What’s the Status of Healthcare for Women in Afghanistan Under the Taliban?

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A still image from the August 2022 FRONTLINE documentary "Afghanistan Undercover," investigating he Taliban's crackdown on women.

A still image from the August 2022 FRONTLINE documentary "Afghanistan Undercover," investigating he Taliban's crackdown on women.

August 9, 2022

Before the Taliban took control of Afghanistan in August 2021, many women and girls were already struggling to receive adequate healthcare.

A May 2021 Human Rights Watch report found that, after two decades of conflict in Afghanistan, there was an “an unmet need” for modern forms of contraception; that prenatal and postnatal care, as well as cancer treatment, pap smears and mammograms, were often unavailable or nonexistent; and that medical facilities often lacked staffing and essential supplies. Epidemics of polio, measles, malaria, dengue, cholera and COVID-19 had further strained the country’s healthcare system.

The situation has worsened under the Taliban. By September of last year, only 17% of Afghanistan’s healthcare facilities supported in part by the World Bank were fully functional, according to the World Health Organization. And as Ramita Navai investigated in the new FRONTLINE documentary Afghanistan Undercover, the regime has cracked down on women’s rights, with accounts of women being arrested and detained for leaving home without a male guardian. Some experts told FRONTLINE the Taliban’s restrictions have also impacted women and girls’ ability to seek medical care.

“It’s an absolute cataclysm,” said Heather Barr, associate director of women’s rights at Human Rights Watch and author of the organization’s 2021 report.

Here’s a closer look at the current status of healthcare for women and girls in Afghanistan.

What barriers to healthcare do Afghan women face now?

In a report released at the end of July, Amnesty International scrutinized the treatment of women and girls under the Taliban’s regime, from ability to work and travel outside the home to domestic violence to forced marriage. Nicolette Waldman, co-author of the report and a researcher with the crisis response program at Amnesty International, said these infringements complicate access to healthcare.

“It just turns healthcare into kind of an obstacle course that’s just not worth the risk for many women and girls,” Waldman said.

For example, a Taliban mandate announced in December 2021 said women weren’t allowed to travel more than 45 miles without a male relative to escort them, according to Al Jazeera. HRW previously found that nearly 10% of the population had to travel more than two hours to reach a medical facility, and nearly half had to travel more than 30 minutes. That could mean women without a male guardian, or mahram, might not be able to visit a healthcare professional. Some news outlets have reported on Taliban officials preventing doctors from treating women without a mahram. And even women who have a mahram may not feel comfortable discussing certain needs, such as reproductive care, in front of the guardian, Barr said.

“What if you’re going to have an abortion or an STD examination? Or you’re going because of some issue you don’t want to discuss in front of your male family member?” asked Barr. “It’s a massive disincentive to go and seek healthcare.”

A subsequent Taliban decree in May 2022 ordering all women to cover their faces in public also suggested women avoid leaving their homes unless necessary. Waldman said confusion over what constitutes “necessary” has led to fear of punishment among women. Barr said she’s also heard reports of women only being allowed to receive care from female healthcare providers.

“All of these things together just begin to add up to a situation where there’s very little healthcare available for them,” Barr said.

Alaa AbouZeid, who leads the emergencies team for the World Health Organization’s Afghanistan office, said cultural barriers are a bigger obstacle for women in receiving healthcare than Taliban decrees and that families may prefer women see female doctors rather than male doctors. While he had heard of one hospital that wouldn’t see female patients without a mahram, he attributed that to a local decision rather than a Taliban rule.

“Being a female in Afghanistan is not easy,” AbouZeid said. “It’s because of cultural issues in Afghanistan that limits the movement of women and girls, and sometimes make it difficult for them to access basic services, including health services.”

Barr and Waldman said that while there are pre-existing barriers for women in Afghanistan, restrictions on their movement have gotten worse under the Taliban’s rule, which can affect their ability to access or work in healthcare.

