Autore: Patrizia Fabbri

For over two decades, Afghanistan has held a grim record: most refugees registered by the United Nations came from this country, a territory squeezed between cumbersome neighbors, ecologically fragile, culturally hybrid, but perceived as stagnant.

This “record” later shifted to Syrians devastated by civil war, but Afghans never stopped emigrating, as evidenced by some 2020 reports, the UNHCR “Global Trends” report, and recent statements by UN High Commissioner for Refugees, Filippo Grandi, who stated, “The crisis of forced migrations from Afghanistan is one of the largest and most prolonged in UNHCR’s seven-decade history.” Today, about 2.7 million Afghan refugees live abroad, while another 2.6 million are internally displaced, forced to leave their homes due to insecurity, natural disasters, poverty, or choice. Afghanistan remains the second-largest source of refugees worldwide.

In 2012, a tripartite agreement between Afghanistan, Pakistan, and Iran, mediated by the United Nations, aimed to promote the voluntary return of most Afghans. Thanks to the UN, about 5.3 million people have returned since 2001. However, many remain abroad despite the “Solutions Strategy for Afghan Refugees,” the tripartite agreement. The Joint Way Forward agreement, signed between the European Union and the Kabul government in Brussels in October 2016, provides for the return—even forced—of all Afghans whose asylum requests are rejected by member countries. Europe conditioned the allocation of millions of euros in development aid on the acceptance of repatriations and found an ally in Turkey, which began mass deportations of Afghans in 2018 without seeking assistance from the International Organization for Migration.

According to a report published in November 2019 by the Afghanistan Human Rights and Democracy Organization (AHRDO), 19,390 Afghans were sent back by EU countries between 2015 and 2017, about half of them forcibly. Eurostat indicates that in 2019, 26,900 orders to leave the EU were issued to Afghan citizens. From January 1 to mid-April 2019, 4,219 Afghans were forcibly repatriated from the EU and Turkey (most—3,560—from Turkey).

Regarding the situation after the Taliban took power, the International Rescue Committee’s May 2023 report accused EU leaders of “astonishing negligence” towards Afghan refugees, many of whom remain trapped in “prison-like” conditions on Greek islands. “Afghans now represent the third-largest refugee population globally, and the resettlement needs of Afghan refugees in the EU area have rapidly increased, almost tripling year on year, from 96,000 in 2022 to over 273,000 in 2023.” In the early months, there was a strong commitment from EU countries to help at-risk Afghans access protection pathways to Europe, but today, according to IRC, these commitments “are falling short, with 271 Afghan refugees resettled in the EU last year, meeting less than 0.1% of the current need.”

However, cities in Afghanistan are also unsafe. Additionally, the institutional system is unable to meet the needs of the internally displaced, which grow annually due to climate change and cannot absorb the demographic and social pressures of those returning from abroad. In March 2020 alone, 16,000 undocumented Afghan migrants returned to the country. From January to early September 2020, over 376,000 Afghans returned from Iran and Pakistan. In a single month, from August 22 to September 21, 81,000 returned from Iran. They are part of that immense pool of informal workers who will no longer be able to support their families. The history of Afghan migrations shows that Afghans have a long history of migrations—internal, regional, transnational—that precede the conflict. Mobility has always been part of Afghanistan’s social and cultural landscape. War, insecurity, and poverty are not the only drivers of migration: war has intensified and dramatized an ongoing process.

In this already difficult context, women’s mobility has become even more restricted, especially in more conservative areas like Kandahar, Khost, and Helmand provinces, where MSF conducted interviews that testify to the extreme difficulty of movement for women and girls.

But even in Kabul, the situation is no better: some MSF workers reported that women traveling alone without a mahram (a male family member) in shared taxis are sometimes asked to sit in the back seat and cover the cost of all three seats as no one else is allowed to share the taxi with them. This adds an additional financial burden and can make a woman’s trip to a healthcare facility two or even three times more expensive than a man’s. This affects women’s ability to reach a hospital (impacting timely and adequate primary and secondary healthcare access), a workplace, or any other place. This issue, reported by MSF in 2014, has worsened since.

The ban on women and girls accessing hammams (public baths), parks, and gyms, combined with mahram and hijab policies, has created an environment where it is difficult for women and girls to leave their homes. In the words of a former student, “Women are in prison; they can’t work, study, or go out. We are depressed,” as stated in the June 2023 UN Human Rights Council report, which also notes that groups of more than three or four women are regularly dispersed by officials to prevent protests. An interviewee explained, “Even if a small group of girls sits together, the Taliban ask what they are doing.”

In June 2021, two months before the Taliban seized power and twenty years after the US-NATO occupation, the Afghan school system already faced significant challenges.

According to UNICEF, the school population comprised 6.6 million in primary school (including 2.6 million girls, about 4 out of 10) and 3.1 million in secondary school (including 1.1 million girls), while 4.2 million children, 60% of whom were girls, did not attend any school.

However, by the end of primary education, 93% of students had not achieved the minimum competency level.

