No Woman Left Behind: Exceptional Efforts Increase Health Care Access for Afghan Women

Giyan, 12 August 2022 – When heavy rains fall in Afghanistan, roads are regularly blocked. However, bad weather conditions rarely stop the mobile health teams of the International Organization for Migration (IOM).

To tend to the communities most affected by the 22 June earthquake, the health teams drive their loaded vehicles through riverbeds, over hills, through valleys and over mountains. Sometimes, members of the health teams must find an alternative way to reach remote villages on foot. Since the beginning of the humanitarian response to the recent earthquake, IOM’s health teams have been camping in the humanitarian hubs built by IOM.

In a green clearing, just below a small hamlet affected by the earthquake, they spread out. IOM mental health and psychosocial support (MHPSS) staff set up their blue tents to organize the sessions with children on one side and women on the other, while tables are positioned around the clearing to listen to the men. Community members have identified psychological support as their key need.

Members of the health team descend the hill, conducting medical examinations in tents. Consultations with doctors are organized on one side while a mobile pharmacy is deployed on the other side.

“Sayda, a 10-year-old girl, lost vision in her left eye after [the ceiling] fell on her. When I first saw her, she was still in shock, she looked tired, and was a bit confused, with no one by her side. She lost two members of her family, was very scared and mentioned suffering from headaches and nightmares. She won’t even enter rooms, as she is worried that the ceiling will fall again,” explained Setayesh, an IOM MHPSS counsellor.

“The majority of people living between Paktika and Khost regions are in urgent need of emergency care. Counsellors are also needed because the survivors are severely affected,” she added.

Badam, a 32-year-old father, described how aftershocks continue to occur in the area and fuel the fear of the people of Giyan. “When the shaking started again, I ran to the tent and threw myself on the ground. I thought it was starting all over again when we already had nothing left,” he recalled. “These sessions are the first time that we learned about and discussed our feelings and how to process what happened.”

Setayesh is organizing a session with the children of the village, to offer them an opportunity to talk about their experiences, their feelings, their dreams and lives after the disaster. The children then draw what they would like to be when they grow up and laughter breaks out as everyone compares their drawings.

Together, they are making small paper boats containing all their painful thoughts which they place on a small stream in the middle of the clearing. The boats sail downstream while the rest of the village watches the event, silently.

At the same time, a car arrives on the scene. A woman is sitting inside but cannot get up because of high blood pressure. Doctors rush to assist her. She has been suffering at home for days.

While men and children can often travel to receive much-needed medical services, many women report not being able to receive regular medical care due to their lack of access to health facilities, as their movement is often restricted.

The mobile nature of IOM's health teams allows them to serve women directly in their homes. However, access remains complicated, and the urgency to assist is a race against time given the upcoming winter season.

In Paktika province, rumours, misconceptions and lack of accurate information about humanitarian services present another challenge in accessing the community – especially women.

“The male heads of households and most of the family members have a misconception that services being provided by humanitarian actors come in exchange  for sharing the women’s pictures with males or non-Muslims and uploading the pictures on the internet. Meanwhile, some community leaders also thought that services were mostly linked to domestic violence cases, and it would have a negative impact on their lives that might lead to family conflicts,” says Dr. Nadia Hakim, part of IOM's MHPSS team.

Since August 2021, accessing basic health care has been carrying more risks for women in Afghanistan. Many suffer in silence from various diseases while being prevented from seeking the necessary medical support. Women are disproportionately impacted by barriers to accessing health services due to restricted decision-making and mobility, as well as gender norms that prohibit them from interacting with anyone outside of their family members. As a result, most of the services are received by men, and women are not part of decision-making processes.

This sentiment was shared by Badam, who explained, “When they asked to see the women, I didn't agree with the IOM staff imposing their values and trying to change our culture. I was not comfortable with women attending sessions and being influenced.”

IOM’s humanitarian responses are adapted to the cultural context within each country and region. Mindful of how the provision of services such as counselling sessions may be perceived among the community, MHPSS counsellors in Afghanistan are meeting with community leaders to explain the aim of humanitarian activities. Male community members are invited to psychoeducation and community awareness sessions on health and mental health, and support group sessions are organized for male community members.

Each year, freezing winter temperatures, especially in Afghanistan’s mountainous regions, increase respiratory infection outbreaks including pneumonia and asthma. For IOM’s mobile health teams, the upcoming cold season could create major challenges in reaching communities. Despite all the challenges winter presents, IOM’s mobile health teams will work around the clock to ensure that timely, life-saving care and treatment can be offered in hard-to-reach locations.

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