“There are just so many more barriers now in place for women and girls’ access to health that … are cascading from the many restrictions, in general, on their movement,” Waldman said.

According to the Amnesty report, another factor limiting access to healthcare for women, especially reproductive services, is forced marriage — reports of which Navai investigated between Taliban fighters and young girls in Afghanistan’s Badakhshan province. HRW found that child marriage, in particular, is linked to early and closely spaced pregnancies, which can carry the risk of death for the mother and child.

When Navai asked Bilal Karimi, a Taliban deputy government spokesperson, about reports of forced marriage in Afghanistan Undercover, he said, “We tell everyone that you must follow Islamic standards,” and, “We will never allow our people to commit such indecent acts.”

“Other countries should not impose on us what is good for them,” he said. “We have our own culture, interests and values.”

Gala Melgar, a gynecologist working with Doctors Without Borders in Khost, Afghanistan.
Gala Melgar, a gynecologist with Doctors Without Borders in Khost, Afghanistan. (Sarah Laevens)

What’s it like to give birth in Afghanistan today? A doctor shares her observations.

Gala Melgar is a gynecologist in Khost, a provincial capital southeast of Kabul, near the Pakistan border, at a maternity hospital run by the international aid group Doctors Without Borders (also known as Médecins Sans Frontières or MSF). Originally from Spain, Melgar has been working in Afghanistan since May. She said her hospital currently handles around 1,650 complicated deliveries per month, or about 50 a day — cases involving expectant mothers with high blood pressure or who are diabetic, for example.

After the Taliban took control of the government last year, the hospital opened its admissions to women who were having normal vaginal deliveries, because other facilities in the area weren’t able to accept all of the patients. At that point, hospital staff were seeing about 2,000 deliveries a month, Melgar said.

Some of her patients can’t afford transportation to the hospital, and Melgar said she once treated a patient who had walked seven hours to receive care. Treatment also can be delayed if a male guardian isn’t available to accompany a woman to the doctor.

“It can happen that there’s a woman pregnant in the house, and she starts bleeding or she starts being in labor, and if the husband is not around, then she cannot go out of the house — even if she wants to go for medical advice or even if she thinks that her life is threatened by a medical situation,” Melgar said.

Have medical professionals treated women who have attempted suicide under the new regime?

 In Afghanistan Undercover, Navai visited Herat Regional Hospital, in the nation’s third-largest city, and learned doctors there were treating women who had attempted suicide. After coming to power, the Taliban had closed shelters that had helped women in violent marriages, Navai found.

Shahnaz Pirouz, a plastic surgeon in the hospital’s burn unit, had seen numerous self-immolation cases. Navai spoke with one woman, Nuria, who was being treated at the hospital after drinking bleach.

“I drank it because he beat me,” Nuria said in the documentary about her husband. “I can’t bear this pain anymore.”

Nuria’s mother said she knew of five or six other women in their village who also recently tried to kill themselves.

The administration of Herat Regional Hospital said off-camera that while the hospital has seen suicide cases, those numbers have decreased under the Taliban’s leadership. But several doctors told Navai hospital records were inaccurate. One doctor, speaking on the condition of anonymity out of concern for her safety, said cases involving domestic violence or forced marriage linked to the Taliban aren’t registered and could number as many as 30 to 50 in that hospital alone since the regime took power.

Can Afghan women still work in healthcare?

After initially discouraging women from working, the Taliban urged women in healthcare to come back to work in August 2021, less than two weeks after taking control of the government and amid a wave of professionals fleeing the country, according to Reuters.

“The Ministry of Public Health of the Islamic Emirate advises all women employees in the centre and provinces that they should attend work regularly,” read a statement from spokesperson Zabihullah Mujahid. “They will face no impediment to performing their duties from the Islamic Emirate.”

