This profile refers to people with disabilities, including mental disabilities, as well as those who have severe medical issues, including mental health issues.
COI summary
The Afghan government lacked funds to operate and sustain its healthcare facilities. Most healthcare was provided by NGOs. Hospitals, especially outside the cities, have been in general unable to provide adequate care and common medications. Besides public healthcare facilities, there has also been a widely used but very expensive private sector. Approximately 90 % of Afghans had access to healthcare facilities within a two-hour distance [Key socio-economic indicators 2020, 2.6].
In 2020, health facilities and medical workers in Afghanistan continued to be targeted and threatened. For this period, the World Health Organization (WHO) recorded 89 incidents that occurred in 18 provinces and affected 72 healthcare facilities, 57 of which were closed, 11 damaged, two destroyed, and another two looted. The provinces with the biggest numbers of closed healthcare facilities were Nuristan (17), Nangarhar (15), Helmand (10), and Kandahar (8). Both of the two healthcare facilities that were reported destroyed were located in Helmand [Security June 2021, 1.4.3].
In the first seven months of 2021, the WHO also recorded destructions and closures of healthcare facilities in several provinces, including in Badghis, Balkh, Ghazni, Helmand, Herat, Jawzjan, Kandahar, Kunar, Laghman, Logar, Nangarhar [Security June 2021, 2.3, 2.4, 2.10, 2.12, 2.13, 2.14, 2.16, 2.19, 2.21, 2.22, 2.23].
Mental healthcare facilities are often under-equipped and qualitative mental healthcare is scarce. The country still suffers from lack of trained professionals [Key socio-economic indicators 2020, 2.6.2, 2.6.3].
In Afghanistan, people with mental and physical disabilities are often stigmatised. Their condition is at times considered to have been ‘related to God’s will’. Mistreatment of those people by society and/or by their families has occurred. Women, displaced persons and returned migrants with mental health issues are particularly vulnerable. There is also lack of appropriate infrastructure and specialist care that covers the needs of people with disabilities. The existing structures are largely concentrated in a few urban centres [Key socio-economic indicators 2020, 2.6].
Risk analysis
The lack of personnel and adequate infrastructure to appropriately address the needs of people with (severe) medical issues would not meet the requirement that an actor of persecution or serious harm is identified in accordance with Article 6 QD, unless the individual is intentionally deprived of healthcare.[28]
In the case of persons living with mental and physical disabilities, the individual assessment whether discrimination and mistreatment by society and/or by the family could amount to persecution should take into account the severity and/or repetitiveness of the acts or whether they occur as an accumulation of various measures.
Not all individuals under this profile would face the level of risk required to establish well-founded fear of persecution. The individual assessment of whether there is a reasonable degree of likelihood for the applicant to face persecution should take into account risk-impacting circumstances, such as: nature and visibility of the mental or physical disability, negative perception by the family, etc.
Nexus to a reason for persecution
Available information indicates that the persecution of persons living with noticeable mental or physical disabilities may be for reasons of membership of a particular social group, defined by an innate characteristic and distinct identity linked to their stigmatisation by the surrounding society.