Afghanistan: The Changing State of its Health System and the Contribution of NGOs and the International Community

  • Katerina Karyda Department of International and European Studies, University of Piraeus, Greece
  • Dareia Moka Department of International and European Studies, University of Piraeus, Greece
Keywords: Afghanistan; Health System; Talibans; NGOs; International Community

Abstract

In unstable or low-income states, incapacity to react to population demands typically derives from insufficient health systems. High-income countries have incentives to offer them health aid since a humanitarian catastrophe might damage global peace and stability. Diseases and epidemics heighten the hazard. International community and NGOs must intervene. Afghanistan is a country that needs this help, due to recurrent hostilities, unstable regimes, the covid epidemic, and the return of the Taliban. As a result, Afghanistan has been lacking a competent health system for years. Despite some successful initiatives to rebuild and enhance the Afghan health system following the Taliban's fall in 2001, it's significantly more chaotic now. The Taliban's return to power has harmed Afghanistan's health. Several causes have lowered Afghan residents' health, with women suffering the most since they are typically deprived from basic medical treatment. Moreover, socioeconomic changes have also been noticed after the overthrow of the previous government. The broader context of the health situation in Afghanistan looks increasingly ominous, prompting the international community to lift its sanctions and provide aid.

References

Acerra, J. R., Iskyan, K., Qureshi, Z. A., & Sharma, R. K. (2009). Rebuilding the health care system in Afghanistan: an overview of primary care and emergency services. Int J Emerg Med, 2(2), 77–82. https://doi.org/10.1007%2Fs12245-009-0106-y.
Amnesty International (2021a, December 6). Afghanistan: Survivors of gender-based violence abandoned following Taliban takeover – new research. https://www.amnesty.org/en/latest/news/2021/12/afghanistan-survivors-of-gender-based-violence-abandoned-following-taliban-takeover-new-research/.
Amnesty International (2021b, August 19). Afghanistan: Taliban responsible for brutal massacre of Hazara men – new investigation. https://www.amnesty.org/en/latest/news/2021/08/afghanistan-taliban-responsible-for-brutal-massacre-of-hazara-men-new-investigation/.
Ariana News (2020). Survey finds at least 10 million Afghans infected with COVID-19. https://www.ariananews.af/survey-finds-at-least-10-million-afghans-infected-with-covid-19/.
Atalayar (2021, September 23). Afghanistan's health system on the brink of collapse. https://atalayar.com/en/content/afghanistans-health-system-brink-collapse.
Barlett, L. A., Mawji, S., Whitehead, S., Crouse, C., Dalil, S., Ionete, D., Salama, P., & Afghan Maternal Mortality Study Team (2005). Where giving birth is a forecast of death: maternal mortality in four districts of Afghanistan, 1999-2002. The Lancet, 365(9462), 864-870. https://doi.org/10.1016/S0140-6736(05)71044-8.
Batakis, D., Sidiropoulos, S. and Vozikis, A. (2020). What is the Role of International Law in Global Health Governance on the Period of Covid-19. HAPSc Policy Briefs Series, 1(2): 153-1 65. DOI: 10.12681/hapscpbs.26493.
Batniji, R., & Songane, F. (2014). Contemporary Global Health Governance: Origins, Functions, and Challenges. In Brown, G. W., Yamey, G. & Wamala, S. (eds). The Handbook of Global Health Policy. Chapter 3. John Wiley & Sons, Ltd. https://doi.org/10.1002/9781118509623.ch3.
Biswas, S. (2021). The Coronavirus Pandemic and Global Governance: The Domestic Diffusion of Health Norms in Global Health Security Crises. Jadavpur Journal of International Relations, 25(2), 208–234. https://doi.org/10.1177/09735984211042094.
Bloom, M. (2022, February 4). Afghan women face increasing violence and repression under the Taliban after international spotlight fades. The Conversation. https://theconversation.com/afghan-women-face-increasing-violence-and-repression-under-the-taliban-after-international-spotlight-fades-176008.
Bornemisza, O., Ranson, M. K., Poletti, T. M., & Sondorp, E. (2010). Promoting health equity in conflict-affected fragile states. Social Science & Medicine, 70(1), 80–88. https://doi.org/10.1016/j.socscimed.2009.09.032.
