30 May 2025 | Afghanistan, Asia and Pacific, News and features, Volume 54.01 Spring 2025
This article first appeared in Volume 54, Issue 1 of our print edition of Index on Censorship, titled The forgotten patients: Lost voices in the global healthcare system, published on 11 April 2025. Read more about the issue here.
Over the past 15 years, Bibi Jan has already endured the unimaginable pain of losing four of her children due to malnutrition and inadequate medical facilities. She is now deeply anxious about the health of two of her three surviving children.
I met the 30-year-old in December 2024 at the Zabul Provincial Hospital. I found her sitting beside her two sick children, aged six and three, her face etched with worry. She spoke in a trembling voice.
“Each of [my children] passed away after reaching six months or one year of age,” she told me. “Now, my two other children are also sick. I brought them to this hospital for treatment. The doctors have admitted them. I am staying here while my husband visits us during the day and returns home at night.”
Bibi got married when she was only 15 to a man who was 15 years her senior. “My father gave me away in marriage when I did not consent,” she said. Since then, she has given birth nine times, but only one daughter and two sons have survived.
The women and children’s ward of the hospital was so overcrowded that it was nearly impossible to find any space. Every bed was occupied, and some patients were sharing a single cot or lying on the floor, waiting desperately for medical attention.
Sitting next to Bibi was another woman, 37-year-old Fatima, who had brought her two-and-a-half-year-old child in for treatment. “Due to a lack of sufficient food, my children suffer from malnutrition and one of them is severely ill,” she said. “We barely have anything to eat at home, let alone access to proper medical care.”
The tragic accounts of Bibi and Fatima are just two of countless stories that reflect the dire humanitarian crisis in the southern province of Zabul. Women and children in this province face life-threatening health risks daily. The Zabul Provincial Hospital, which is the only major healthcare centre in the region, is grappling with critical shortages of medicine and medical equipment.
One of the doctors at the hospital, who preferred to remain anonymous, described the grim reality of their struggle: “We are trying to save patients’ lives with the minimal resources available, but we lack adequate medicine and equipment. Foreign aid is not distributed properly, and most of it goes to specific Taliban-affiliated groups. Ordinary people, especially women and children, are deprived of this aid.”
The drastic reduction in international aid following recent political changes has plunged Afghanistan’s healthcare system into an unprecedented crisis. This includes both the reduction of government healthcare assistance within the country since the Taliban’s takeover and recent reductions in foreign aid, particularly from Donald Trump’s administration in the USA and his cuts to United States Agency for International Development (USAID) funding.
Organisations that once provided crucial support to medical centres in Zabul have either suspended their assistance or significantly reduced the resources they provide. Meanwhile, the Taliban lacks the capabilities and infrastructure to manage this growing catastrophe, and has actively enforced policies that make healthcare access harder.
A worsening nationwide problem
According to the United Nations Office for the Co-ordination of Humanitarian Affairs (OCHA), Afghanistan has a maternal mortality rate that is nearly three times the global average – for every 100,000 births, 600 women die.
In a recent report, the OCHA warned that this year nearly half of Afghanistan’s population – or 22.9 million people – will require humanitarian assistance just to survive. The report also stated that 14.8 million people, more than a third of the country’s population, will face acute food insecurity by early 2025.
This crisis extends far beyond Zabul. The Abu Ali Sina Balkhi Provincial Hospital in Balkh is also overwhelmed by the growing number of patients and the worsening economic situation.
At about 4pm one afternoon, a sudden commotion erupted in the overcrowded hallways of the hospital. A 42-year-old man, visibly pale and weak, was lying on a stretcher. He was a roadside vendor who had earned no income that day. His blood sugar levels had spiked dangerously high, leaving him unable to move.
His 12-year-old son and a coworker, both visibly distraught, had rushed him to the hospital. Despite the doctors’ immediate attention, his condition was too severe for him to be saved. About 20 minutes later, a doctor’s voice emerged from his office: “The patient has passed away.”
Hospital officials then turned to his young son and requested that he contacted a family elder to collect the body.
