COMMON ANALYSIS
Last update: January 2023
[Main COI reference: KSEI 2022, 6, pp. 46-52]
The health system continued to face shortages of supplies, fuel, and money to pay health workers’ salaries. Similarly, field reports indicated that health facilities were lacking medical supplies and equipment, while needs were high. Further, it was reported on a lack of adequate medicines and a lack of food supplies for patients. It was also noted in March 2022 that around 35 % of healthcare facilities lacked access to basic water, sanitation and hygiene facilities.
In February 2022, gunmen reportedly killed seven members of polio vaccination teams in three separate incidents in Kunduz and Takhar province, leading the UN to suspend the vaccination campaign in these provinces.
Women with more complex health needs, such as pregnant women, have reportedly been facing major issues with regard to access to healthcare, including fear and insecurity, mobility restrictions due to the need to be accompanied in public by a mahram or the need to travel long distances to reach health services. Female patients were also reportedly allowed to be attended only by women healthcare professionals. Women lacked sufficient means of safe transportation and there was a shortage of trained female personnel [KSEI 2020, 6.3, p. 49].
An article quoted health workers from Ghazni district describing an incident where two unaccompanied women were reportedly forced out of a clinic by the Taliban. In another incident, a midwife was reportedly detained, and medical staff of the clinic was facing prosecution for having attended to a single woman giving birth. Taliban reportedly denied that such incidents took place.
In March 2022, the Taliban MPVPV ordered healthcare institutions to deny medical assistance to female patients without a hijab [Targeting 2022, 5.2.5, p. 120].
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 were largely concentrated in a few urban centres [KSEI 2020, 2.6, pp. 56, 57, 59].
It is important to note that serious harm must take the form of conduct of an actor (Article 6 QD). In itself, the general unavailability of healthcare is not considered serious harm meeting the requirements of inhuman or degrading treatment under Article 15(b) QD in relation to Article 6 QD, unless there is intentional conduct of an actor, such as the intentional deprivation of the applicant of appropriate healthcare.
The actor requirement may be satisfied in specific cases of denial of healthcare, such as in the case of women denied access to healthcare due to not being accompanied by a mahram, not wearing a hijab, or not being allowed to be seen by a male healthcare professional, or in the case of some persons with physical disabilities or mental health problems, who may experience stigmatisation. In such cases, a nexus to a reason for persecution may also be substantiated and refugee status may be granted. If nexus to a reson for persecution is not substantiated, Article 15(b) QD would apply.