In the stark, rugged landscape of Afghanistan, where conflict and crisis have been a relentless tide, the public health system represents a critical lifeline for millions. It is a story of profound vulnerability and astonishing resilience, a sector perpetually caught between devastating collapse and fragile, hard-won progress. The updates from Afghanistan’s health sector are not just medical bulletins; they are a barometer of the nation’s stability and a testament to the humanitarian workers who operate within an incredibly complex environment.
For decades, the system has been heavily reliant on international aid, which funded everything from doctors’ salaries to essential medicines. The political transition of August 2021 triggered an immediate and catastrophic shock to this aid-dependent infrastructure. Overnight, billions of dollars in development assistance were frozen, and the World Bank and other major donors paused their funding. The Sehatmandi project, which was the backbone of primary healthcare—supporting over 2,300 health facilities and providing care for millions of Afghans—faced imminent collapse.
In the months that followed, a desperate humanitarian effort, led by agencies like the World Health Organization (WHO) and UNICEF, managed to secure stopgap funding to prevent a total implosion. Salaries for health workers were paid, essential drug supplies were maintained, and clinics remained open—but on life support. This emergency intervention averted the worst-case scenario of complete systemic failure, but it also highlighted the system’s extreme precarity. The health system today exists in a state of managed crisis, sustained almost entirely by temporary humanitarian grants rather than sustainable development investment.
Critical Updates and Current Realities
- The Funding Paradigm Shift: The most significant update is the fundamental shift from development aid to humanitarian funding. Long-term investments in system strengthening, health workforce training, and infrastructure have largely been replaced by short-term, emergency-focused grants. This creates immense uncertainty. Health facilities can operate month-to-month, but planning for the future—procuring advanced equipment, launching new public health campaigns, or expanding coverage—is nearly impossible. Donor conferences pledge essential funds, but these are often a fraction of what is needed and come with stringent reporting requirements that are difficult to meet under the current governance structures.
- The Female Health Worker Crisis: Perhaps the most damaging blow to the system has been the restrictions on female education and employment. The December 2022 edict banning Afghan women from working for national and international NGOs was later partially walked back for the health sector following urgent negotiations. However, the environment remains restrictive and fraught with challenges.
The critical role of female health workers cannot be overstated. They are the only providers who can culturally access and treat half the population—women and girls. Without them, pre- and post-natal care, maternal health, family planning, and the treatment of women and children grind to a halt. While many female health staff continue to work bravely, their movement is often hampered, and their morale is low. The ban on girls’ education beyond the sixth grade also decimates the future pipeline of nurses, midwives, and female doctors, creating a time bomb for the health sector’s future capacity. - Resurgence of Disease and Malnutrition: The weakened system is battling a rise in preventable diseases. Economic collapse and widespread malnutrition have lowered immunity, creating fertile ground for outbreaks.
- Malnutrition: An estimated 3.4 million children and pregnant or breastfeeding women suffer from acute malnutrition, weakening their bodies and making them susceptible to other illnesses.
- Infectious Diseases: There have been significant outbreaks of measles, cholera, and dengue fever. The re-emergence of polio, once on the brink of eradication, is a major setback. Inaccessible areas and vaccine hesitancy continue to hinder eradication campaigns.
- Mental Health: The psychological scars of generations of war, displacement, and economic despair are profound. Mental health services are desperately needed but remain severely under-resourced and stigmatized.
- Successes Amidst the Struggle: Despite the overwhelming challenges, there are updates that speak to the resilience of the health workforce and the effectiveness of targeted aid.
- Continued Vaccination Campaigns: Through immense effort, partners like WHO and UNICEF have continued nationwide polio and measles vaccination campaigns, often negotiating access at the local level to reach millions of children.
- Maintaining Basic Service Delivery: The fact that most primary health care clinics and hospitals are still functioning is a monumental achievement. Millions of consultations, births, and vaccinations are still conducted each month, a credit to the dedication of Afghan health workers who continue to serve their communities despite often not receiving regular pay.
- Disease Surveillance: Systems for detecting and responding to disease outbreaks have been maintained, allowing for rapid response to threats like the cholera outbreaks in 2023.
The Road Ahead: Challenges and Imperatives
The future of Afghanistan’s health system hangs in a delicate balance. Several critical issues will determine its trajectory:
- Sustainable Financing: The current model of emergency humanitarian funding is not sustainable. The international community must find innovative ways to channel resources directly to the health system to ensure the long-term payment of salaries, maintenance of facilities, and procurement of supplies. This requires difficult political negotiations and robust third-party monitoring mechanisms to ensure funds are used appropriately.
- Protecting Women’s Role in Healthcare: The full and free participation of women in every aspect of the health workforce is non-negotiable for an effective system. Continuous advocacy to protect their right to work and learn is essential. This includes finding ways to support female students who are currently barred from universities to prevent a lost generation of medical professionals.
- Addressing the Brain Drain: Afghanistan has long suffered from a “brain drain” of skilled professionals. The economic and political situation has accelerated this trend, with doctors, nurses, and specialists seeking opportunities abroad. Incentivizing skilled health workers to stay and serve their communities is a huge challenge.
- Integrating Health and Nutrition: The health crisis is inextricably linked to the food security crisis. A comprehensive approach that combines food assistance, clean water access, and healthcare is essential to break the cycle of malnutrition and disease.
- Building Climate Resilience: Afghanistan is one of the world’s most vulnerable countries to climate change. Increasing episodes of drought and flooding disrupt agriculture, displace populations, and exacerbate health problems like water-borne diseases. The health system must be fortified to respond to these climate-related shocks.
Conclusion: A System Worth Saving
The updates from Afghanistan’s health system tell a story of a nation fighting for its well-being against staggering odds. It is a system being kept on life support by the heroic efforts of its own health workers and the international humanitarian community. The progress made over the past twenty years—in reducing infant mortality, increasing life expectancy, and expanding access to care—is in real danger of being reversed.
Investing in Afghanistan’s health is not just a moral imperative; it is a strategic necessity for regional and global stability. A healthy population is the foundation of any society. Preventing the collapse of this system is a race against time, requiring unwavering commitment, creative solutions, and a global resolve to not abandon the people of Afghanistan in their hour of greatest need. The doctors, nurses, and midwives who show up to work every day are doing their part; the world must ensure they have the tools to succeed.