Many of the patients seeking treatment in hospitals across the country have lost their jobs, struggle with chronic illnesses exacerbated by economic hardship, or suffer from the psychological toll of Taliban rule. Additionally, cases of suicide among women, driven by social issues such as domestic violence and forced marriages, have been steadily increasing.
Taliban restrictions further endanger healthcare access
The OCHA has expressed serious concerns over the increasing restrictions imposed by the Taliban on women’s employment and education in the healthcare sector. These policies have drastically limited access to essential medical services for mothers and children across Afghanistan.
According to the OCHA, the country’s economy has shrunk by nearly a third since August 2021. The ongoing political crisis, an inefficient financial system, severe cuts in development budgets and Taliban-imposed restrictions have seriously damaged the country’s ability to deliver basic services.
The organisation highlighted the alarming maternal mortality rate during childbirth in particular, emphasising that the Taliban’s restrictions on women working in healthcare have made access to medical care increasingly difficult.
In addition to these policies, last year the Taliban also banned women from studying in medical institutes, further depleting the already inadequate number of female healthcare workers and stopping them from being able to train in professions such as nursing, midwifery and dentistry. These were some of the only educational avenues left for women.
The desperate need for female doctors
In Badakhshan province, women are particularly affected by the shortage of female doctors. Fatima, a 24-year-old woman, expressed her deep concerns: “I always accompany my relatives who come from remote areas to the central hospital in Badakhshan because they don’t know the way. The situation is truly worrying. There are so many patients but not enough female doctors. We must wait for hours just to get seen by one.”
She recounted the harrowing experience of one of her neighbours who suffered severe complications due to a lack of doctors.
“Several specialised doctors we had have all left the country,” she said. “My neighbour had to undergo surgery in the absence of specialists, but due to severe bleeding she had to go through another surgery within a week. She nearly died.”
Dr Noshin Gohar Karimi, who works at Faizabad Provincial Hospital, voiced similar concerns on his Facebook page: “The workload in Faizabad Provincial Hospital has exceeded the capacity of the staff. Unfortunately, due to a lack of budget, increasing bed capacity and staff recruitment are not possible. The hospital was originally designed for 128 beds, but today more than 310 patients are admitted. In the paediatric ward, which has only 30 beds, 120 sick children and their mothers are currently being treated.”
The healthcare workforce crisis
The shortage of medicines and lack of funding remain among the most pressing challenges in Afghanistan’s healthcare system. A nurse at a government-run, public hospital in Kabul highlighted the ongoing crisis: “We used to have more staff, but over the past two years the workforce has decreased significantly. Now, one person has to do the work of several people and, as a result, patients do not receive adequate care. In addition to that, doctors and nurses face persistent delays in their salaries.”
She added: “Before the Taliban took over, medical equipment was already scarce but, after that, even that small supply stopped. Many machines have become old and worn out, and hospital officials say they have no budget to replace them.”
A nurse at a private hospital in Kabul also reported severe staff shortages in various departments. “There is a lack of personnel in all sections. In the nursing department, especially, we do not have enough staff and are forced to do the work of several people alone, while our salaries have also been reduced.”
With a collapsing healthcare system, increasing restrictions on women and dwindling international aid, Afghanistan faces a healthcare catastrophe that threatens the lives of millions.
Additional reporting by Rukhshana Media reporters
28 May 2025 | Europe and Central Asia, News and features, Newsletters, Russia
My predecessor Ruth Anderson used to joke that we weren’t working hard enough because we hadn’t been banned in Russia. Perhaps she was onto something. We’re still not banned there, as far as I know. Amnesty International though appears to have met the mark – or rather crossed a Kremlin red line. This week, Russian authorities labelled Amnesty an “undesirable organisation”, accusing it of being a “centre for the preparation of global Russophobic projects”. Any association with the group is now a criminal offence.
This is no empty label. Just ask Galina Timchenko, co-founder and CEO of the independent Russian-language news outlet Meduza. She’s now facing criminal charges for organising the activities of an “undesirable organisation” – namely, Meduza itself, which earned that designation back in January 2023 for its reporting on Russia’s full-scale invasion of Ukraine. The charges stem from her publishing two videos, one in September 2024 and another in March 2025, which authorities claim were designed to “foment protest sentiment”. If convicted, she could face six years in prison.
