KABUL, Afghanistan — Growing up in a family genetically predisposed to blindness, Shah Marai developed a keen eye as a photographer.
For about 20 years, Mr. Marai, a veteran photojournalist, covered Afghanistan, his war-torn homeland, and its profound human suffering, but often with a soft touch. He rose to become the chief photographer in Kabul for Agence France-Presse, his income supporting a large family that included three blind brothers and two blind children.
On Monday, he was among a couple of dozen journalists in Kabul covering a rush-hour suicide bombing when a second attacker detonated his explosives amid reporters and first-responders. Altogether 25 people were killed, including Mr. Marai and eight other journalists.
Mr. Marai, who was 41, got his start as a photographer during the Taliban regime in the 1990s, when the practice was largely banned. He started first as a driver for A.F.P., and then slowly began to do photographic work, often in secret, when most news bureaus could not get a foothold in the country and relied on brave local residents like him.
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After the fall of the Taliban in 2001, a new wave of optimism was clear in Mr. Marai’s work, as he covered elections and the rebuilding of a ravaged country.
But following a brief period of relative calm, the war in Afghanistan has grown devastatingly violent in recent years. Mr. Marai’s work as news photographer often meant rushing to the site of the latest suicide bombing, and then following funerals and shattered families.
“There is no more hope,” he wrote in 2016, as he was arranging for his two brothers who were not blind to risk the migrant trail to Europe. “Life seems to be even more difficult than under the Taliban because of the insecurity.”
“That injury, I felt like it banished me from a relationship,” he said in an interview last week. “Like, that’s it, you’re done, you’re by yourself for the rest of your life. I struggled with even viewing myself as a man for a long time.”
But now, four weeks after the surgery, he said, “I feel whole again.”
He asked that his name not be published, because of the stigma associated with genital injuries. Except for his immediate family and a few close friends, he has told no one about the nature of his wounds, he said.
Dr. W.P. Andrew Lee, the chairman of plastic and reconstructive surgery at Johns Hopkins, said the goal of this type of transplant is “to restore a person’s sense of identity and manhood.”
For most men, that means regaining the ability to urinate while standing up and to have sex. Dr. Lee thinks transplantation can make both possible, though healing and nerve regeneration will take time. Urination is expected first, within a few months. Nerves grow from the recipient into the transplant at the rate of about an inch a month.
“We’re hopeful we can restore sexual function in terms of spontaneous erection and orgasm,” Dr. Lee said.
Although the scrotum was transplanted, the donor’s testes had been removed for ethical reasons: Keeping them might enable the recipient to father children that belonged genetically to the organ donor, something not considered acceptable by medical guidelines.
Because the recipient’s own reproductive tissue was destroyed, he will not be able to have biological children. He takes testosterone to compensate for the loss of his testes, and is being treated with another drug, Cialis, to encourage erectile function.
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How many men might need this type of transplant is not known. Data from the Defense Department show that more than 1,300 men sustained so-called genitourinary injuries in Iraq and Afghanistan, and that 31 percent of those injuries involved the penis.
About 20 percent of the penile injuries were considered severe — but how many might warrant a transplant is not clear. Women in the military have also suffered genitourinary and reproductive injuries, but they are less common.
Teams at Johns Hopkins and at the Massachusetts General Hospital are both evaluating more candidates for the surgery — some hurt in the military, others affected by accidents or illness. But it can take a long time to find a matching donor — the Johns Hopkins patient waited more than a year on the transplant list — so no rush of operations is expected.
The Department of Defense has funded some of the research, but Johns Hopkins is paying for the first operation, which Dr. Lee estimated would cost from $300,000 to $400,000. The surgeons — nine plastic and reconstructive surgeons, and two urologists — worked for free.
Dr. Lee said he hoped for grants from the Pentagon to help pay for future operations, and also for insurance coverage, which is not available now for this type of transplant.
After the explosion that injured the soldier, he remained conscious, he remembered, but knew he was sinking into shock. He passed out on the medevac helicopter. His next memory was waking up in the United States, relieved to be alive.
Soon, the gravity of the damage hit. A military doctor told him it was permanent and irreparable.
