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
2 Apr 2020 | News and features, Statements
[vc_row][vc_column][vc_column_text]Index on Censorship is among 107 organisations that are urging governments to respect human rights and civil liberties as they attempt to tackle the coronavirus pandemic through digital surveillance technologies.
“As the coronavirus continues to spread and threaten public health, governments are taking unprecedented actions to bring it under control. But the pandemic must not be used to usher in invasive digital surveillance,” said Jessica Ní Mhainín, Policy Research and Advocacy Officer at Index on Censorship. “Measures must have a legal basis, be targeted exclusively at curtailing the virus, and have safeguards in place to prevent violations of privacy.”
STATEMENT:
The Covid-19 pandemic is a global public health emergency that requires a coordinated and large-scale response by governments worldwide. However, states’ efforts to contain the virus must not be used as a cover to usher in a new era of greatly expanded systems of invasive digital surveillance.
We, the undersigned organisations, urge governments to show leadership in tackling the pandemic in a way that ensures that the use of digital technologies to track and monitor individuals and populations is carried out strictly in line with human rights.
Technology can and should play an important role during this effort to save lives, such as to spread public health messages and increase access to health care. However, an increase in state digital surveillance powers, such as obtaining access to mobile phone location data, threatens privacy, freedom of expression and freedom of association, in ways that could violate rights and degrade trust in public authorities – undermining the effectiveness of any public health response. Such measures also pose a risk of discrimination and may disproportionately harm already marginalised communities.
These are extraordinary times, but human rights law still applies. Indeed, the human rights framework is designed to ensure that different rights can be carefully balanced to protect individuals and wider societies. States cannot simply disregard rights such as privacy and freedom of expression in the name of tackling a public health crisis. On the contrary, protecting human rights also promotes public health. Now more than ever, governments must rigorously ensure that any restrictions to these rights is in line with long-established human rights safeguards.
This crisis offers an opportunity to demonstrate our shared humanity. We can make extraordinary efforts to fight this pandemic that are consistent with human rights standards and the rule of law. The decisions that governments make now to confront the pandemic will shape what the world looks like in the future.
We call on all governments not to respond to the Covid-19 pandemic with increased digital surveillance unless the following conditions are met:
1. Surveillance measures adopted to address the pandemic must be lawful, necessary and proportionate. They must be provided for by law and must be justified by legitimate public health objectives, as determined by the appropriate public health authorities, and be proportionate to those needs. Governments must be transparent about the measures they are taking so that they can be scrutinized and if appropriate later modified, retracted, or overturned. We cannot allow the Covid-19 pandemic to serve as an excuse for indiscriminate mass surveillance.
2. If governments expand monitoring and surveillance powers then such powers must be time-bound, and only continue for as long as necessary to address the current pandemic. We cannot allow the Covid-19 pandemic to serve as an excuse for indefinite surveillance.
3. States must ensure that increased collection, retention, and aggregation of personal data, including health data, is only used for the purposes of responding to the Covid-19 pandemic. Data collected, retained, and aggregated to respond to the pandemic must be limited in scope, time-bound in relation to the pandemic and must not be used for commercial or any other purposes. We cannot allow the Covid-19 pandemic to serve as an excuse to gut individuals’ right to privacy.
4. Governments must take every effort to protect people’s data, including ensuring sufficient security of any personal data collected and of any devices, applications, networks, or services involved in collection, transmission, processing, and storage. Any claims that data is anonymous must be based on evidence and supported with sufficient information regarding how it has been anonymised. We cannot allow attempts to respond to this pandemic to be used as justification for compromising people’s digital safety.
5. Any use of digital surveillance technologies in responding to Covid-19, including big data and artificial intelligence systems, must address the risk that these tools will facilitate discrimination and other rights abuses against racial minorities, people living in poverty, and other marginalised populations, whose needs and lived realities may be obscured or misrepresented in large datasets. We cannot allow the Covid-19 pandemic to further increase the gap in the enjoyment of human rights between different groups in society.