But it’s not just human rights organisations and independent journalists in the Kremlin’s crosshairs. This week, a Russian court fined tech giant Apple 10.5 million roubles (approximately $130,900) across four administrative cases. Three related to alleged violations of the country’s anti-LGBTQ+ “propaganda” laws, which were made even more draconian in 2023. The fourth was for allegedly failing to delete content at the request of the Russian authorities.
A journalist from Mediazona, one of Russia’s last remaining independent outlets, covered the court proceedings and offered a glimpse into how such hearings operate. Here’s a telling moment: “Our reporter notes that the judge read the decision at such a rapid pace it was virtually impossible to grasp the precise details of the claims. We then approached the court’s press secretary to request that a summary of the official court record be released for clarity. The response was terse: ‘The hearing is closed.’”
In the past, Apple has received criticism for its compliance with Russian censorship demands, from removing VPNs to restricting certain apps. These are moves it has defended as the price of staying in the country. Now it’s paying a different, more literal price.
As for Index, we remain unbanned – and unbowed. We continue to report on Russia in both our magazine and online, including recently interviewing artist and musician Yaroslav Smolev, and Nadezhda Skochilenko, mother of political prisoner and Index award winner Aleksandra Skochilenko. This isn’t actually about provoking the Kremlin. It’s about doing our job: telling the truth, and shining a light on one of the most authoritarian regimes in the world.
23 May 2025 | Africa, News and features, Nigeria, Volume 54.01 Spring 2025
This article first appeared in Volume 54, Issue 1 of our print edition of Index on Censorship, titled The forgotten patients: Lost voices in the global healthcare system, published on 11 April 2025. Read more about the issue here.
With a growing population that now exceeds 200 million, Nigeria’s demand for effective healthcare is immense – but the sector is critically underfunded. Less than 4% of the country’s GDP has been spent on health in recent years, resulting in operational inefficiencies, the deterioration of medical infrastructure, health professionals migrating to other countries, and medical tourism, where wealthier Nigerians pay for healthcare abroad instead of at home.
This year, the health sector was allocated only 5.18% of the total governmental budget, which will further impact the provision of quality services and deepen disparities in access.
Last September, the World Bank approved a $1.57 billion loan for Nigeria, including $570 million to strengthen primary healthcare provision. This is one of many international funds provided to help improve the country’s healthcare infrastructure. However, systemic failures including corruption divert essential resources away from those who need them most.
A recent report from Transparency International – a global coalition against corruption – highlights corruption as a barrier to effective healthcare delivery globally and indicates that $500 billion is lost to the problem annually. Nigeria ranks 140 out of 180 in its Corruption Perceptions Index, reflecting its pervasive nature within the country’s institutions. In healthcare, corruption manifests in many ways, including organ trafficking and unethical transplants, counterfeit drugs and the diversion of humanitarian aid.
In north-east Nigeria, the illegal trade of Ready-to-Use Therapeutic Food, which is intended for malnourished children, highlights the severe misuse of humanitarian aid, with healthcare workers implicated in diverting supplies for sale in local markets.
Systematic financial abuse has also been documented by organisations set up to help Nigerians access affordable, quality healthcare. The National Health Insurance Scheme (NHIS), for example, allegedly misappropriated more than 6.8 billion Nigerian Naira ($4.5 million) through illegal allowances between 2016 and 2017. Despite its mandate to reduce out-of-pocket healthcare spending, the NHIS has managed to cover only 5% of Nigerians since it began in 2005, with the majority of Nigerians still financing their own healthcare through out-of-pocket payments.
A report by the news agency Sahara Reporters revealed rampant corruption at the National Hospital Abuja in Nigeria’s capital, where patient-staff bribery and payments to private accounts are common. In another concerning account at a community health centre in Lagos, one anonymous healthcare worker told Index that contracted health workers who were paid to immunise young children had recorded discarded oral polio vaccinations as “administered”. This distortion not only alters public health data but also places entire communities at risk of preventable diseases. There was also alleged misuse of resources, with the source reporting that solar-powered lights intended for use in healthcare centres were installed in the homes of local politicians instead.
