second year in a row.
The ICRC, whose trademark is its neutrality and independence, is the only aid agency to have access throughout the country, including Taliban-held regions.
"Behind the notion of Taliban, there is a complex reality," Kellenberger said, referring to a myriad of armed opposition groups in Afghanistan.
A growing number of war-wounded are seeking medical care at Mirwais hospital in Kandahar in southern Afghanistan, he said.
Some 1,000 new patients with weapon-related injuries were registered at Mirwais in August and September, twice as many as during the same period a year ago, an ICRC spokesman said.
"Even in provinces not affected by open warfare, roadside and suicide bombs as well as air strikes or night raids are commonplace," the ICRC said in a statement issued on Oct. 29.
ICRC officials visited a total of 3,000-4,000 detainees held by Afghan forces as well as by U.S. and international forces in the past year, according to Kellenberger. ICRC reports on their health and conditions of detention are confidential.
Other major operations are in Iraq, where it is seeking 85.8 million Swiss francs, Sudan (82.8 million) and Pakistan (82.4 million).
"I look at the list and ask myself the question, in which conflict is there a realistic expectation of a political solution in the next year? I do not see many," Kellenberger said. (Editing by Jonathan Lynn and Jon Hemming)
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