The Plight of Women and Health Care in Afghanistan
ByZieba Shorish-Shamley, Ph. D.
Two decades of war have devastated and almost totally destroyed Afghanistan's economic structure, political structure, health care system, educational system and many other aspects of the Afghan socio-cultural life. The Afghan traditional agricultural economy has been transformed to a drug economy where the main cash crop is opium. Afghanistan that once was the land of heroes, honor, dignity and hospitality, has become the land of terror, torture and injustice.
There is proxy war by the foreign nations with geopolitical and economic interests. There are war crimes, crimes against humanity, genocide, and cultural genocide. There are persecution and prosecution of people based on their gender, religious belief, political affiliation, ethnicity and language. There are illegal arms and drugs trafficking and terrorist training. There are trafficking of women and girls, forced prostitution and marriages. There is child labor, and boys as young as ten years old are forced by the warring factions to fight in the Afghan arm conflict.
In this setting in Afghanistan, there is no legitimate, effective and functioning central government. There is no functioning independent, impartial and unified judicial system. There does not exist any constitution, institution of civil society, or rule of law. There is no central monitoring system for human rights violations or a mechanism to provide redress to the victims. Local and tribal customs rule and the Taliban who control most of the country, do not see themselves bound by the international standards of human rights.
In the name of Islam, the Taliban militia and other warring factions are committing all the above mentioned crimes. The Taliban have implemented gender apartheid policies that has banished the Afghan women from the public sphere of their society. The Afghan women have become voiceless, invisible, non-beings with no right to an independent existence. They are stripped of all the basic human rights that are necessary to human existence.
Islam granted men and women equal rights to education, economic viability, work, freedom of movement, expression and many other rights that are fundamental to human existence and dignity in the 6th century AD. Today in the world, Islam the religion of peace, compassion and justice is represented as the religion of war, violence, cruelty and injustice. Our religion is grossly politicized, ideologically abused and distorted. It has become a hostage to the fanatic groups, such the Taliban whose misguided interpretation of Islam, combined with their tribal laws and customs have made the women of Afghanistan virtual prisoners in their own society.
The suffering of the Afghan people, particularly the Afghan women, starts with the former Soviets invasion 1979. During ten years of war with the Soviets, the Afghan women were subjected to torture, rape and various other inhuman acts in order to obtain information from them on the activities of the Mujahidin. Since 1992, various Mujahidin groups have subjected the people of Afghanistan, especially women and children, to various forms of oppression, restriction and torture.
Since the Taliban invasion of the country, they have continued to commit ethnic genocide example of which is the Taliban killing frenzy when they took over Mazari-Sharif on August 8, 1998. The Taliban massacred ten to eleven thousand people belonging to the Hazara ethnic group and other ethnic groups. They took the Hazara and other ethnic women as spoils of war or female slaves. The women were either forced to marry the Taliban militia or they were sold as female slaves to others.
Some the females who were forced into marriage or sold as slaves, were nine to ten years of age. Taliban have continued to displace internally and externally hundreds of thousands of ethnic people from their homes, villages and cities. Thousands of other ethnic people are either in the Taliban's concentration camps, or have disappeared.
The Taliban have implemented gender apartheid policies in Afghanistan that have lead to starvation, malnutrition and disease among women and children. Some women in Kabul commit suicide either to escape witnessing their children starves to death or to escape "living" under the Taliban rule
The women are killing themselves in various ways. Some are taking caustic Soda, some are jumping from buildings, and some use poison. Most of these women were civil servants who lost their jobs. In Kabul almost half of 80,000 civil servants were women or female university students.
Since the Taliban have banned women from work, and their are 50 to 60 thousands widows in the city of Kabul alone, children have become the only bread earners for their families. Boys and girls as young as eight and nine years old, beg and/or sell their bodies in the street in order to provide food for their families. There are forced marriages of young girls ages eight to nine to the Taliban militia.
According to various sources such as Doctors Without Borders, UNICEF, WHO, PHR and other organizations reports, there are increasing numbers of women in Afghanistan, particularly in Kabul who suffer depression, neurosis and other more severe forms of mental illness such as schizophrenia, and psychosis.
According to a study that was conducted by UNICEF mental health specialists who interviewed more than 300 children, ages 8 to 18, in Kabul, 72% of children experienced the death of a family member between 1992 and 1996. In 40% of these cases the child lost a parent.
Almost all of the children have witnessed acts of violence during the fighting, while two-thirds of them saw dead bodies or parts of bodies and nearly half saw many people killed at one time in rocket and artillery attacks. Ninety percent of the children interviewed believed that they would die during the conflict.
According to reports by UNICEF and Save the Children, about 300,000 to 400,000 children have been killed during the past 20 years of war and about four million children have died in the same period from malnutrition and illness. The report also states that about 268,000 Afghan children under the age of five die each year from easily treatable illnesses such as diarrhea and pulmonary conditions. Landmines are other killers of the Afghan children. There are about 10 million landmines in Afghanistan, which makes the country one of the most heavily, mined place in the world.
The Taliban have denied the Afghan women the rights for an education. The Ban has had a strong negative effect on the education of boys as well. According to the UN report (02/20/97) about 70% of the teachers in Kabul were women.
Banning education for women has had a serious negative effect on land mine-awareness programs, because many of the trainers were women. Over 500, 000 people have been injured and thousands have been killed by the 10 million land mines that are scattered throughout the country ((UN, 1997). Save the Children (1996) estimate shows that in the city of Kabul, about 50% of the land mine victims are children and that about 30% victims of land mines in other areas of Afghanistan are children.