Brink, S. (2021, December 21). No pay for staff. No patient supplies. No heat. This is health care in Afghanistan. NPR. https://www.npr.org/sections/goatsandsoda/2021/12/21/1063840640/no-pay-for-staff-no-patient-supplies-no-heat-this-is-health-care-in-afghanistan?t=1658816041387&t=1659015822525.
Broon, J., & Tran, M. (2009, November 2). Hamid Karzai declared winner of Afghanistan's presidential election. The Guardian. https://www.theguardian.com/world/2009/nov/02/hamid-karzai-afghanistan-winner-election.
Byrd, W. (2021). Afghanistan’s Economic and Humanitarian Crises Turn Dire. United States Institute of Peace, Analysis and Commentary. https://www.usip.org/publications/2021/10/afghanistans-economic-and-humanitarian-crises-turn-dire.
CFR (n.d). The U.S. War in Afghanistan, 1999 – 2021. Council of Foreign Relations. Retrieved (August 4, 2022). https://www.cfr.org/timeline/us-war-afghanistan.
Cousins, S. (2021). Afghan health at risk as foreign troops withdraw. The Lancet, 398(10296), 197-198. https://doi.org/10.1016/S0140-6736(21)01643-3.
Cousins, S. (2022). Afghanistan's health crisis deepens under the Taliban. The Lancet, 399(10332), 1290-1291.https://doi.org/10.1016/S0140-6736(22)00609-2.
Dawi, A. (2022, March 21). Is Afghanistan a Republic of NGOs?. VOA. Retrieved June 30, 2022, from https://www.voanews.com/a/is-afghanistan-a-republic-of-ngos/6494871.html.
Development Initiatives. (2020, July). Aid spent on health: ODA data on donors, sectors, recipients - Factsheet. Reliefweb. https://reliefweb.int/report/world/aid-spent-health-oda-data-donors-sectors-recipients-factsheet-july-2020 .
Essar, M.Y., Hasan, M.M., Islam, Z., Riaz, M. M. A., Aborode, T. A., & Ahmad, S. (2021). COVID-19 and multiple crises in Afghanistan: an urgent battle. Conflict and Health 15, 70. https://doi.org/10.1186/s13031-021-00406-0.
Ewing, P., & Naylor, B. (2017, August 21). 'We Are Not Nation-Building Again,' Trump Says While Unveiling Afghanistan Strategy. npr.org. https://www.npr.org/2017/08/21/545044232/trump-expected-to-order-4-000-more-troops-to-afghanistan?t=1659954157535.
Ferguson, J. (2022, January 5). Afghanistan Has Become the World’s Largest Humanitarian Crisis. the NEW YORKER. https://www.newyorker.com/news/dispatch/afghanistan-has-become-the-worlds-largest-humanitarian-crisis.
Fjeldstad, O. H., Bøås, M., Bjørkheim, J., & Kvamme, F. M. (2018). Building tax systems in fragile states. Challenges, achievements and policy recommendations. Chr. Michelsen Institute and Norwegian Institute of International Affairs, CMI Report 3. https://www.cmi.no/publications/6491-building-tax-systems-in-fragile-states-challenges.
Frost, A., Wilkinson, M., Boyle, P., Patel, P., & Sullivan, R. (2016). An assessment of the barriers to accessing the Basic Package of Health Services (BPHS) in Afghanistan: was the BPHS a success?. Globalization and Health, 12, 71. https://doi.org/10.1186/s12992-016-0212-6.
Ghaedi, M. (2022, January 2). Taliban are revoking Afghan women's hard-won rights. DW, Asia. https://www.dw.com/en/taliban-are-revoking-afghan-womens-hard-won-rights/a-60283590.
Glinski, S. (2022). Afghanistan six months on from the Taliban takeover – photo essay. The Guardian. https://www.theguardian.com/world/2022/mar/04/afghanistan-six-months-on-from-the-taliban-takeover-photo-essay.
Global Health. (2022, August 29). Donor Tracker. Retrieved July 5, 2022, from https://donortracker.org/sector/global-health.
Gostin, L. O., Moon, S., & Meier, B. M. (2020). Reimagining Global Health Governance in the Age of COVID-19. American Journal of Public Health, 110(11), 1615–1619. https://doi.org/10.2105/ajph.2020.305933.
Health Alliance International (2008). NGO Code of Conduct for Health Systems Strengthening. Retrieved from: http://ngocodeofconduct.org/pdf/ngocodeofconduct.pdf.
Hill, P. S. (2011). Understanding global health governance as a complex adaptive system. Global Public Health, 6(6), 593–605. https://doi.org/10.1080/17441691003762108.
