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Afghan child mortality declined following the US invasion, so what impact will their withdrawal have?

The image shows the Afghanistan national flag in the foreground, with camera crews and armoured vehicles to the rear.

Child mortality rates have fallen consistently in Afghanistan since the 2001 US-led invasion according to new data released by UNICEF.

The data, released last month, shows that despite births rising over the last two decades, the number of under 5s dying in the country has decreased year on year, having risen consistently throughout the 1990s where civil war and eventual Taliban rule dominated the country.

This graph shows an increase on the amount of children being born in Afghanistan between 1996 and 2021
Data obtained from the World Development Indicators

But with the Taliban sweeping back to power across most of the country in 2021 following an eventually successful insurgency campaign, there is concern amongst many Afghans about the future of the nation’s children and healthcare more broadly.

Dr Orzala Nemat is a political ethnographer from Afghanistan with two decades of experience in development practice, research, and academia who said: “I do worry that the return of the Taliban will undo all the work done in the last two decades.”

The period of Taliban rule saw child mortality numbers increase significantly, culminating in a median estimation of 124,874 deaths of children under five in the year 2000, the Taliban’s last full year in power.

The graph shows an increase in the amount of children under 5 dying in Afghanistan between 1990 and 2000.
Data obtained via UNICEF

To put this in context, the population of Afghanistan in the year 2000 was roughly the same as that of Australia. In that year, Australia recorded 1571 deaths.

The Taliban, meaning “students” in Pashto, is a predominately Pashtun organisation that was formed by former members of the Mujahadeen in the years following the 1989 withdrawal of the Soviet Union.

The Taliban’s influence grew throughout the 90s, leading to them eventually capturing Kabul in 1996 and overthrowing the regime led by President Burhanuddin Rabbani.

The group enjoyed significant popularity as they assumed power, due in large parts by their ability to bring law and order to a country weary after decades of conflict.

Yet whist the braun was able to bring security, the brain was unable to facilitate the conditions required to tackle the lack of medical services throughout the country.

Their introduction of a strict interpretation of sharia-law served to exasperate already deep-seated limitations on medical delivery, most notably by banning the education of women, placing strict limits on how doctors could interact with female patients as well as forcing women to be chaperoned by a male relative.

Dr Nemat describes the country’s health services as being non-existent in many districts of Afghanistan in the nineties.

Afghanistan is made up of 34 provinces and 387 districts nationwide with Dr Nemat noting that: “In most of the districts, we did not have hospitals with beds.

“Where we did, they would usually be at the provincial level and even then, they would not be in every province.

“At this time, services did not reach the heavily mountainous regions nor the remote areas in the central highlands meaning that the mortality rate was always high.”

Dr Nemat highlights this in conjunction with decades of war as being the main factors driving some of the highest numbers of child mortality in the world.

The September 11th terrorist attacks and subsequent US invasion, saw the US and coalition partners, collectively known as the International Afghan Security Force (ISAF), maintain a troop presence for two decades, in which time, the child mortality figures declined each year, falling to 81,903 in 2022.

The graph shows a fall in the amount of children under 5 dying in Afghanistan following the US led invasion of the country.
Data obtained via UNICEF

So, is it too simplistic to attribute the fall in numbers to the military intervention of ISAF? Dr Nemat believes that whilst it is a significant moment, the answer is much more nuanced.

Dr Nemat said: “post-2001 there was no end to conflict but the political arrangement as a result of the Bonn conference resulted in the return of a massive number of professionals back to the country.

“But we had huge financial interventions by the World Bank and UN which brought a lot of resources and saw an unprecedented amount of infrastructure building such as roads, hospitals, clinics and schools.

“We had never had this before, we had hospitals but not with the international funding and this started to reduce the mortality rate.”

Dr Hassamussin Jamal is a paediatrician working in Baghlan province, Afghanistan who agrees with Dr Nemat.