This failure is linked to the ongoing war situation, poverty and hunger, lack of transportation, the risk of assaults and kidnappings during the school-home commute, early marriages, traditional roles, inadequate and often militia-occupied school buildings, rampant corruption that nullified foreign funding, and poorly trained staff: only 38% of male teachers and 34% of female teachers, who are assigned to girls’ classes, held the required degree (14th grade).

Lessons were short, and class sizes were excessive, ranging from 40 to 60 students per class.

Between 2001 and 2021, the literacy rate doubled (from 17% to nearly 30%), but remained highly uneven by gender (female illiteracy ranged between 84% and 87%) and geographical areas, with rural areas being heavily disadvantaged.

After the Taliban took power in August 2021, the gradual reopening of schools excluded girls from the 7th grade onward (age 12), leading to strong internal protests and international condemnation. Pressures from foreign donors, interested in normalizing relations with the de facto government, resulted in exemptions from some previously imposed sanctions, such as UN Security Council Resolution 2615 of December 22, 2021, supported by three US “General Licenses,” which resulted in donations for humanitarian emergencies and girls’ education: on September 13, 2021, ECW (the UN fund for educational emergencies), Italy, and the USA donated $12 million; on January 18, 2022, the European Union donated €50 million to pay teachers; on January 25, 2022, the Asian Development Bank donated $405 million for food, health, and education; on March 1, 2022, the World Bank donated $1 billion, and so on.

The pressures to limit gender oppression intensified internal conflict between government factions, with one side wanting to negotiate for funds and the other being uncompromising. Despite some provinces reopening schools to girls, in December 2022, university education was banned for them, and over 100,000 female students were expelled from studying subjects (like medicine and primary school pedagogy) where female employment is somewhat tolerated.

Meanwhile, the quality of education is utterly compromised: fundamentalist religious subjects largely replace other subjects, especially the sciences. Teachers and female students are subjected to oppressive measures that discourage school attendance.

Lastly, educational institutions are targeted by terrorist attacks mainly affecting women and girls: the attack on the Kaaj Educational Center on September 30, 2022, in Kabul, killed 54 people and injured another 114; most victims were young Hazara women and girls preparing for university entrance exams.

In 2022, 95% of the population did not have enough food to eat. It is projected that in 2023, over 3 million children and 840,000 pregnant and breastfeeding women will suffer from acute malnutrition. These figures alone suffice to imagine the health conditions of Afghans. But malnutrition is part of an extremely fragile healthcare situation, and the data is alarming:

• Tuberculosis causes about 13,000 deaths every year;
• In 2022, 78,441 cases of measles were recorded, more than double compared to 2021, with 394 deaths;
• In mid-2022, a severe cholera outbreak occurred, affecting children under 5 years in 55.4% of cases;
• 208,771 cases of Covid-19 were registered with about 8,000 deaths, numbers that the WHO considers underestimated due to limited tracking and diagnosis;
• In recent years, the Taliban have made polio vaccination impractical in every territory they occupied, putting up to three million children at risk of infection;
• Afghanistan has one of the highest infant mortality rates in the world with 638 deaths per 100,000 live births (2017 data, the latest available).

In addition to diseases, there are thousands of injuries from attacks, armed clashes, and natural disasters. The Afghan public healthcare system is underfunded, short-staffed, and dysfunctional, while the private system, due to high costs, is prohibitive for most of the population.

Until August 2021, the Sehatmandi project, funded by the World Bank, supported about two-thirds of all public facilities. With the suspension of funding, the system collapsed and healthcare workers stopped receiving salaries: “This happened,” reads the 2023 report by Doctors Without Borders, “after many had not been paid for months due to a mix of insufficient funds and poor management, including misuse of the funds themselves.”

In June 2022, UNICEF, the World Bank, and WHO agreed on a $333 million funding for the provision of emergency health services, but concerns about the management of these funds remain.

In fact, humanitarian organizations like Doctors Without Borders, the International Red Cross, Emergency, and UN agencies have been replacing the public healthcare system for years.

The chronic shortage of qualified healthcare personnel worsened after the Taliban’s return due to restrictions imposed on women, whose presence among healthcare workers was very high. For the same reason, most entities supporting people with disabilities have closed or reduced their services.

While it is very complex and costly for all Afghans living in rural areas to reach healthcare facilities, for women, due to movement restrictions, it has become an almost impossible task. Consequently, the health of women and children is further compromised.

As reported in the June 2023 Human Rights Council report, women routinely give birth without professional assistance or incur significant debts to give birth in private healthcare facilities. Women attempting to enter pharmacies alone have been denied access.

Another scourge is mental distress: contrary to Taliban claims that suicides have decreased and mental health has improved since August 2021, reports of depression and suicide are widespread, especially among adolescent girls prevented from continuing their studies.

But another grave abuse against women is occurring, as noted in the UN High Commissioner for Human Rights’ annual report: officials from the Ministry for the Promotion of Virtue and Prevention of Vice conduct inspections at medical facilities to ensure male doctors are not treating women. This ban equates to a death sentence given the obstacles to the work of female doctors, whose numbers will further decrease due to the ban on women accessing universities.