The Health Crisis of the Taliban's Afghanistan (29 Nov 2023)

In late summer of 2021, all remaining coalition forces departed Afghan soil as the Taliban militant group seized control of the nation, capturing the capital of Kabul. Coalition forces seemingly took with them the lifeblood of the country’s public health system; following the Taliban’s seizure of power, the nation’s public health system collapsed. Healthcare has never been the Taliban's main concern; during their first rule from 1996-2001, they banned women from all 22 hospitals in Kabul, resulting in Afghanistan becoming the world leader in maternal mortality (Bajaj). However, the collapse the nation is facing is a result of much more than the dearth of prioritization of healthcare. In this essay, I will explore how the health crisis in Afghanistan is composed of three primary and compounding intersectional injustices. These injustices include the removal of Western aid, the rise of institutionalized sexism, and natural disasters, each making the issue worse. First, I’ll break down each of the three contributing factors. Then, I’ll propose a possible multi-sectoral approach that addresses these various injustices to rebuild the nation’s healthcare system.

The Taliban’s takeover was swift and messy. Forces of America and her allies had little time to prepare the country for the impending regime change, as the coalition was focused primarily on the removal of all personnel and as many assets as possible. The sudden departure of these allies caused drastic consequences for their host nation. 124,000 civilian contractors supporting infrastructure were evacuated in a matter of days, many of whom were healthcare providers (Anwari). The departing Western countries were more focused on evacuation and suspension of aid than humanitarian support to the desert country (Bajaj): for example, the US “suspended its recognition of Afghanistan's Central Bank, cutting off the country's economy from the world and severely hampering the payment of life-saving assistance and the salaries of millions of essential workers, including health workers and teachers” (Cousins). Suspension of foreign aid during evacuation proceedings presented the potential that up to one million Afghan children might die of starvation, as the aid propped up food, water, electricity, and medical care; roughly 90% of Afghan health facilities were at risk of shutting down due to lack of foreign funding (Bajaj). I argue that the United States and its Western allies have an obligation to the nation, despite its new leadership. The rapid removal of civilian contractors and foreign funding is particularly devastating as the country’s infrastructure was built upon this aid. To withdraw rapidly and leave the task of governance in the hands of a militant group is to doom the country the United States has spent twenty years supporting. It’s not the Taliban, whom the US seeks to punish, that suffer the most, either; rather it is the civil population of Afghanistan whose way of life that has been built over the last twenty years was suddenly uprooted. While continued support from Western countries may run the risk of sanctioning a government that violently overthrew its host country, the situation is dire enough to warrant that continued support. Up to half of the country is in humanitarian need (Bajaj). When the United States occupied Afghanistan, women were allowed to attend secondary school; it was something the West saw as a necessary rule to implement. The Taliban, however, do not see it that way.

Sharia Law is a system of law modeled after the teachings of Islam. In their desire to establish Sharia Law in the country, the Taliban have taken to legislating institutionalized sexism in Afghanistan. Women have been disproportionately impacted by the collapse of the nation's healthcare system. 95% of Afghan households are not getting enough food, and that number rises to 100% in households headed by women (Cousins). The implications of the new regime’s attitude towards women even delves into household life; there’s no protection or shelter or support services for women experiencing gender-based violence in the country anymore; with the withdrawal of coalition forces and establishment of the new government, all programs that supported women evaporated overnight (Cousins). Women now also fear seeking aid due to the Taliban’s presence, this coming about as maternal mortality rises drastically following the regime change (Glass). Women’s movements are restricted without Mahram, meaning it is difficult for single women or women without a husband to even leave the house (Anwari). Not only is their struggle compounded, but their struggle in and of itself causes the healthcare system to suffer.

On March 23rd 2022, the Taliban stripped young women of their right to secondary schooling (Cousins). This means that women who could have become nurses or contributed to the economy to decrease the rate of starvation will never get the opportunity to do so, worsening the crisis. Many women who might choose a career in health ended up fleeing the country so that they may be able to pursue secondary education (Nguyen). Thus, not only does institutionalized sexism pose a short-run issue that threatens the country’s birth rate and its female population, but it also threatens the long-run outlook on the nation’s public health system.