Hoffman, S. J., & Cole, C. B. (2018). Defining the global health system and systematically mapping its network of actors. Globalization and Health, 14, 38. https://doi.org/10.1186/s12992-018-0340-2.
Human Rights Watch (2021, May 6). Afghanistan: Health Care for Women Hit by Aid Cuts. hrw.org https://www.hrw.org/news/2021/05/06/afghanistan-health-care-women-hit-aid-cuts.
Human Rights Watch (2022a). Afghanistan: Economic Roots of the Humanitarian Crisis. HRW. https://www.hrw.org/news/2022/03/01/afghanistan-economic-roots-humanitarian-crisis#_Why_did_the.
Human Rights Watch (2022b). Afghanistan: Hunger Crisis Has Economic Roots. HRW https://www.hrw.org/news/2022/03/01/afghanistan-hunger-crisis-has-economic-roots .
Jain, B., Bajaj, S. S., Noorulhuda, M., & Crews, R. D. (2021). Global health responsibilities in a Taliban-led Afghanistan. Nature Medicine, 27(11), 1852–1853. https://doi.org/10.1038/s41591-021-01547-8.
Kallini, S. X. (2021). Being a Woman under Taliban’s Theocratic Regime. HAPSc Policy Briefs Series, 2(2), 31–38. https://doi.org/10.12681/hapscpbs.29490.
Khan, G. (2021, August 5). Reclaiming Pashtunwali: Pashtuns Need To Redefine ‘Honour’ As A Gender-Equal Idea. The Friday Times. https://www.thefridaytimes.com/2021/08/05/reclaiming-pashtunwali-pashtuns-need-to-redefine-honour-as-a-gender-equal-idea/
Kondro, W. (2007). Where's the health in Afghanistan's reconstruction?. Canadian Medical Association Journal, 177(3), 233. https://doi.org/10.1503%2Fcmaj.070901.
Laub, Z. (2017, May 1). The U.S. War in Afghanistan. Council on Foreign Relations. Retrieved August 2, 2022, from https://www.cfr.org/timeline/us-war-afghanistan .
Lavietes, M. (2022, January 26). LGBTQ Afghans face surge of rape, torture after Taliban takeover, report says. NBC NEWS. https://www.nbcnews.com/nbc-out/out-news/lgbtq-afghans-face-surge-rape-torture-taliban-takeover-report-says-rcna13303.
Lucero-Prisno, D. E., Essar, M. Y., Ahmadi, A., Lin, X., & Adebisi, Y. A. (2020). Conflict and COVID-19: a double burden for Afghanistan’s healthcare system. Conflict and Health, 14, 65. https://doi.org/10.1186/s13031-020-00312-x.
Maizland, L. (2021, September 15). The Taliban in Afghanistan. Council on Foreign Relations. https://www.cfr.org/backgrounder/taliban-afghanistan.
Mellen, R., & Ledur, J. (2022, January 25). Afghanistan faces widespread hunger amid worsening humanitarian crisis. The Washington Post. https://www.washingtonpost.com/world/2022/01/24/afghanistan-humanitarian-crisis-hunger/.
Ministry of Public Health (n.d.). Sehatmandi Project. Retrieved (August 22, 2022). https://moph.gov.af/index.php/en/sehatmandi-project.
Moreno, L. B. (2021, November 29). Women’s Healthcare In Danger Under Taliban Rule. Human Rights Pulse. https://www.humanrightspulse.com/mastercontentblog/womens-healthcare-in-danger-under-taliban-rule.
Najafizada, E. (2021). A Taliban ban on women in the workforce can cost economy $1bn. Al Jazeera. https://www.aljazeera.com/economy/2021/12/1/talibans-ban-on-women-in-the-workforce-can-cost-economy-1bn.
Navias, M. S. (2002). Finance Warfare as a Response to International Terrorism. The Political Quarterly, 73(s1), 57-79. https://doi.org/10.1111/1467-923X.73.s1.6.
Nemat, A., Raufi, N., Essar, M. Y., & Zeng, Q. (2021). A Survey on the Health and Financial Status of Private Educational Institutions in Afghanistan During COVID-19 Pandemic. Journal of Multidisciplinary Healthcare, 14, 1683-1689. https://doi.org/10.2147/JMDH.S319872.
