Badakhshan, Afghanistan

Overview of the healthcare conflicts in Badakhshan:

Remote, mountainous areas with poor infrastructure and harsh weather make travel and service delivery difficult year-round.
High maternal mortality rates and a severe shortage of skilled healthcare workers leave many women giving birth without professional care.
Prenatal and postpartum services are lacking, and clinic closures are a significant concern.
Contaminated water sources affect health, with only 27% of the rural population having access to clean water, and women and girls often walk long distances to collect it, disrupting education.
Most families live in poverty and struggle to afford necessities like medicine and travel.
The Taliban takeover has led to cuts in international aid and a lack of clinics, schools, and offices in some villages.

Geography of Afghanistan

Afghanistan is a landlocked country (surrounded by land with no direct access to the sea) in South-Central Asia, bordered by Pakistan, Iran, Turkmenistan, Uzbekistan, Tajikistan, and China.
Afghanistan is approximately the size of Texas, with most of the land being mountain ranges from the northeast to the southwest. From the north and southwest, the land also spreads into plains and deserts.
Afghanistan has three major rivers, but only the Kabul River reaches the sea via Pakistan's Indus River. Badakhshan is a remote (far from cities) and mountainous province (area within a country) in northeastern Afghanistan.

Geographic Consequences of Gaps in Maternal Health

Afghanistan has the highest maternal mortality rate (number of women who die during pregnancy or childbirth) in Asia, with the worst conditions in remote regions like Badakhshan province. About 77% of Afghanistan's population lives in rural areas, where over 60% of the roughly 500 daily births occur with limited access to healthcare. Poor infrastructure, long travel distances, and harsh weather severely limit access to skilled medical care, forcing many women to give birth without professional assistance. Additionally, the 2018 Afghanistan Health Survey revealed that 35% of women had no prenatal visits (support during pregnancy) and over 50% received no postpartum (after birth) care. In 2002, Badakhshan's maternal mortality rate was an astonishing 6,507 per 100,000 live births, which is more than ten times the national average of 620 in 2020. In contrast, the U.S. rate in 2021 was 32.9 per 100,000.

Causes of High Mortality Rates

A combination of factors drives the alarmingly high rates in Afghanistan:

Poor roads and infrastructure
Extreme weather events during summer can reach at least 80 degrees Fahrenheit, while winter often brings heavy snowfall and rapidly dropping temperatures.
Widespread poverty and malnutrition
A shortage of skilled healthcare workers, exactly 2.5 healthcare workers per 10,000 people (as of 2020), which is far below global standards.
Low levels of education and health awareness

Image credit: https://www.health.state.mn.us/communities/rih/coe/clinical/obafghan/inafghan.html

According to Dr. Hajera Zia Baharestani, a gynecologist at Faizabad maternity hospital, there's a severe lack of trained staff, awareness, and access to healthcare facilities. UNICEF reports that only 3.3% of women in the region give birth in medical facilities, with 41% giving birth in unsanitary conditions, such as by riverbanks in summer or animal sheds during winter.

The human impact is illustrated by people like Abdul Haq, a resident of Big Pamir village, Badakhshan, who lost his 29-year-old wife during childbirth. "We don't have clinics, schools, or government offices here," he says.

Image credit: https://www.health.state.mn.us/communities/rih/coe/clinical/obafghan/inafghan.html

Impact of Water Scarcity on Women and Girls

Residents of Badakhshan have determined that access to clean drinking water is one of their most urgent needs. For over 20 years, droughts, natural disasters, and flash floods have caused a severe shortage and degradation of already-scarce water supplies, leaving many villages without access to safe water and making them more vulnerable to disease. In the absence of reliable sources, compelling people to drink from rivers, waters that cows and sheep also use. This has led to widespread health issues, including children falling ill and adults suffering from kidney and stomach problems due to contamination (unsafe substances due to unhealthy germs).

Across Afghanistan, water scarcity is a growing crisis that disproportionately affects women and girls.

Only 42% of people have access to safe drinking water.
In rural areas, just 27% have access to clean water.
Women and girls are primarily responsible for collecting water, often from unsafe sources.
This daily task can take hours, limiting time for education (lack of clean water and proper toilet facilities affects girls as primary school is often the highest level of education), income-generating work, rest, or caregiving.
Waterborne illnesses (diseases caused by using dirty water) are common and increase the risk of infections during labor and delivery.
Delivering in unsanitary environments (e.g., riverbanks) without proper hygiene can lead to fatal infections for mothers.

Additionally, limited water for agriculture and livestock is worsening food insecurity and trapping families in cycles of poverty and hunger.

Impact of the Taliban Takeover

The Taliban (a political and religious group in Afghanistan) retook control in 2021, impacting the already fragile healthcare system and further increasing the risks for pregnant women, especially in remote areas. Since then, most international aid (support, money), which used to fund 70–80% of the country's health system, has been cut. This led to:

Closure of clinics
Unpaid or fleeing medical staff
Severe shortages of medicine, supplies, and fuel
Restrictions on women's education and mobility, reducing female healthcare providers, and limiting mothers' access to healthcare

Remote provinces like Badakhshan were affected the most, often receiving aid last and losing services first.

Economic Struggles and Patient Burden

With Afghanistan's healthcare system deteriorating:

Doctors in unsupported clinics earn as little as $32/month
Patients must buy their own medicine
Families spend large portions of their income on travel and treatment, pushing them deeper into poverty

Around 90% of Afghans live below the poverty line. While public hospitals are technically free, they are overcrowded and under-resourced. Private hospitals, although better equipped, are unaffordable for most. Afghanistan's remote geography, underdeveloped infrastructure, and ongoing conflict have created overlapping crises in health and water access, especially in provinces like Badakhshan. Maternal mortality remains among the highest in Asia, worsened by poverty, lack of care, and recent restrictions under Taliban rule. At the same time, water scarcity has left communities without clean drinking water for decades, causing widespread illness. Women and girls bear the brunt of these crises, spending hours collecting water from contaminated sources, missing out on education and income, and facing heightened health risks during childbirth.

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