Dr Jamal said: “Crucially, the US and international aid allowed us to start vaccination programmes and improve socio-economic conditions for many people, meaning they had access to things such as clean water which all contributed to lowering child mortality.”

The removal of the Taliban and the installation of a pro-western government allowed girls to be educated, removed restrictions on employment and enabled travel without a male chaperone.

Naturally, education and the ability to discuss health issues with a female healthcare worker, without going through a male relative had significant benefits on prevention of illness, early diagnosis and treatment.

But there are growing fears amongst many Afghans that the Taliban’s return to power following the US withdrawal in 2021, will undo much of the work done this century to improve healthcare services across the country.

Many of the freedoms given to women since 2001 have already been revoked with bans on female health workers and laws requiring women to be accompanied by a male chaperone reintroduced.

Currently, a woman may only be seen by a male doctor and must be fully clothed, making diagnosis of gynaecological conditions or issues during or after pregnancy virtually impossible.

The return of the Taliban has also seen a fall in living standards for most of the population, with a recent UN report stating that since the US withdrawal, almost all Afghans are now living in poverty, with the economy falling by 30%.

Heartbreakingly, the report estimates that nearly half of the country’s children under 5 are suffering from acute malnutrition, with 1.1 million suffering from severe malnutrition, nearly double the number in 2018 and 10% more than the previous year.

The table shows how Afghanistan and countries ranked similarly to it compare in terms of life expectancy, years at school and income.
Data taken from the UN's Human Index Report 2022. It shows that even amongst countries with similar rankings to Afghanistan, the country still has significantly more children dying than any other.

This fall in fortunes for the Afghan population is underlined by the United Nations Human Development Index with the country slipping to 182nd of 193 countries worldwide, down from 169 in 2014.

The index, uses statistics such as life expectancy at birth, expected years of schooling and gross national income, to assess the fortunes of countries; Afghanistan is sandwiched between Guinea and Mozambique in the rankings.

I speak to Dr Jamal about these issues, his concern for the future of his country’s healthcare system all too evident throughout.

Our initial interview is postponed due to severe flooding in his province in mid-May, which claim the lives of 2000 people, according to the World Food programme.

It is hard to escape the feeling that the lack of media coverage is an all too evident sign of the attention being given, or not, to the country’s plight as it struggles to compete with higher-profile tragedies.

Dr Jamal, Dr Nemat, experts from the UN and the Council on Foreign Affairs are all in agreement that the biggest hinderance to the delivery of healthcare in Afghanistan now and in the coming years is international sanctions.

The sanctions, which were placed on the Taliban due to broken promises regarding female education and women’s rights have made the ability to procure drugs difficult, even for the few Afghans who could afford to do so.

Dr Jamal said: “Right now, the lack of recognition of our government is the biggest problem because preventative aid has been stopped with the focus solely on emergency aid.

“This combined with a lack of female staff means that we are unable to maintain our healthcare services and it will lead to increased numbers of children dying.”

All evidence suggests that the Taliban’s return to power, has led to the quality of life for the vast majority of Afghans deteriorating.

Time will tell if this impact manifests itself in an increase in child mortality but the prognosis at this stage is not good.

What the data shows is that with access to education, basic sanitation, nutrition and medicine, children can be prevented from losing their lives unnecessarily.

Whilst the last two decades have still seen high numbers of children dying across the country, even when compared with countries facing similar challenges, a reduction of nearly 40% between 2000 and 2022 shows a step in the right direction.

The use of sanctions to coerce to the Taliban to stick to its promises might be the only leverage that western countries have, but it puts the lives of Afghan children in perilous danger.

This is not to absolve the Taliban of blame; the opposite is true. Their insistence on self-flagellation by hampering the efforts of NGOs, preventing professionals from operating and denying women the ability to comfortably obtain the care they need, will see thousands of children who could grow to be their country’s future die before they see their sixth birthday.


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