Sabera Turkmani, Sheena Currie , 2025-04-16 09:41:00
- Sabera Turkmani, research fellow1,
- Sheena Currie, former senior technical adviser and technical consultant2
1Global Women’s & Newborn Health Group, Burnet Institute, Melbourne, VIC, Australia
2Afghan Midwives Association, Kabul, Afghanistan
- Correspondence to: Sabera.turkmani{at}burnet.edu.au
Afghanistan’s health system is on the brink of disaster. The system heavily depends on external funding, and 80% of its health facilities face closure owing to a severe funding shortfall.12 Afghanistan remains one of the most protracted humanitarian emergencies in the world. The population is grappling with entrenched poverty, climate induced crises, and barriers to women’s equality and participation in public life following the political transition in August 2021 when the Taliban regained control of the country.3 If international donors do not intervene to fill funding gaps, Afghanistan’s fragile health system will crumble, with deadly consequences.
The collapse of the previous government resulted in the suspension of international development assistance, which previously accounted for 75% of public expenditure, including maintenance of the public health system.3 The Basic Package of Health Services was developed in 2003 with support of multilateral agencies to improve access and deliver effective, equitable, and sustainable primary care services for all, but especially for women and children.4 Over the past 20 years, international support helped Afghanistan make substantial strides towards universal health coverage in extremely challenging circumstances. By 2020, over 2000 health facilities were functioning nationwide, and 87% of the population could reach a health service facility within two hours.5 This was a remarkable improvement in access and advancement of gender equity.
However, donor fatigue and changing geopolitical focus have created a funding crisis that threatens to erase the progress of the last two decades.1 Funding cuts, notably the recent United States Agency for International Development (USAID) cuts, have precipitated the closure of health facilities across the country, severely compromising access to essential health services for millions of people. This diminishing multilateral support, accelerated by the current US political environment, led to withdrawal of funding from United Nations (UN) agencies, including the UN Population Fund and the World Health Organization (WHO).167 Globally, USAID has cut $877m (£666m; €770m) from maternal and child health activities, with Afghanistan losing over $200m across all sectors.8 Large projects led by non-governmental organisations that provided much needed technical support to the health sector have stopped. This is leading to, for example, disrupted contraceptive supplies, reduced coverage and quality of maternal and child healthcare, and weakened health institutions.
The 2025 Afghan Humanitarian Needs and Response Plan highlights frequent communicable disease outbreaks, a high malnutrition rate, and poor access to safe water and sanitation. The most severe needs are in underserved areas and among vulnerable groups, particularly women, children, adolescent girls, and displaced populations.9
Women and children are on the forefront of the crisis
Afghanistan’s severely under-resourced and fragmented health system, political turmoil, rights restrictions, and poverty are contributing to alarmingly poor maternal and child health and nutrition. The impending collapse of health facilities represents a profound regression in the nation’s social and developmental trajectory, particularly in gender equity and women’s rights.
Since 2020, the participation of women in the healthcare workforce has been increasingly suppressed. Female health professionals face systematic restrictions, harassment, and, in many cases, complete exclusion from employment—prompting an exodus of skilled workers from the country.10 Decades of progress towards universal health coverage, equity, and development are being jeopardised.110
Sustained investments by UN agencies, USAID, and other development partners in public healthcare—most notably through the education and deployment of midwives—had previously contributed to a notable decline in maternal mortality.10 But recent UN projections forecast a substantial rise in maternal and neonatal deaths between now and 2028 directly linked to the withdrawal of funding and disruption of primary care.2 Pregnant women will give birth without the presence of skilled providers or access to emergency obstetric and newborn care.101112
Routine immunisation services and paediatric care have broken down. A deadly measles outbreak in early 2025 resulted in a substantial number of child fatalities.13 Afghanistan also has one of the highest child stunting rates globally—affecting about 45% of children under five years old—and widespread malnutrition.14
A call for urgent international action
Afghanistan faces a life-and-death emergency that demands immediate and coordinated action from the international community.
International donors, including governments, private donors, and philanthropic institutions, must act urgently to secure emergency financing. This funding could help prevent the closure of health facilities by providing financial support for frontline actors operating on the ground, including Civil Society and grassroots organisations.
While short term, stopgap funding is critical, and it must transition into sustained financial support into the future. Strengthening cross sectoral collaboration, headed by mechanisms like the Health Cluster led by WHO, is essential to ensure coordinated delivery of services despite political constraints.
Maternal and child health services must be preserved, which includes funding and safeguarding emergency obstetric and newborn care, reproductive health, and child immunisation programmes. Female health workers, especially midwives and nurses, need support and protection to continue their lifesaving work. The bans on women’s education, particularly in healthcare, threaten health and must be reversed through sustained diplomatic pressure and advocacy.
Policymakers must take a pragmatic approach to ensuring service delivery in the face of ongoing political restrictions. This approach includes investing in community based healthcare models that rely on local infrastructure, expanding midwife-led care, and exploring digital health and telemedicine options to reach remote populations.
Sustaining Afghanistan’s healthcare system is a humanitarian imperative and strategic investment in international stability and disease prevention. Afghanistan needs a realistic and forward-looking strategy to build resilient, equitable, and inclusive health systems.