The economic and human resource crises that followed Afghanistan’s change of government in August 2021 have exacerbated mental health issues and decimated the limited facilities previously available. With the most basic of basic needs being prioritised by organisations that remain in-country – and international funding withdrawn – mental health service provision has all but collapsed.
Afghan women are more likely than men to experience traumatic events, develop post-traumatic stress disorder, and think about or commit suicide. A 2018 study found that 32% of women had witnessed the death of someone they knew. A 2021 study found that there is a much higher risk for girls experiencing psychiatric problems (45% vs. 14% of boys), PTSD (79% vs. 31%), depression (79% vs. 31%), and anxiety (78% vs. 21%).
Since the Taliban takeover, the situation appears to be worsening, especially for vulnerable groups. In September 2022, parents told Save the Children of “uncontrollable crying, nightmares, aggressiveness and self-harm.”
We draw on a rapid review of the research and our recent experiences conducting interviews for humanitarian clients in 10 Afghan provinces to bring the issue (back) to the fore. Mental health is a humanitarian crisis in itself but long-term impacts may exacerbate conflict, perpetuate cycles of poverty and reinforce family and community instability.
What’s changed since August 2021?
Afghan women continue to be deprived of their fundamental rights despite Taliban promises that they would be guaranteed in accordance with Sharia law. Women are systematically excluded from political participation and public life, face restrictions on mobility, access to public facilities, working outside homes and attending schools for girls above sixth grade. Violence, discrimination and forced marriage appear to have increased, sometimes in direct response to household financial crisis. There’s no data to reliably quantify this impact, but the psychological pressures have almost certainly increased.
Systems down, demand up
Decades of war have severely affected Afghans’ mental well-being and has resulted in limited investment in services and personnel. There is a dearth of clinical psychologists. While previous governments trained 800 healthcare providers to provide psychosocial counselling, many have since left the country in response to Taliban rule.
Even where services are available, stigma and poverty limit access. The 2019-2023 mental health strategy survey found less than 10% of people in need were accessing available mental health support. Gender discrimination, inability to pay fees, poverty and poor mental health literacy are formidable barriers, as are cultural and geographic factors.
Some women face a double blow in that the same men who are the source of their trauma are also the gatekeepers to assistance. According to the 2016 Ministry of Public Health data, approximately 87% of Afghan women and girls experience some form of abuse in their lifetimes, much of it by family members. In many provinces, women cannot visit the doctor without a male relative accompanying them.
There are severe challenges which will not be overcome easily. Yet there are reasons to be hopeful. Crucially, the issue is not being ignored. A number of international development organisations such as UN Women, the World Justice Project, the World Bank and media platforms such as Al Jazeera, Skynews, and BBC are highlighting the current injustices experienced by women and children.
Mental Health and Psychosocial Support (MHPSS) is mainstreamed in the humanitarian response, if underfunded. In addition, the 2022 Humanitarian Response Plan, led by the UN Office for the Coordination of Humanitarian Affairs (OCHA), aims to train 3,000 health practitioners on Prevention of Sexual Exploitation and Abuse, which will be a crucial measure to mitigate future harm.
Finally, while challenges facing women are serious, restrictions are uneven. In some places – Kabul, Herat, Balkh and perhaps others – there is relative freedom. As a female member of our network in Kabul told us in November: “I can visit [male or female] doctors without anybody coming with me… I think Balkh and Herat are similarly open.”