Newbrander, W., Waldman, R., & Shepherd-Banigan, M. (2011). Rebuilding and strengthening health systems and providing basic health services in fragile states. Disasters, 35(4), 639–660. https://doi.org/10.1111/j.1467-7717.2011.01235.x.
Nomura, S., Sakamoto, H., Ishizuka, A., & Shibuya, K. (2021). Tracking Development Assistance for Health: A Comparative Study of the 29 Development Assistance Committee Countries, 2011–2019. International Journal of Environmental Research and Public Health, 18(16), 8519. https://doi.org/10.3390/ijerph18168519.
Nordstrom, L. (2021, November 2). The Taliban has a hit list for the Afghan LGBT community, NGO says. France24. https://www.france24.com/en/asia-pacific/20211102-the-taliban-has-a-kill-list-for-the-afghan-lgbt-community-ngo-says.
Norwegian Refugee Council. (2022, January). Life and Death: NGO access to financial services in Afghanistan. Reliefweb. https://reliefweb.int/report/afghanistan/life-and-death-ngo-access-financial-services-afghanistan-january-2022.
OpIndia (2021, September 21). Taliban radicals thrash male doctor for attending to a female patient, medical attention to pregnant women almost impossible in Afghanistan. opindia.com. https://www.opindia.com/2021/09/afghanistan-male-doctor-thrashed-for-attending-to-female-patient-women-healthcare-risk/ .
Palmer, N., Strong, L., Wali, A., & Sondorp, E. (2006). Contracting out health services in fragile states. BMJ, 332(7543), 718–721. https://doi.org/10.1136/bmj.332.7543.718.
Pleming, S. (2009, November 15). Clinton wants tangible Afghan progress from Karzai. Reuters. https://www.reuters.com/article/idINIndia-43962220091115.
Radio Free Europe Radio Liberty (2019). Over 400,000 Afghans Returned Home From Iran, Pakistan, Says Migration Organization. RFERL. https://www.rferl.org/a/afghans-400-000-afghans-returned-home-iran-pakistan-iom/30246200.html.
Saeed, K. M. I. (2017). Burden of Hypertension in the Capital of Afghanistan: A Cross-Sectional Study in Kabul City, 2015. International Journal of Hypertension, 2017, 3483872. https://doi.org/10.1155/2017/3483872.
Sanadgol, A., Doshmangir, L., Majdzadeh, R., & Gordeev, V. S. (2021). Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review. Globalization and Health, 17, 129. https://doi.org/10.1186/s12992-021-00778-1
Sidiropoulos, S., Emmanouil-Kalos, A., Kanakaki, M. E. and Vozikis, A. (2021). The Rise of NGOs in Global Health Governance and Credibility Issues in the 21st Century. HAPSc Policy Briefs Series, 2(2), 278-288. DOI: 10.12681/hapscpbs.29516.
Sidiropoulos, S., Valachea, S., Kanakaki, M. E., Emmanouil-Kalos, A., Tsimogiannis, G., & Vozikis, A. (2022). Development Assistance for Health and the Role of NGOs in the Africa Region: The Case of the Central African Republic. Journal of Regional Socio-Economic Issues, 12(1), 44–58. https://www.researchgate.net/publication/358090428.
Skolnik, R. (2019). Global Health 101 (Essential Public Health) (4th ed.) [E-book]. Jones & Bartlett Learning.
Steinhardt, L. C., Waters H., Rao, K. D., Naeem, A. J., Hansen, P., & Peters, D. H. (2009). The effect of wealth status on care seeking and health expenditures in Afghanistan. Health Policy and Planning, 24(1), 1–17. https://doi.org/10.1093/heapol/czn043
The Straits Times. (2021, October 4). 'We lack everything': Afghanistan's health system at breaking point. Retrieved June 18, 2022 from https://www.straitstimes.com/asia/south-asia/we-lack-everything-afghanistans-health-system-at-breaking-point.
The White House. (2011, June 22). Remarks by the President on the Way Forward in Afghanistan. obamawhitehouse.gov. Retrieved August 8, 2022. https://obamawhitehouse.archives.gov/the-press-office/2011/06/22/remarks-president-way-forward-afghanistan.
The World Bank. (2019). Life expectancy at birth, total (years) - Afghanistan. worldbank.org. Retrieved May 24, 2022. https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=AF.
The World Bank (2022c). The World Bank In Afghanistan. The World Bank. Accessed 22/07/2022. https://www.worldbank.org/en/country/afghanistan/overview.