Environmental disasters have taken their toll on the desert country, compounding the crisis at hand. The country’s worst drought in thirty years occurred in 2022 (Cousins), negatively impacting the season’s harvest. Acute food insecurity is exacerbated by this struggle, but that’s not the only environmental factor at play. Earthquakes, flash floods, heavy rain, and landslides have ravaged the country’s landscape (particularly in the southeastern provinces), leaving thousands dead or injured, with the total damage impacting hundreds of thousands of people (Nguyen). The environmental events on their own are not necessarily injustices. However, people in Afghanistan are disproportionately vulnerable to the aftermath of these events because of the other injustices occurring in the country. Alongside the US withdrawal, western aid abandoned the Afghan people, leaving them to deal with these issues in the hands of a government already incompetent to rule a country with no natural disasters. Some issues in the nation cannot be rectified easily, such as natural disasters; but I believe that several injustices, such as institutionalized sexism and foreign aid, can and should be addressed and fixed so that the country may heal.

A multi-sectoral approach is required to attack a larger problem composed of multiple intersecting issues, which we see in the case of Afghanistan. The magnitude of the collapse is due to the compounding effect these issues have upon one another. The first step should be to reinitiate foreign aid into the country. I believe it is the moral obligation of Western forces which once occupied the country to see that they take care of the nation during the ongoing transitory period. As I previously stated, the West’s sanctions against the Taliban (through mechanisms like un-recognizing the central bank) have severe ramifications on the civilian population. To establish an administrative framework and infrastructure that leaves a population dependent upon a foreign entity for its survival, only to remove that foreign entity and thus collapse the framework that the people depend upon and provide them no aid for the transitory period is a gross injustice. This is not the first time this sort of collapse has happened in Afghanistan, in which a “facade of stability can be built over decades but collapse within days” (Bajaj). What the authors of this article recommend is a plan for more durable foreign investments into the country, allowing funds to create a foundation for the country to combat acute malnutrition and inaccessible healthcare. 80% of the nation’s GDP came from foreign aid during the Western occupation, so to maintain a functioning government, the Taliban will need to turn to the international community. In doing so, the international community may be able to leverage this need for some political say in the country.

Foreign political actors could then petition for women’s rights in Afghanistan. Allowing women to return to secondary schooling would immediately improve the country’s GDP, and enable women to work in industries crucial to the survival of the country’s population (like healthcare). Before the Taliban’s takeover there was already a shortage of female healthcare workers, a shortage which deepened following their rise to power. UNICEF estimates that the yearly short-run loss of excluding women from secondary education is $500m, and if the current cohort of Afghan women were allowed to complete secondary education, $5.4bn would be added to the Afghan economy, equivalent to roughly a third of the country’s current GDP (Anwari). These changes to the economy could greatly reduce the ongoing health crisis in the country by providing the required funds for healthcare and funds for food.

Thus, Afghanistan’s public health crisis has brought misery to millions. The collapse of the economy, natural disasters, institutionalized sexism, and the withdrawal of foreign aid have all built upon one another to build an intersectional monster of a crisis. A solution to the problem comes in the form of multiple solutions to multiple sub-problems; primarily, the issue of economic collapse in the face of the loss of foreign aid, alongside the issue of institutionalized sexism in the country. With the attention and support of the international community, Afghanistan can set up the public health framework it needs to sustain life long-term under its new government.

Works Cited

Jain, Bhav, et al. “Global Health Responsibilities in a Taliban-Led Afghanistan.” Nature News, Nature Publishing Group, 8 Nov. 2021, www.nature.com/articles/s41591-021-01547-8. 

Anwari, Palwasha. “Afghanistan’s Health System under the Taliban: Key Challenges.” The Lancet, 23 Sept. 2022, www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01806-2/fulltext. 

Cousins, Sophie. “Afghanistan’s Health Crisis Deepens under the Taliban.” The Lancet, 2 Apr. 2022, www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00609-2/fulltext. 

Glass, Nancy. “The Crisis of Maternal and Child Health in Afghanistan.” The Lancet, 2 Nov. 2022, www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02170-5/fulltext. 

Tao, Ngoc Phuong Hong, et al. “Healthcare Collapse in Afghanistan Due to Political Crises, Natural Catastrophes, and Dearth of International Aid Post-COVID.” Journal of Global Health, U.S. National Library of Medicine, 11 Jan. 2023, www.ncbi.nlm.nih.gov/pmc/articles/PMC9830451/.