Challenges faced by whistleblowers
Amid these challenges, whistleblowing has emerged as a critical strategy for combating corruption. Experts identify it as an accountability tool that can promote transparency and reduce corruption in healthcare service delivery. However, it is fraught with challenges, including intimidation, a lack of legal protection and a culture of silence. Whistleblowers endure significant personal risks, including emotional distress, underscoring the need for protective measures and a supportive environment.
A major shortcoming is the law. Onyinyechi Amy Onwumere, of the Civil Society Legislative Advocacy Centre (CISLAC), provides free, confidential and professional legal advice to victims and witnesses of corruption. She noted: “Nigeria does not have a comprehensive whistleblowing law. Existing protections are fragmented and insufficient, leaving whistleblowers vulnerable to retaliation.
“Whistleblowers in Nigeria’s healthcare system often encounter retaliation, including threats, suspension or sacking, and even physical harm. These actions create a toxic atmosphere where human rights violations thrive, and potential whistleblowers are discouraged from coming forward.
“The failure to adequately protect whistleblowers leads to a deteriorating healthcare system and a loss of public trust.”
There is also a lack of awareness among potential whistleblowers regarding their rights and the protections and reporting mechanisms that do exist, she added. According to the Centre for Fiscal Transparency and Public Integrity, a Transparency and Integrity Index the organisation compiled found that only 10 ministries, departments and agencies out of 512 in Nigeria have a whistleblower policy. “This is far from best practice,” said Onwumere.
Cultural and systemic barriers
Cultural and societal norms create a challenging environment for whistleblowers. Informal corruption networks thrive where they are tolerated, particularly when they benefit the community. Tosin Osasona, a programme manager at the NISER/MacArthur Foundation Research Grant Project on Corruption Control in Nigeria, explained: “In a society where loyalty is highly valued, speaking out against one’s institution can be perceived as a betrayal.”
This attitude discourages people from stepping forward.
Osasona highlighted the professional risks that whistleblowers face. “They often encounter blacklisting by seniors, reduced future job prospects and ostracisation. The reality is that potential whistleblowers are intimidated, isolated and discouraged.”
He stressed the need for a dedicated whistleblower reporting system tailored to the healthcare sector. “A reporting mechanism that guarantees confidentiality, independence, and impartiality is essential to breaking the cycle of corruption,” he said.
One community health officer told Index that patients who were already burdened by the cost of treatment could find themselves extorted for basic medical services. They explained how a patient recently reported a staff member for selling injections that were meant to be free and for inflating the cost of other items.
“Instead of facing disciplinary action, the individual was merely transferred to another clinic in the subdivision.”
And when staff members are the whistleblowers, they ultimately get transferred, “perpetuating a cycle of corruption and silence with no real change”, the source added.
This climate of suppression extends to the media, where censorship continues to stifle investigative journalism – particularly on financial embezzlement. Despite amendments, authorities continue to misuse the broad powers of the 2015 Cybercrimes Act to detain and prosecute journalists uncovering corruption.
The path forward
There are severe consequences of widespread corruption in healthcare, including loss of life, increased healthcare costs and a deterioration of the health sector, disproportionately affecting vulnerable people.
Yusuff Adebayo Adebisi, a pharmacist and director of research and thought leadership at the international organisation Global Health Focus, said: “Corruption in healthcare resource allocation damages patient care. It deprives people who need treatment of crucial supplies and funding. This problem leads to drug shortages, outdated equipment and neglected facilities – all of which put patients at risk. Some people turn to expensive private clinics or skip treatment entirely because vital resources have been syphoned away.”
A recent review from five English-speaking West African countries, including Nigeria, suggests that poor working conditions and low wages push some healthcare workers to engage in unethical behaviour. Adebisi emphasised that “a real solution calls for a detailed understanding of how corruption operates in each place so that decision-makers can craft effective strategies that address these problems at their core”.