UNAMA. (2022, August 11). UN Humanitarian Coordinator reaffirms commitment to meeting life-saving needs and supporting vulnerable communities across Afghanistan. UNAMA. Retrieved August 21, 2022, from https://unama.unmissions.org/un-humanitarian-coordinator-reaffirms-commitment-meeting-life-saving-needs-and-supporting-vulnerable .
UNDP. (2022). Sustainable Development Goals. United Nations Development Programme. Retrieved June 30, 2022, from https://www.undp.org/sustainable-development-goals?utm_source=EN&utm_medium=GSR&utm_content=US_UNDP_PaidSearch_Brand_English&utm_campaign=CENTRAL&c_src=CENTRAL&c_src2=GSR&gclid=CjwKCAjw7IeUBhBbEiwADhiEMdK-rpXMA1S2dM-qyRWciWKRUQF1MCc4R4cnJu9A3u--o9rnp39zdxoChBAQAvD_BwE#good-health.
United Nations (2021, August 18). Afghanistan: Medical lifeline to millions must not be cut, warns WHO. UN News. https://news.un.org/en/story/2021/08/1097992
United Nations (2021). Afghanistan’s healthcare system on brink of collapse, as hunger hits 95 per cent of families. UN NEWS. https://news.un.org/en/story/2021/09/1100652.
United Nations (2022). Afghanistan: 500,000 jobs lost since Taliban takeover. UN NEWS., Retrieved May 23, 2022. https://news.un.org/en/story/2022/01/1110052.
Universal Health Coverage Partnership. (2022, January 28). Stories from the field: Special series on the COVID-19 response – Afghanistan | Universal Health Coverage Partnership. Retrieved July 13, 2022, from https://www.uhcpartnership.net/story-afghanistan/ .
UN Press. (2022, March 2). To Avert ‘Irreversible’ Damage in Afghanistan, International Community Must Engage with Country’s De Facto Authorities, Mission Head Tells Security Council. United Nations. Retrieved August 21, 2022, from https://press.un.org/en/2022/sc14815.doc.htm .
Waldman, R., Strong, L. & Wali, A. (2006). Afghanistan’s Health System Since 2001: Condition improved, prognosis cautiously optimistic. Afghanistan Research and Evaluation Unit. https://reliefweb.int/report/afghanistan/afghanistans-health-system-2001-condition-improved-prognosis-cautiously.
Wallace, M. R., Hale, B. R., Utz, G. C., Olson, P. E., Earhart, K. C., Thornton, S. A., & Hyams, K. C. (2002). Endemic infectious diseases of Afghanistan. Clinical Infectious Diseases, 34, Issue Supplement_5. https://doi.org/10.1086/340704.
World Bank. (2020). Cause of death, by communicable diseases and maternal, prenatal and nutrition conditions (% of total) – Afghanistan. https://data.worldbank.org/indicator/.
World Bank. (2022b). Current health expenditure (% of GDP) - Afghanistan. Retrieved May 13, 2022. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=AF.
World Bank. (2022b). World Development Indicators (Last Updated: 09/16/2022). https://databank.worldbank.org/source/world-development-indicators/preview/on (accessed 21/09/2022).
World Food Programme (2022). A global food crisis. WFP. Accessed 25/07/2022 https://www.wfp.org/global-hunger-crisis.
World Health Organization (2022, January 24). Afghanistan’s health system is on the brink of collapse: urgent action is needed. WHO. Retrieved May 23,2022. https://www.who.int/news-room/feature-stories/detail/afghanistan-s-health-system-is-on-the-brink-of-collapse-urgent-action-is-needed.
World Health Organization (n.d.b). Global health estimates: Leading causes of DALYs. WHO. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-estimates-leading-causes-of-dalys.
World Health Organization (n.d.a). Afghanistan. WHO, Regional Office for the Mediterranean. Retrieved May 24, (2022).http://www.emro.who.int/afg/programmes/non-communicable-diseases.html .
Zhao, Y., Micah, A. E., Gloyd, S., & Dieleman, J. L. (2020). Development assistance for health and the Middle East and North Africa. Globalization and Health, 16, 4. https://doi.org/10.1186/s12992-020-0545-z .
Published
2022-10-04
How to Cite
Karyda, K., & Moka, D. (2022). Afghanistan: The Changing State of its Health System and the Contribution of NGOs and the International Community. International Journal of Social Science Research and Review, 5(10), 160-176. https://doi.org/10.47814/ijssrr.v5i10.645