Badakhshan, 17 October 2023 – In Afghanistan’s northernmost province, at the end of the Silk Road corridor, the scent of winter has begun to fill the air. The periwinkle-colored Kokcha River is shrinking as glaciers appear in the high mountains. Harsh winters and regular snowstorms isolate this region from the rest of the country, and the hard-to-reach rural villages high in the mountains are often cut off from Faizabad, Badakhshan province’s capital.

For the past ten years, the International Organization for Migration's (IOM) mobile health teams have been taking the slopes, climbing up the mountains to provide health care and raising awareness on mental and physical health. For ten years the teams have ensured health service coverage in remote areas and in targeted isolated districts (known as "white zones") across the country, including for nomadic populations.

As the country’s de-facto authorities (DfA) have systematically been restricting women’s rights and freedoms since seizing control in August 2021, their access to basic services such as health care has also shrunk. A recent summary report on country-wide women’s consultations in Afghanistan published jointly by UN Women, the United Nations Assistance Mission in Afghanistan, and IOM has found that women are experiencing severe financial and mental hardships. As a result, the services of IOM’s mobile health teams have become even more crucial.

 Villages in mountainous Badakshan can be particularly difficult to reach. Photo: IOM/Léo Torréton

Shaima, a 45-year-old mother of two, lives in one of the remote villages where IOM’s mobile health teams regularly visit.

After having two children, Shaima and her husband had moved from Iran to his village in Northeastern Afghanistan. At the age of 14, she was forced to marry an Afghan man ten years older.

“I’ve never had the same freedom as in Iran. I've never really been accepted by my in-laws or the people around me, but I've been forced to stay here, stuck and depressed, and with the new rules, my husband barely lets me go out and is harder on me,” she explains.

Against the backdrop of a systematic exclusion of women from public life and a protracted economic crisis, conflicts within families have increased. Women report deteriorating relationships with male family members. As a result, the mental health of many Afghans has deteriorated. Two-thirds of women report psychological problems, and a growing number of women are experiencing increased feelings of isolation, anxiety, and depression.  

“My son turned 17 and left, and my daughter got married and I felt completely alone,” Shaima says. “I couldn't sleep, I had constant headaches and anxiety attacks all the time. One day, on my way back from the bazaar, I saw the doctor's sign and thought I'd better go and see him for some advice. But I couldn’t enter alone. At the same time, I was ashamed, because if anyone saw me, they might think badly and that I was crazy, and things would have been worse in our village. So, I couldn't bring myself to go and see the counsellor,” Shaima confesses.

Shaima eventually saw a counsellor when IOM’s mobile health teams came to her village. Having regular headaches, her husband suggested that she go and see the IOM doctors, not thinking it was related to her mental health. Seeing that she was no longer washing herself, the doctors immediately referred her to a counsellor, whom she has now been seeing for a year. 

For a year now, following awareness sessions in her community, Shaima has been seeing a counsellor regularly. Photo: IOM/Léo Torréton

Psychological suffering and struggles are a reality in Afghan communities, but mental health has been taboo for decades. Community members suffering from mental illnesses, severe psychological stress or depression are hidden by their families, or even stigmatized and excluded within their community.

“They call it by different names, which can even be madness or stupidity, and this seriously affects people with mental health problems,” explains Palwasha, a 38-year-old mother from Faizabad and an IOM counsellor. 

Mobile health teams aim to normalize health and mental health struggles within communities to enhance the well-being of Afghans across the country. However, since January 2023, the country’s DfA have significantly reduced the number of mobile health teams permitted to operate in favor of static health facilities. In May, humanitarian organizations counted 730 mobile health teams; to date 398 mobile teams have been deployed, with a major reduction expected by December. The reduced number of mobile health teams significantly impacts community activities, particularly for mental health.

IOM's Mental Health and Psychosocial Support (MHPSS) programme in Afghanistan provides psychosocial and mental health support to migrants, returnees, and host communities across the country.

Many different activities are organized for participants of the MHPSS sessions, such as drawing their thoughts and problems. Photo: IOM/Léo Torréton

On the right bank of Faizabad, overlooking the river, sits the IOM Basic Health Centre, one of six set up in Badakhshan. In the morning, the centre is bustling with patients. Every day, as many as 200 people visit the centre for medical or therapeutic consultations.

In a cozy room on the second floor of the Health Centre, white curtains filter the light and Palwasha practices her group session on a local rug. After holding hands while performing breathing exercises, Palwasha places a string on the rug representing a lifeline, with flowers representing their wishes and stones for their pitfalls. Each of the participants places the stones and flowers in the order representing their story.

In Palwahsha's session, participants take turns explaining their life story by placing flowers and stones along a rope. Photo: IOM/Léo Torréton

“At least here, they can share their pain with a person that is kind, that they feel comfortable with and keep confidentiality,” says Palwasha.

“When possible, I come here and I do feel good about it. But next month it will be winter, it will be too complicated to come here,” explains Shaima.

Each year, freezing winter temperatures and heavy snowfalls, particularly in the mountainous regions of Afghanistan, cut communities off from cities and thereby access to services, such as health care. As a result, women living in hard-to-reach places like Shaima will find it more difficult to access MHPSS services.

Mental health is a universal human right for all. Without mobile health teams, IOM and humanitarian partners cannot reach the most vulnerable across Afghanistan. Mobile health teams must continue to operate to ensure equal access to a comprehensive range of mental health care services for people across Afghanistan.

This story was written by Léo Torréton, Media and Communications Officer, IOM Afghanistan. For more information, please contact:

SDG 3 - Good Health and Well Being
SDG 5 - Gender Equality
SDG 10 - Reduced Inequalities