“That was crushing, but when he walked away I thought, he hasn’t been a doctor long enough, he doesn’t know what he’s talking about,” the patient said. “You got all this technology, how can you tell me this is permanent? There’s got to be something.”
He felt isolated, even in the hospital among other wounded soldiers.
“There were times you’d be hanging out and guys would be talking about getting hurt, and that’s one of the first things when they get blown up, to check down there, and they would say things like, ‘If I lost mine I’d just kill myself,’” he said. “And I’m sitting there. They didn’t know, and I know they didn’t mean any offense, but it kind of hits you in the gut.”
He struggled with thoughts of suicide, he said: “When I would actually think about killing myself, I would think, ‘Am I really just gonna kill myself over a penis?’”
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He learned to walk with prosthetic legs, left the hospital and lived on his own in an apartment. But he had trouble connecting with other people, and even when he no longer needed OxyContin for physical pain he kept taking it to numb his emotions.
He managed to wean himself off it. He saw a therapist. He earned a college degree and began making plans to attend medical school.
But relationships or even dating felt out of the question. If he got close to someone, he would have to disclose his wounds, and the thought filled him with anxiety.
“It is a lonely injury,” he said.
In 2012, he began consulting Dr. Richard J. Redett, the director of pediatric plastic and reconstructive surgery at Johns Hopkins, about a procedure to create a penis from his own tissue, possibly the skin on the inside of the forearm.
That operation makes urination possible, but requires an implant to achieve an erection. The procedure was appealing, but Dr. Redett also mentioned a future possibility that seemed much more promising: a transplant.
“Basically, if you do a transplant, you’re going to have the real thing again,” the patient said.
He decided to wait.
He passed an exhaustive screening process. Certain nerves and blood vessels have to be intact, along with the urethra, the tube that carries urine out of the body.
Candidates also have to qualify psychologically — to be able to understand the risks and benefits and stick to their anti-rejection medicine, as well as have a family or other support network.
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Families of organ donors are asked specifically for permission to use the penis, and past requests have been made for research purposes. Carisa M. Cooney, a clinical research manager in plastic and reconstructive surgery at Johns Hopkins, said that when families hear that the goal is to help wounded veterans, many consent.
In this case, the donor’s family sent the soldier a message via New England Donor Services: “We are all very proud that our loved one was able to help a young man that served this country. We are so thankful to say that our loved one would be proud and honored to know he provided such a special gift to you. As a family, we are very supportive of all the men and women who serve our country and grateful for the job you did for this nation. Please know that this is truly a heartfelt statement, as we have several veterans in the family. We hope you can return to better health very soon and we continue to wish you a speedy recovery.”
The donor was from another state, and three surgeons from Johns Hopkins — Dr. Redett, Dr. Damon Cooney and Dr. Gerald Brandacher — flew there by private jet to operate on him, an exacting procedure to remove precisely the tissue that would be needed.
They had to coordinate with teams from other institutions who were collecting other organs, and at times there were 25 people in the operating room, Dr. Brandacher said. Part of his role was to remove nine vertebrae from the donor, to provide stem cells that the Johns Hopkins team would infuse into the recipient to help prevent rejection and minimize the amount of anti-rejection medicine needed.
The patient said that before the surgery, he wondered if he would accept the new body parts, mentally and emotionally.
“What tripped me out at first is sometimes I would get a thought like, ‘Am I going to be able to see it as my own?’” he said. “That thought would creep in. But once I had it done, that’s the only way I see it. It’s mine.”
Looking ahead, he sketched out his hopes.
“Definitely, to do well in school, to go to medical school and follow my career as a doctor, find my niche in the field and just excel at it. Maybe settle down and maybe eventually find someone, and get into a relationship, maybe. Just that normal stuff.”
But many Afghan and American officials say there is often an overlap between the facilitating networks used in urban attacks claimed by the Islamic State in recent years and those used by the extreme elements of the Taliban, particularly the Haqqani Network, which had a long history of deadly urban attacks even before the rise of the Islamic State.
In the small foothold the Islamic State maintains in eastern Afghanistan, it carries out particularly barbaric acts of violence. In the Chaparhar district of Nangarhar Province, officials said three brothers were beheaded by the group late on Sunday. Their father, a medical doctor, was killed by the Islamic State last year.