Barr said the Taliban has allowed women to hold jobs that men can’t perform, such as certain healthcare positions. But Barr has heard reports of women who said they haven’t returned to work because they were afraid of retaliation or harassment from Taliban officials.

Barr also said many healthcare professionals have left Afghanistan out of fear for their safety, among other reasons.

Because information about Afghanistan is limited under Taliban rule, it’s not clear how many women currently are working in medicine across the country.

According to Doctors Without Borders, about 450 staff, more than half of whom are women, work with Melgar at the hospital in Khost. Men generally aren’t allowed inside, but if they do enter the facility, everyone has to abide by gender-segregation rules, Melgar said.

Even before the Taliban took control of Afghanistan, the country was experiencing a widespread shortage of medical professionals, according to WHO. The country had 4.6 medical doctors, nurses and midwives per 10,000 people, which is below the threshold for critical shortage of 23 professionals per 10,000 people, according to a WHO study from 2018. Barr pointed out that the Taliban’s restrictions on education for women and girls have already started to affect the country’s supply of healthcare professionals.

“You would’ve expected to have a class of nurses and midwives and doctors graduating every year, including women,” Barr said. “There’s no class of women graduating from high school this year; there’s no class of women entering training programs.”

Has the Taliban put restrictions on women who work in medicine?

Interpretation of Taliban rules regarding women working in healthcare may vary by region or medical facility, Barr said. Taliban suggestions like the one from May, that women avoid leaving their homes if possible, can lead to uncertainty among hospital administrators, as well as among the general public.

The mahram mandate can make it difficult or even impossible for women to travel to and from work, Waldman said. Although Mujahid of the Taliban previously said the mahram mandate wouldn’t apply to daily activities, such as traveling to work or school, some women told Amnesty International they were stopped and questioned by Taliban officials while traveling shorter distances without a mahram.

Some women who have continued working in healthcare told Amnesty International they were ordered to stop treating male patients. One dentist said her male patients stopped seeing her because they were afraid of facing repercussions from the Taliban. And a nurse at a government hospital in Kabul said Taliban officials who regularly visited her workplace harassed her when they saw her wearing her uniform.

“Then one day they said I should not wear my uniform,” the nurse said, according to the Amnesty International report. “I said I respect my uniform, because I worked so hard to get it, and they had no right to tell me what to wear. … One of them slapped me in the face, and another pointed his gun at me, and said they could kill me, and I wouldn’t be able to do anything.”

The nurse participated in a protest against the Taliban following the incident. She was fired from her job a few days later, she said.

How is Afghanistan’s healthcare system currently funded?

Before the Taliban took control of Afghanistan, foreign aid funded a large portion of the country’s public sector, with $600 million in healthcare funding coming from the World Bank and other international bodies. But after the Taliban came to power in August 2021, sanctions imposed against the Taliban froze much of this financial assistance.

The resulting nationwide economic instability also impacted household finances, with many people in Afghanistan unable to afford medical care, Barr and Waldman told FRONTLINE.

In September 2021, the United Nations released $45 million in emergency funds that detoured Taliban control and instead went directly to nongovernmental organizations working in Afghanistan, NPR reported. That money helped fund clinics and health centers across the country through the end of 2021, according to the United Nations Office for the Coordination of Humanitarian Affairs. Since then, other organizations have stepped up, including the World Bank, which in June announced a plan to contribute about $330 million toward essential health services.

AbouZeid called Afghanistan’s healthcare system “totally dependent on foreign aid” and said there wasn’t enough funding to deal with unusual crises, such as the June earthquake that killed about 1,000 people.

“This system has been dependent on donors for 15, 20 years,” AbouZeid said. “When Taliban entered and donors stopped the funding, the whole system collapsed. And this should not be the case with a proper, sustainable health system.”


Chantelle Lee

Chantelle Lee, Tow Journalism Fellow, FRONTLINE/Columbia Journalism School Fellowship

Twitter:

@chantellehlee

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