6. If governments enter into data sharing agreements with other public or private sector entities, they must be based on law, and the existence of these agreements and information necessary to assess their impact on privacy and human rights must be publicly disclosed – in writing, with sunset clauses, public oversight and other safeguards by default. Businesses involved in efforts by governments to tackle Covid-19 must undertake due diligence to ensure they respect human rights, and ensure any intervention is firewalled from other business and commercial interests. We cannot allow the Covid-19 pandemic to serve as an excuse for keeping people in the dark about what information their governments are gathering and sharing with third parties.
7. Any response must incorporate accountability protections and safeguards against abuse. Increased surveillance efforts related to Covid-19 should not fall under the domain of security or intelligence agencies and must be subject to effective oversight by appropriate independent bodies. Further, individuals must be given the opportunity to know about and challenge any Covid-19 related measures to collect, aggregate, and retain, and use data. Individuals who have been subjected to surveillance must have access to effective remedies.
8. Covid-19 related responses that include data collection efforts should include means for free, active, and meaningful participation of relevant stakeholders, in particular experts in the public health sector and the most marginalized population groups.
Signatories:
7amleh – Arab Center for Social Media Advancement
Access Now
African Declaration on Internet Rights and Freedoms Coalition
AI Now
Algorithm Watch
Alternatif Bilisim
Amnesty International
ApTI
ARTICLE 19
Asociación para una Ciudadanía Participativa, ACI Participa
Association for Progressive Communications (APC)
ASUTIC, Senegal
Athan - Freedom of Expression Activist Organization
Barracón Digital
Big Brother Watch
Bits of Freedom
Center for Advancement of Rights and Democracy (CARD)
Center for Digital Democracy
Center for Economic Justice
Centro De Estudios Constitucionales y de Derechos Humanos de Rosario
Chaos Computer Club - CCC
Citizen D / Državljan D
Civil Liberties Union for Europe
CódigoSur
Coding Rights
Coletivo Brasil de Comunicação Social
Collaboration on International ICT Policy for East and Southern Africa (CIPESA)
Comité por la Libre Expresión (C-Libre)
Committee to Protect Journalists
Consumer Action
Consumer Federation of America
Cooperativa Tierra Común
Creative Commons Uruguay
D3 - Defesa dos Direitos Digitais
Data Privacy Brasil
Democratic Transition and Human Rights Support Center "DAAM"
Derechos Digitales
Digital Rights Lawyers Initiative (DRLI)
Digital Security Lab Ukraine
Digitalcourage
EPIC
epicenter.works
European Digital Rights - EDRi
Fitug
Foundation for Information Policy Research
Foundation for Media Alternatives
Fundación Acceso (Centroamérica)
Fundación Ciudadanía y Desarrollo, Ecuador
Fundación Datos Protegidos
Fundación Internet Bolivia
Fundación Taigüey, República Dominicana
Fundación Vía Libre
Hermes Center
Hiperderecho
Homo Digitalis
Human Rights Watch
Hungarian Civil Liberties Union
ImpACT International for Human Rights Policies
Index on Censorship
Initiative für Netzfreiheit
Innovation for Change - Middle East and North Africa
International Commission of Jurists
International Service for Human Rights (ISHR)
Intervozes - Coletivo Brasil de Comunicação Social
Ipandetec
IPPF
Irish Council for Civil Liberties (ICCL)
IT-Political Association of Denmark
Iuridicum Remedium z.s. (IURE)
Karisma
La Quadrature du Net
Liberia Information Technology Student Union
Liberty
Luchadoras
Majal.org
Masaar "Community for Technology and Law"
Media Rights Agenda (Nigeria)
MENA Rights Group
Metamorphosis Foundation
New America's Open Technology Institute
Observacom
Open Data Institute
Open Rights Group
OpenMedia
OutRight Action International
Pangea
Panoptykon Foundation
Paradigm Initiative (PIN)
PEN International
Privacy International
Public Citizen
Public Knowledge
R3D: Red en Defensa de los Derechos Digitales
RedesAyuda
SHARE Foundation
Skyline International for Human Rights
Sursiendo
Swedish Consumers’ Association
Tahrir Institute for Middle East Policy (TIMEP)
Tech Inquiry
TechHerNG
TEDIC
The Bachchao Project
Unwanted Witness, Uganda
WITNESS
World Wide Web Foundation
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