Before the Taliban retook control of Afghanistan in August 2021 following the U.S. withdrawal, many women and girls, especially those not in more urban centers like Kabul, Kandahar, and Herat, were already struggling to receive proper medical care. Prior to the withdrawal of foreign forces, there was an unmet need for modern forms of contraception, prenatal and postnatal care, preventative reproductive care and monitoring such as pap smears and mammograms, as well as cancer treatment and more specialized surgeries involving amputation or the removal of tumors, etc. Hospitals and medical facilities also often lacked staffing, essential supplies, and the proper procedures and protocols for triage and associated coordination. Unmitigated outbreaks of polio, measles, malaria, dengue fever, cholera, and COVID-19 further strained Afghanistan’s struggling and overloaded healthcare system. This situation has deteriorated rapidly in the past year and a half.
Shortly after the U.S. withdrawal, only 17% of healthcare facilities there, supported in part by the World Bank, were fully functional. The Taliban regime has cracked down on women’s rights, and the restrictions placed on women and girls that render them second class citizens at best and chattel property at worse have also severely impacted their ability to seek and obtain medical care.
The Taliban have essentially forbidden women to work outside the home, which means that female doctors and surgeons cannot practice and cannot treat patients except in underground environments, which are rare and fraught with concern over discovery by the Taliban, surely leading to the arrest and torture of those involved.
Women in the Taliban-controlled Afghanistan cannot freely travel outside the home without a male guardian, which further reduces access to care in a patriarchal, religious, and insular culture that already frowns on contraception and other aspects of female healthcare. Women are ordered to over their faces in public, which further chills travel for women.
Additionally, 10% of the population must travel more than 2 hours to reach a medical facility, and nearly half must travel more than 30 minutes, which further restricts access to care. There have also been many cases of the Taliban preventing doctors from treating women if there was not a male guardian present, as confidentiality surrounding female medical care is not honored or considered. Many male patients stopped seeing female doctors as well, due to fear of retaliation from the Taliban. There are many reports of women, even in urban centers, not being permitted to see a doctor unless that doctor is a woman. But with women doctors not allowed to practice, what this functionally means is that Afghan women and girls are cut off from receiving medical care.
In addition to barriers created by the Taliban, cultural stigmas also thwart access to care. Families often prefer women see female doctors rather than male doctors, and Afghan women are unlikely to prevail against a male guardian who states this must be so.
A persistent problem in Afghanistan that makes these barriers to care that effectively preclude care in many circumstances is forced marriage, often with young girls. Child marriage, in particular, is closely linked to early pregnancies and pregnancies in quick succession, often in a body that is not yet mature or developed enough to easily sustain that pregnancy. Early and closely spaced pregnancies can often carry the risk of death for the mother and the child. Even in situations where a woman is of age to bear children, if she experiences contractions or bleeding when a male family member is not home, she cannot easily obtain care. Home births and miscarriages can be very traumatic and dangerous, sometimes fatal, even if the expectant mothers are of age.
Closely related to medical care is mental healthcare and domestic abuse. After coming into power, the Taliban closed shelters that had helped women in violent marriages. Many of these women were severely depressed and suicidal. As a result of this widespread closure, Afghanistan saw an increase in suicides by women, often by self-immolation or the consumption of bleach. In cases where those attempts were not successful, those women required medical care that they could not easily access, often would not have the blessing and accompaniment of the male guardian that likely abused them, and that they perhaps would not have needed to access if shelters and mental health agencies remained open.
While the Taliban claim that they now urge women in healthcare to return to work, and have even boasted of training women doctors to be able to see female patients, this has not had a measurable impact on Afghan women’s ability to access care, and the veracity of such claims should be doubted. Many female professionals, including those in healthcare, have fled the country or are too afraid of retaliation and harassment by the Taliban to ever return. Many such professional women no longer enjoy the support of their husbands or male guardians to return to work, so they cannot.
Still, some female medical practitioners remain under the auspices of Doctors without Borders, but they are nowhere near enough in number to adequately meet the country’s needs. In the hospitals where they do work, men generally are not allowed inside. Other women doctors, nurses, and healthcare staff work covertly in underground operations, but the dangers associated with that choice serve as a deterrent to many. Furthermore, unlike previous years, there is no graduating class of nurses, midwives, doctors, or surgeons anymore, nor are there any classes of women entering training programs. This is certain to have long-reaching ramifications for many years to come, and women and girls will die as a result.
Prior to the fall of Afghanistan to the Taliban, foreign aid funded much of the country’s public sector, with $600 million in healthcare funding coming from the World Bank and other international bodies. Afterward, however, sanctions imposed against the Taliban froze much of this financial assistance. The resulting economic instability also meant a lot of Afghans could no longer afford food, heat, and their homes, much less medical care. The United Nations did secure $45 million in funds in 2021 that bypassed Taliban control and went to NGOs in Afghanistan to help with funding clinics and health centers through the end of 2021. Additional money is expected to be contributed by the World Bank as well, but this renders Afghanistan’s healthcare system totally dependent on foreign aid, which is not sustainable and will continue to result in preventable deaths, especially for women and girls.