Empowering healthcare professionals to safely report corruption and mismanagement requires a combination of legal protection, secure reporting channels and a supportive workplace culture. Adebisi said that whistleblower protection laws are “essential” and should be communicated clearly to staff “so they know they will be shielded from retaliation”. Secure, anonymous platforms – such as confidential hotlines or encrypted digital tools – can also help professionals speak up without fear of losing their jobs or facing harassment.
Training and awareness programmes on ethics and accountability can boost staff confidence. Adebisi suggested that “working with professional associations, non-governmental organisations and community groups adds an extra layer of support and helps create a culture where reporting is seen as a collective responsibility rather than an individual risk”.
International models provide useful insights into how Nigeria can strengthen its whistleblowing framework. For instance, in the UK, National Health Service organisations rely on “Freedom to Speak Up guardians” who serve as neutral, trusted people who staff can approach with sensitive concerns. In some Latin American countries, partnerships between government agencies and civil society groups have led to digital whistleblowing platforms that maintain user anonymity. These ideas could be tailored to Nigeria, said Adebisi, taking into account the “unique challenges” of different regions.
Artificial intelligence can also enhance these efforts. He explained that “tools powered by machine-learning can track procurement data, pinpoint suspicious patterns in drug prescriptions and flag irregularities that might indicate theft or bribery”. While technology alone won’t solve the issue, he believes that integrating AI with “robust legal frameworks” and education programmes could help to “significantly strengthen oversight”.
“There’s no single solution that works for every institution, so it’s important to combine strategies that promote accountability, protect staff and foster a culture of transparency.”
A lack of accountability can have real-world consequences. One nurse in a teaching hospital told Index how corruption in resource management exacerbated existing disparities.
“Some wards are fully equipped with state-of-the-art machines, have a constant power supply and are staffed with highly efficient medical personnel,” she explained. “Meanwhile, other units struggle with outdated equipment, erratic electricity and severe staff shortages.”
When whistleblowers have the support of the media and the public, their reports can lead to meaningful reform. Onwumere highlighted the Ministry of Niger Delta Affairs scandal, where a whistleblower’s revelations of looting at the ministry prompted policy changes. Similar pressure in the healthcare sector could drive accountability and bring change.
Ensuring that those who expose wrongdoing in healthcare can speak out freely is not merely a matter of individual rights – it is a critical step towards a functional and equitable healthcare system for the tens of millions of Nigerians who depend on it.
23 May 2025 | Afghanistan, Africa, Americas, Asia and Pacific, El Salvador, Europe and Central Asia, Kenya, News and features, Palestine, Russia, Tanzania, Uganda, United States
In the age of online information, it can feel harder than ever to stay informed. As we get bombarded with news from all angles, important stories can easily pass us by. To help you cut through the noise, every Friday Index publishes a weekly news roundup of some of the key stories covering censorship and free expression. This week, we look at the arrest of a human rights lawyer and how Russia has banned Amnesty International.
Detained for her work: Leading human rights lawyer arrested for supporting immigrants
Cristosal is one of the most prominent groups working to defend human rights in Central America. Over recent months, it has supported those wrongfully deported to El Salvador from the USA, and now one of its most prominent figures is paying the price for this work. Ruth López, chief legal officer in anti-corruption for Cristosal, has been arrested in El Salvador over a decade-old embezzlement accusation from when she worked in electoral courts.
Arrested late on Sunday 18 May, her family and legal team have no knowledge as to her whereabouts and are concerned about her safety. Numerous human rights organisations have come out in her defence, condemning her arrest as a violation of due process, and outlining the “environment of fear” that is prevalent in the country.
Cristosal wrote on Bluesky that Lopez is “likely the victim of short-term enforced disappearance”, constituting a “serious human rights violation under international law”. López has led multiple legal cases against the Salvadoran government, and Cristosal claims that she has been the target of smear campaigns and social media attacks coordinated by Nayib Bukele’s government, and that this is its latest attempt to silence her for her work.
No amnesty for Amnesty: Prominent human rights group banned in Russia
On Monday 19 May, Russia officially announced that it would ban the prominent human rights organisation Amnesty International from operating within the country, designating it “undesirable”. The Kremlin claims that Amnesty is the “centre of preparation of global Russophobic projects”, and that it “[justifies] the crimes of Ukrainian neo-Nazis”.
