Recently WHO completed a high-level mission to Kabul, Afghanistan, where they met with senior members of the Taliban leadership, UN partners, health care workers, and patients, and WHO staff.
According to WHO, Afghanistan’s health system is on the brink of collapse. Unless urgent action is taken, the country faces an imminent humanitarian catastrophe. The WHO visit allowed the delegation to witness the immediate needs of the Afghan people firsthand and meet with stakeholders to define ways to urgently scale up our health response.
Acting on the UN principles of neutrality and independence, the Taliban government should engage in constructive dialogue to address differences and find solutions that will allow them to continue WHO’s life-saving work for millions of innocent Afghans affected by decades of conflict.
Taliban must focus on a number of priority health issues that need immediate attention, as well as the need to invest in achieving longer-term development goals.
Cuts in donor support to the country’s largest health project, Sehetmandi, has left thousands of health facilities without funding for medical supplies and salaries for health staff. Many of these facilities have now reduced operations or shut down, forcing health providers to make hard decisions on who to save and who to let die.
Only 17% of all Sehatmandi health facilities are now fully functional. This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts.
Nine of 37 COVID-19 hospitals have already closed, and all aspects of the COVID-19 response have dropped, including surveillance, testing, and vaccination. Prior to August this year, 2.2 million people had been vaccinated against COVID-19. In recent weeks, vaccination rates have decreased rapidly while 1.8 million COVID-19 vaccine doses in the country remain unused. Swift action is needed to use these doses in the coming weeks and work towards reaching the goal of vaccinating at least 20% of the population by the end of the year based on national targets.
Afghanistan is one of two countries in the world where polio remains endemic. With only one case of wild poliovirus reported so far this year, compared to 56 in 2020, there has never been a better time to eradicate polio. However, the polio program will struggle to respond if the basic immunization infrastructure begins to collapse around it. Measles outbreaks are also spreading. With access to all communities no longer impeded, the Taliban government can cooperate with WHO and partners which are ready to begin a country-wide house-to-house polio vaccination campaign and include measles and COVID vaccination in an integrated campaign.
Taliban government should particularly emphasize the need for women to maintain access to education, health care, and to the health workforce. With fewer health facilities operational and fewer female health workers reporting to work, female patients are hesitant to seek care. The IEA Taliban lead government must be committed to working with partners to invest in the health education of girls and women, as well as continue training female health workers.
In the years after the US-led military invasion and the defeat of the Taliban government in late 2001, the Afghan government and international donors gave priority to developing an effective health system, including extending access to basic health care to all parts of the country. The effort led to important achievements, including significant declines in maternal mortality, and increases in provision of prenatal care, use of modern contraception, and attended births.
But even with two decades of effort and the expenditure of hundreds of millions of dollars, the delivery of health services for women remains far below international standards, and the progress that has been achieved is being eroded in important ways.
Currently, women and girls struggle to access even the most basic information about health and family planning. There is an unmet need for modern forms of contraception; prenatal and postnatal care is often unavailable; specialty care, such as modern cancer and fertility treatment, is largely nonexistent; routine preventative care such as pap smears and mammograms are almost unheard of, and a large proportion of births are still unattended by a professional.
Health facilities often lack sufficient staffing and essential supplies and equipment. Afghanistan has 4.6 medical doctors, nurses, and midwives per 10,000 people, far below the threshold for a critical shortage of 23 healthcare professionals per 10,000 people as defined by the World Health Organization. Women often struggle to access care due to costs, including transportation to a health facility, and for medications and supplies for which patients are obliged to pay.
When they can obtain care, it is often of poor quality. Distance remains a problem for a significant proportion of the population; almost 10 percent of people cannot reach a health facility within 2 hours and 43 percent must travel more than half an hour. Lack of access to adequate care drives Afghans to spend US$285 million a year on medical tourism, mostly to Pakistan and India, draining funds from the health sector. Progress on some key indicators, such as accessing prenatal care and skilled birth attendance, is now stagnating or even reversing. Corruption at all levels threatens the delivery of health services and demands for bribes drive people away from seeking care.
As per the survey done by Human Rights Watch, it emerged that the healthcare system is increasingly unaffordable to the estimated 61 to 72 percent of Afghan women who live in poverty, and one in which women often have more children than they want because of lack of access to modern contraception; face risky pregnancies because of lack of care, and undergo procedures that could be done more safely with access to and capacity to use more modern techniques.
It is crucial that donors prioritize meeting the urgent needs of Afghans—including those of women and girls for health care. The US along with other world powers should assess the need for aid and their commitment to providing it separately from their humiliating decision to withdraw their forces. They should fully appreciate the depth and urgency of the needs in Afghanistan, and not use political and security developments to justify disengaging when the need for international assistance is greater than ever.
AISSC would like to place recommendations as made by Human Rights Watch in its report to the Taliban lead Government of Islamic Emirate of Afghanistan.
- Continue prioritizing support and reform of the health system and include a strong focus on women’s health.
- Increase monitoring and strengthen accountability measures, such as complaint mechanisms to reduce and end corruption in the health sector.
- Develop and implement a plan to provide comprehensive sexuality education to all Afghans, including women and girls, and people who do not attend formal education.
- Expand access to psychosocial support and mental health services, including a focus on providing these services, in a gender-sensitive manner, to women and girls.
- End the requirement that a husband must consent to his wife accessing contraception.
- Track the provision of health services in provinces and districts, including: the number of health facilities closed, the reasons for closure, the number of health facilities operating, the number and gender of staff in different roles present in those facilities, the number and gender of patients seen in those facilities, and services provided, and regularly publish this data.
- Support provision of health services and reform of the health system and respect the right of everyone, including all women and girls, to have full access to all health services.
- Permit and facilitate education for girls and women to ensure literacy about family planning and health, and support training future female health workers.
- Do not threaten, attack, or extort resources from health workers or facilities.
- Permit comprehensive sexuality education and full access to modern contraception.
Written by Hon’ Executive Board Member of AISSC – Syed Shah Fahad Hussain
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