As mass-casualty attacks have increased in Kabul, the country’s capital, Kabul Province has become the deadliest one for civilians, surpassing Taliban-dominated southern areas where local residents have long borne the brunt of the war, now in its 17th year. Last year, nearly 500 civilians were killed in attacks in the city and 1,350 were wounded, according to the United Nations.
While the violence has turned life in Kabul into a game of chance, more recently the odds have been worse for Shiites like Mr. Allahdad.
His home is on a busy road in a western Kabul neighborhood. Almost every street pole is adorned with a photograph of an attack victim.
“He was just a poor man’s son trying to earn bread for his children,” said his elderly father, Hussain Ali Allahdad, wiping his tears with a white kerchief.
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As visitors arrived on Monday morning to pay their respects, someone would recite another verse of the Quran before hands were raised in prayer. The father would lean back against the wall and close his eyes.
Many visitors apologized for having shown up so late, busy with other funerals and burials. One had a cousin killed in the bombing, another had a brother-in-law, a third had a neighbor.
The visitors tried to console the father by emphasizing that in the eyes of the Shiite community, his son was a martyr who had sacrificed his life for a noble cause.
“Not everyone gets the rank of martyr,” said one visitor who walked with a limp.
“Yes, he was lucky to become a martyr,” said another. “That he has left us burning here — that’s a separate issue.”
In western Kabul where many Shiites live, Mr. Allahdad had quite a presence — not only for his reputation as a wrestler, but also as the defender of an increasingly vulnerable community. Some Shiite youths have started carrying weapons at religious gatherings, no longer trusting the authorities to protect them. They looked to Mr. Allahdad as a mobilizer and a leader.
“He was my student for 20 years — he started wrestling when he was 13,” said Sher Jan Ahmadi, deputy head of the country’s wrestling federation.
Mr. Allahdad had amassed many accolades in his wrestling career, the medals hanging at his home and office. He won domestic tournaments as a teenager, and in his youth he dominated his weight class of 214 pounds. In one of the last international tournaments he took part in, held in Pakistan, he won a silver medal.
When he retired from competing after having torn a leg muscle four years ago, he could not break with the sport entirely. He started coaching a local wrestling club, with about 150 students arriving for daily training at 6 a.m. On his Facebook page, he shared a Russian meme: a babushka rushing to a wrestling mat to smack an opponent who was pinning her son down.
Mr. Allahdad also had an entrepreneurial ambition. He began with a small crockery business, then expanded to a travel agency that specialized in pilgrimages to Mecca, in Saudi Arabia, and the Shiite holy city of Karbala in southern Iraq. He awarded free trips to his best wrestling students.
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As attacks escalated against Shiite places of worship in Afghanistan, the former wrestler found a more urgent use for his strength. He became a volunteer emergency responder, often among the first at the scene.
When suicide bombers armed with rifles and grenades stormed the largest Shiite shrine in Kabul two years ago, a photographer captured an image of Mr. Allahdad carrying a wounded girl. His embroidered clothes were soaked with blood, his eyes red from tears and smoke.
When another mosque was attacked last June, cellphone video showed Mr. Allahdad rushing a bloodied middle-aged man on his shoulder to the back of a police truck. Covered in blood again, he sat on the floor and said he might have dislocated his hip. Someone bent down to help him out.
“Good?” the person asked.
“Yes, good,” said Mr. Allahdad as he got back on his feet and rushed back into the smoke coming from the mosque.
Late on Sunday evening, hundreds of mourners gathered at the walled family cemetery, where just two weeks earlier Mr. Allahdad and two dozen relatives had planted trees to welcome spring. His body was removed from an ambulance, and after a brief prayer, lowered into his grave.
Just days before he was killed, Mr. Allahdad had expressed to an older brother, Ghulam Sakhi, how tired he had been: “For three months, or six months, I just want to go somewhere where I don’t hear anything.”
MAZAR-I-SHARIF, Afghanistan — Four attacks across Afghanistan on Saturday night and Sunday killed at least 26 government security officers, while two schools were also set ablaze, according to Afghan officials.