The Taliban's gender-apartheid policies have brought about the "Feminization of Poverty" in Afghanistan. According to the United Nations estimate about 150, 000 women in Kabul have been forbidden from work. There were about 40, 000 women working in public services in Kabul. Women made up about 70% of all teachers, about 50% of civil servants and about 40% of medical doctors (UN 1997).
Afghanistan has the third highest infant mortality rate in the world, that is, 185 per 1, 000 live births and under-5 mortality rate of 257 per 1, 000. It has maternal mortality of 100 per 10, 000 live births (UN 1997, WHO 1996).
Most children die of childhood diseases including measles, diphtheria, tetanus, polio and others because of lack of immunizations. In general through out Afghanistan, children and adults are afflicted with malnutrition, tuberculosis, waterborne diseases, skin diseases, eye diseases, respiratory diseases and other related illnesses (UN report 1997).
The Taliban have allowed some women doctors and nurses to work in public hospitals and private clinics. The women physicians and nurses who are allowed to work in the Taliban controlled areas are exposed to brutal treatment. They are beaten are forced to witness beatings of their female colleagues by the Taliban guards. (Lancet, 1997).
The Taliban also targets male health workers. Male doctors are not allowed to treat female patients, except female members of their own family. The Taliban view male doctors with suspicion and hostility. They are ridiculed and humiliated and public. They are questioned routinely about their moral conducts in the hospitals. Treatments such as this, not only makes it horrible for the health professional on the personal level, it also makes it impossible for them to practice with any authority (Lancet, 1997).
The female patients are also victims of the Taliban's inhuman acts. Women patients who try to seek medical help and venture out in the street are frequently attacked and beaten by the Taliban guards and are ordered not to appear in the street again. For example, A pregnant woman delivered her baby in a street in Kabul, while the guards were beating her husband for trying to take her to the hospital. In one hospital, the Taliban guards ordered 80 female patients to go home, because their modesty could not be preserved in an overcrowded ward (Lancet, 1997).
Doctors Without Borders (1997) reported that a doctor in one of the largest hospitals in Kabul was unable to help a female patient with 80% burns. He was prevented by the Taliban militia from removing the patient's clothing. In September 1997, a highly contagious female TB patient was sent home before the end of her treatment thus putting her family at risk of infection. During the same period a 14-year-old female patient in a critical state was refused emergency care at the Central Polyclinic for lack of basic resources. In early October 1997, a male doctor was called by his neighbor to attend a woman in a deep coma. He referred her to the emergency department of the nearest hospital which refused to admit her (MSF, 1997).
On October 7, 1998, three women and their 3 children, all of whom were in stage 2 of malnutrition (i.e., severely), were trying to get access to an intensive-feeding center. Two other women who were health workers of a humanitarian organization accompanied them. The vehicle in which they were traveling was stopped at a checkpoint; the driver was severely beaten by a member of the Taliban and 2 members of the religious police. He received 25 lashes with an electric cable on the hands and forearms, for having allowed one of the mothers to sit in the front passenger seat. The mothers and their children were forced to leave the vehicle and were unable to reach the feeding center (MSF, 1997)
There is no systematic studies or reports regarding the Afghan people's state of health. There are not that many reports on the spread of infectious diseases, childhood disease and psychological aspect of the Afghan children, women and men. There are not that many, if any, psychiatrist, or psychologist in Afghanistan. There are not any systematic studies on the psychological and physical state of the rape victims. The needs for physical therapy for war and mines' victims are overwhelming, but there are not that many, if any, physical therapist to help the victims. The state of the Afghan people's health is in dire need of attention and research.
The condition of women and children in the refugee camps in Pakistan is also alarming. The information regarding the Afghan refugees in Pakistan is based on my own research that I conducted among the Afghan refugees in Islamabad and Peshawar Pakistan for two weeks in January 1998.
The Afghan refugees condition in the camps is horrendous. The refugees stated that the Pakistani police and government officials discriminate, arrest, beat, take bribes and mistreat the Afghan refugees on a daily base. In the camps, the refugee women and men complained of the lack of security in the camps.
They stated that at night, bands of armed men attack the camps and rape the women. The men and women cried and said, " Please tell the people in charge that we would rather not have food and water, if that helps to have security. Please give us security! " There is forced prostitution of women and young girls in the camps. The women and men stated that the Pakistani police and government officials were part of it. In Pakistan, thousands of Afghan women are forced by their circumstances to either beg on the streets or sell their bodies, in order to feed themselves and their children.
In Pakistan the Afghan refugees are suffering from diseases such as malaria, measles, whooping cough and tuberculosis, chest and skin infections, malnutrition, diarrhea and poor vision. Most of the patients who are suffering from these illnesses are women and children. Widows with children are very much at risk because they do not have anyone to support them financially.
There are not many, if any, health care services for the care of mother and child. There are not many programs, if any, for the reproductive health education. There are not many, if any, medical services for assistance to complicated delivery cases. The most significant reproductive health problem is that of high-risk pregnancies, because of social economic factors such as poverty, malnutrition and lack of education.
The refugee women do not have sufficient education regarding pregnancy and delivery. There is no transportation available for the treatment of obstetric complications to take the patient to a hospital.
The refugee women do not have sufficient information about STDs, and there are not many, if any, facilities to diagnose and treat STDs. The refugee women did not know much about AIDS and HIV.
The women reported a high prevalence of domestic violence. They said that their husbands beat them up because they (i. e., the husbands) do not have jobs and are very frustrated for not being able to support and provide for their family.
The women said that their husbands and themselves as well, beat their children, when they, that is, the parents are upset and the children make too much noise or when the children do not do as they are told. The women reported that among the men there is substance abuse such as using of hashish, heroin, opium and others. There also exist sleeplessness, various forms of depression, and other problems.
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