Afghanistan

• People in need: 28.3 million¹
• People targeted: 23.7 million
• People in need of health assistance: 17.6 million
• Requirements (US$): 188.4 million

Context

For decades, Afghanistan has remained one of the most complex humanitarian emergencies in the world. The withdrawal of international forces and the transfer of the government to de facto authorities in August 2021 had a further devastating impact on the country and the health system. This political and economic instability has left 28.3 million people in need of humanitarian assistance in 2023 – an increase of 16% from 24.3 million in 2022.

This turbulence also means that health facilities remain understaffed and under-resourced, with shortages of medicines and supplies affecting the delivery of essential and quality health care services. Many rural areas have no health facilities at all. In 2022, WHO digitally mapped all underserved areas and identified over 13 million people living in 13 558 villages who have little to no access to basic health services.

The highest burden of this health emergency is borne by women and children in Afghanistan, who continue to be marginalized and are increasingly at risk of poor health outcomes, specifically in the context of reproductive, maternal, newborn and child health.

Areas of health requiring strengthening include:

• Primary and secondary health care delivery, including reproductive health, non-communicable diseases, gender-based violence, mental health and psychosocial support and trauma care services.
• Outbreak preparedness and response, especially in rural and underserved areas. Major disease outbreaks have continued to affect the country in 2022, including outbreaks of acute watery diarrhea, COVID-19, measles, dengue fever, Crimean-Congo haemorrhagic Fever and malaria, which remains endemic. WHO will also continue prioritizing polio eradication by improving campaign quality and addressing immunity gaps in high-risk populations.

Emergency response

WHO has vastly scaled up its operations in 2022 to match the staggering needs within the country and has established a strong network of 7 sub-offices and 1 085 affiliated staff. As of October 2022, WHO is supporting 190 health care facilities and deploying 121 surveillance support teams and 34 outbreak/surveillance teams across the country.

Under the coordination of the UN humanitarian/resident coordinator, WHO leads Afghanistan's health and humanitarian cluster coordination. WHO largely contributed to establishing the Health Strategic Thematic Working Group (H-STWG) and serves as its permanent co-chair. Its operations are aligned with the Transitional Engagement Framework (TEF), the Humanitarian Response Plan (HRP) and the new Health Sector Transition Strategy (HSTS) 2023-2025 – core components supporting the operationalization of the New Aid Architecture for Afghanistan. Believing in the “delivering as one” approach that enhances the coherence, efficiency and effectiveness of the UN at the country level, WHO works hand-in-hand with other UN agencies, funds, programs, key NGOs and civil societies across the country. WHO also plays a leadership role in convening key sectors to foster a “Health in All Policies” approach to improve health care delivery.

Building on its experience, positive track record and stable network in Afghanistan, WHO will use an integrated approach for its strategic objective of “reaching everyone everywhere and putting mothers and children first” by expanding the coverage and increasing the quality of health service delivery, especially in underserved areas, while sustaining the momentum of polio eradication. WHO will also aim to “protect people every day” by scaling up the response to ongoing emergencies and emerging health threats with a focus on disease outbreaks. WHO will continue to “lead the health cluster by coordinating the health sector” and its response to health-related humanitarian needs at national and sub-national levels.

WHO actively engages in mainstreaming gender- and rights-based approaches in all stages of developing national health policies and strategies and in implementing its own programs and policies and advocates for these approaches among UN task forces and forums. As a leading member of the UN Preventing and Responding to Sexual Exploitation, Abuse and Harassment (PRSEAH) Task Force, WHO will continue to support implementing partners to ensure holistic PRSEAH systems are in place and maintained actively. WHO will continue to follow the PRSEAH task force’s recommended protocol and conduct capacity-building sessions for WHO staff and all implementing partners, as well as self-assessments to identify gaps and provide the required support.

Strategic objectives

Key Activities

• Provide basic and essential health services and increase their coverage, with a focus on emergency maternal and child health services and routine immunization programs.
• Increase capacity for nutritional surveillance and enhance frontline health workers’ capacities to identify gender-based violence (GBV) cases and provide standard services.
• Continue to prioritize polio eradication by improving campaign quality and addressing immunity gaps.
• Establish a real-time medical supply chain management, a monitoring system and a regulatory framework.
• Support response to all natural disasters and infectious disease outbreaks, including COVID-19.
• Support public health laboratories to improve case identification, train and deploy rapid response teams (RRTs), provide medical supplies and foster case management to reduce case fatality to a minimum.
• Increase vaccination campaigns and the delivery of emergency and trauma care services, including mass casualty response.
• Set up a model of care by establishing the drug addiction management program, which is closely linked with the mental health and psychosocial support (MHPSS) program within the existing health system.
• Ensure coordination of interventions of all health actors to be guided by evidence and strategy.

Funding Requirements

Overall country funding requirements, including COVID-19, by pillar (US $ '000)

Success Stories

Empowering survivors of gender-based violence through counselling services

Jamila*, 34, is a mother of four young children and a survivor of domestic violence. She was forced into marriage at the age of 17. On the third day after her wedding, she was beaten by her father-in-law because she prepared the food a little late and was deprived of food for a week as a punishment. Every day, she was beaten by her in-laws and husband even during her pregnancy, especially when they found out that she was carrying a girl.

“I will never forget that my husband's family locked me in a barn and treated me like an animal. One day I was beaten almost to death by my in-laws, and they had to take me to the hospital. I arrived at the Jamhoriate hospital with a broken leg and an injury to my head, but that was the best day of my life. I was referred by the doctors to the National Advanced GBV Referral Center and my life has changed since then. I received full support from the staff at the center. Thanks to them, I became aware of my rights and that I shouldn’t tolerate any kind of violence. “I AM A STRONG WOMAN,” Jamila recalls.

*Name changed to protect the survivor’s identity.

For more information

Dr. Dapeng Luo | Country Representative | WHO Afghanistan | luod@who.int

Mr. Mohamed Kakay | External Relations & Partnership Team Lead | WHO Afghanistan | kakaym@who.int