The four attacks struck government outposts in northern and eastern Afghanistan; at least three appeared coordinated. They occurred late at night or early in the morning, with the attackers using long-range sniper rifles and night-vision equipment, according to Afghan officials, who tallied at least 10 wounded in all, along with those killed.
In separate assaults, a girls’ high school in Logar Province, near the capital, Kabul, was burned on April 11, and masked attackers struck a school in the village of Momandara, in Nangarhar Province, on Saturday night, setting archives and labs ablaze, according to education officials.
No one was reported hurt in those two attacks.
There was no immediate claim of responsibility, but government officials blamed Taliban insurgents for the attacks on the government outposts. In recent years, mainstream Taliban forces have normally refrained from attacking schools.
In the Sancharak District, in the northern Sar-i-Pul Province, which has teetered between government and Taliban control over the past year, the governor, Naqibullah Daqiq, said that two government checkpoints in the west had been attacked by Taliban fighters using night-vision equipment and sniper rifles, with one guard killed at first.
When local pro-government militiamen tried to counter the assault, they fell into a Taliban ambush, and 10 others were killed, Mr. Daqiq said.
Nematullah Tofan, the police chief of the district of Dawlat Abad, in another northern province, Faryab, said that two government checkpoints in the village of Khairabad had fallen to Taliban fighters after their snipers killed four government defenders, shooting each of them in the head.
Attacks by insurgents using sophisticated night-vision technology have risen in the past year, especially against police and militia units that do not have such equipment. Afghan officials have asked for the gear to be issued to their police officers, but American officials have been reluctant to do so for fear that it would fall into Taliban hands.
The third attack was in Ghazni Province, in southeastern Afghanistan, where two Afghan Local Police checkpoints in the district of Jaghatu were attacked at 2 a.m. Sunday, killing eight officers and wounding four others, according to Hamidullah Nawruz, a member of the Ghazni provincial council.
Afghan Local Police officers are militiamen defending their own communities; they are generally less trained and not as well equipped as the national police.
A fourth attack took place on Sunday afternoon, when three guards outside Nangarhar University in the eastern city of Jalalabad took a break for worship. Gunmen on a motorcycle opened fire on them while they were praying, killing two immediately, according to a news release from the provincial governor’s office. The third guard fled but was chased by the gunmen and killed as well, according to a witness who insisted on anonymity for fear of reprisals.
The girls’ high school in Logar Province, in a village in Mohammad Agha District, was attacked on April 11 by gunmen who beat up the night watchmen and locked them in a room, then set the school afire, according to Kabir Haqmal, a spokesman for the Ministry of Education. It was unclear why the attack had not been previously disclosed.
The school has 981 female students and 21 teachers, Mr. Haqmal said. It is in the home district of President Ashraf Ghani, 35 miles from Kabul.
In Nangarhar Province, the attack in Momandara was the third time a school in that district had been targeted in the past month, according to Mohammad Asif Shinwari, a spokesman for the provincial education ministry.
Attacks on schools by Taliban insurgents were common 10 years ago but proved so unpopular with communities that the insurgents announced that they would not be continued, even claiming to support girls’ education, although few such schools operate in areas dominated by the militants.
The offer on the table, made by President Ashraf Ghani, included recognition of the Taliban as a legitimate political party, passports for their officials, an office in Kabul or somewhere else they preferred, the release of Taliban prisoners and efforts to remove their leaders from international sanctions lists.
Just because the Taliban may be discussing the offer does not mean they’re going to take it, of course. Most of the Taliban figures reached for comment by The New York Times preferred to remain quiet, referring the queries to representatives in Qatar. Members at the office in Qatar, in return, did not respond to requests for comment.
Some Taliban figures who did speak made sure to express their old mistrust of any peace offer by the Western-backed Afghan government.
Mullah Hamidee, a Taliban military commander in the south, said: “Our stance on peace talk is totally dependent on foreign troops’ abandoning our country. Anytime they set the date for leaving, we will be willing to talk on peace.”
One senior Taliban commander, who spoke on condition of anonymity because he was talking to the news media without the leadership’s permission, insisted that the insurgents were not ready to negotiate directly with the Afghan government. The discussions underway, he said, are over what kind of negotiations might be acceptable, “but the mood of leadership is likely to not initiate peace talks with the Afghan government.”