Amnesty has continually documented Russia’s war crimes in Ukraine since Russia launched its full-scale invasion in February 2022, and the organisation has long been on Russia’s blacklist, with its website blocked and its Moscow office closed since the early days of the war. The group is far from the first to be banned by the Kremlin; since 2015 the register of “undesirable organisations” has been used to ostracise hundreds of human rights groups and media outlets. Amnesty International’s secretary general Agnès Callamard said that “you must be doing something right if the Kremlin bans you”, and outlined the organisation’s intentions to keep exposing Russia’s human rights violations in both Ukraine and Russia.
University protests: Student has degree revoked for pro-Palestine speech
Since Donald Trump was inaugurated in January, university campuses have become key battlegrounds in the fight for free expression in the USA. Some pro-Palestine protesters have been arrested on campus, others have been punished through suspension, and the Trump administration has threatened to withdraw funding from schools and universities that allow what it deems “illegal protests”. International students are at particular risk, as Immigration and Customs Enforcement (ICE) agents have detained and attempted deportations of student protesters who are in the USA on visas or green cards.
Despite the threats facing them, it appears that students are not being deterred from protesting. New York University (NYU) undergraduate Logan Rozos gave a pro-Palestine speech at his graduation ceremony last week, condemning the war in Gaza. “The genocide currently occurring is supported politically and military by the United States, is paid for by our tax dollars and has been live-streamed to our phones,” he said. NYU quickly announced that the university is withholding his diploma while it pursues disciplinary action against him.
Similarly, this week, George Washington University (GWU) student Cecilia Culver criticised her university’s ties to Israel and called for students to withhold donations to GWU in a graduation speech that went viral on social media. She has since been banned from campus, with some groups calling for the withdrawal of her diploma until she apologises.
In February it was announced that a federal government taskforce set up to tackle antisemitism would be investigating events that have occurred at 10 universities, and both NYU and GWU are on this list.
Media shutdown: Taliban fires 300 from national broadcaster in mass budget cuts
As part of an initiative to cut government spending, the Taliban has fired more than 300 members of staff from the prominent national broadcaster Radio Television of Afghanistan (RTA), 91 of whom are women. Many were journalists and editors who had worked for the organisation for decades. The Afghanistan Journalists Support Organization (AJSO) believes that this is more than just a cost-cutting exercise.
In a statement on X, AJSO outlined how this continues a theme of media suppression by the Taliban, and that the decision is part of “the systematic exclusion of women from the public sphere, especially in the media”. The drive to remove women from the workplace has intensified since the Taliban regained control of the country in 2021; state-run nurseries in Kabul have reportedly seen more than 100 female staff dismissed, while hundreds of women professors have been fired from public universities across the country. At the end of last year, women were banned from training as midwives and nurses.
A 2024 UN report also outlined how the Taliban has devastated the country’s independent media landscape, with the latest cuts appearing to be a continuation of these efforts.
Freed on demand: Two activists released from detention in Tanzania following government requests
Boniface Mwangi, a prominent Kenyan activist and journalist, and Ugandan activist Agather Atuhaire have reportedly been returned to their home countries following a three-day detention in Tanzania. Mwangi and Atuhaire were in Dar es Salaam, Tanzania on Monday 19 May for the court case of Tanzanian opposition leader Tundu Lissu when they were arrested. They were taken into custody, with their whereabouts unknown, and allegedly denied access or contact with either their lawyers or families.
The Kenyan government publicly protested the detention, calling on Tanzania to release Mwangi in an open letter on Thursday 22 May – later that day, Mwangi was dumped on the border of Kenya and Tanzania. Mwangi has recounted his experiences in detention, claiming that he and Atuhaire were tortured while in custody. Atuhaire was also found at the border of Tanzania and Uganda, after the Ugandan High Commission wrote to Tanzania seeking information about her whereabouts. Amnesty Kenya has condemned their detentions, and has called for an independent investigation into the allegations of torture and human rights abuses by Tanzanian officials.