While that is far from a rousing endorsement, it is a long way from the Taliban’s outright and fulsome dismissal of past peace initiatives, always insisting that they would talk only to the “occupiers,” meaning the American military, as long as they remained on Afghan soil.
Recently, several former officials involved in previous efforts to negotiate with the Taliban said the United States would need to play larger role as facilitator if the insurgents were to take any prospects of negotiations seriously.
One senior diplomat in Kabul, Afghanistan’s capital, said the government’s offer had been a game changer.
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“The Taliban feel a bit confused, they feel pressured,” he said. “At the Kabul conference, everybody said they should talk to the Afghan government; they are the only ones insisting they should talk to the occupiers.”
As the government of Uzbekistan convened the conference here, pressure on the Taliban came from another, unexpected quarter: the group’s own heartland.
In Lashkar Gah, the capital of Helmand Province, a major Taliban stronghold, a suicide bombing at a wrestling match Friday killed 14 people. This week hundreds of Helmand residents held a sit-in, vowing to carry out a “long march” to the Taliban-held town of Musa Qala to demand peace talks. The protesters included women, rarely seen outside their homes in that conservative corner of Afghanistan.
“The only aim of the sit-in is to stop fighting from both sides,” said one of the organizers, Iqbal Khaibar. “The Taliban should not send bombers and the government should not drop bombs on them.”
He said their march would take place without security: “This is our country and we can go anywhere in it.”
Akram Khpalwak, the head of the Afghan government’s High Peace Council secretariat, was among the optimists. “The narrative needed to change,” he said. “There was a perception that, over the years, the Taliban wanted peace but the government side did not have a clear plan for it, and was not offering a comprehensive plan. We wanted to change that perception, and make an offer that leaves few questions.”
Mr. Ghani’s offer to the Taliban came after consultations among all elements of Afghan society, Mr. Khpalwak said, including the most ardent anti-Taliban factions and the most sympathetic.
So optimistic is Mr. Ghani’s government that when the American secretary of defense, James N. Mattis, visited Kabul recently, the two men spent most of their time discussing the technical measures that would be needed to implement the government’s offers and get peace talks underway, according to Afghan officials briefed on Mr. Mattis’s visit.
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The Taliban are no longer the united force they were under their former leader, Mullah Omar, but they are also reeling from heavy battlefield losses — as is the government side. While the insurgents have continued to gain territory, no clear victory is in sight for either side.
In addition, the Pakistanis have come under heavy pressure from the United States over the issue of Taliban sanctuaries in Pakistan.
The Afghan government hoped that the Tashkent conference would help bring the Russians on board, as well, particularly with the involvement of its Central Asian allies, Uzbekistan and its neighbors. The Uzbek president, Shavkat Myrziyoyev, offered to host eventual peace talks.
But the conference convened in the midst of widespread expulsions of Russian diplomats by Western countries, and Russians were reported to be unhappy with what they see as sidelining Moscow from the peace process.
The American military has accused Russia of working behind the scenes with the Taliban. In a recent interview with the BBC, the American commander, Gen. John W. Nicholson, said the Russian “activity really picked up in the last 18 to 24 months.” He said, “Prior to that we had not seen this kind of destabilizing activity by Russia here.”
That led to a furious response from the Russian Embassy in Kabul. “Those who are really responsible for the deteriorating situation in Afghanistan are trying to put the burden of guilt for their failures on Russia and damage the Russian-Afghan relations,” the embassy said in a statement.
Despite such setbacks, Mr. Ghani’s recent offer was the most concrete sign of progress in at least the past three years.
The high point came in 2015, when the two sides actually met in person near Islamabad, Pakistan, for exploratory talks. But the next session was scuttled when it turned out that the Afghans were, in effect, negotiating with a dead man: The Taliban’s founder, Mullah Muhammad Omar, had died more than two years earlier, and the talks fell apart amid those revelations.
But even if the Taliban are willing to join the peace process, said the senior diplomat, a long process of confidence building and pre-talks lies ahead before any actual, face-to-face peace negotiations. More terrorist bombings in Kabul and other Afghan cities would put the Afghan government in a difficult position, he said.