A doctor says that many of her new patients are schoolgirls who have lost hope.
Photograph: Sam French/ Development Pictures. The image is not of the individual interviewed.
Afghan Witness changed the name of the individual interviewed.
In September 2021, following the Taliban’s takeover of Afghanistan, the World Health Organization (WHO) described Afghanistan’s health system as being “on the brink of collapse”. Several months later, NPR reported that medical staff weren’t being paid and that hospitals were running out of medicine and unable to heat patient rooms. Women’s healthcare has been particularly impacted; maternal and neonatal health care is eroding, the Wall Street Journal (WSJ) wrote in July – a result of “hunger, fleeing hospital staff and curbs on women’s freedom”.
Fatana, not her real name, is an obstetrician in a private hospital in Kabul. While the Taliban have barred most women in Afghanistan from employment, as a healthcare worker, Fatana has been able to continue working – though she says her life has changed in many ways since the group’s return to power.
According to the doctor, most of her patients are now the newlywed wives of Taliban members.
"I see many Taliban members who are over 50 years old married to young women [who are] 20 or 18 years of age," Fatana tells Afghan Witness (AW), adding that many of her patients come to her with issues relating to sexual health. "It is hurtful mentally for me, as a female doctor, to deal with these patients.”
According to human rights organisations, forced marriage is one of several factors limiting women’s access to healthcare, especially reproductive services, and child marriage in particular is linked to early and closely spaced pregnancies, which put both mother and child at risk of death.
When the Taliban returned to power in August 2021, some described the group as ‘Taliban 2.0’, – supposedly a modernised, more inclusive version of their 1990s rule. However, Fatana says the Taliban have not changed. She has witnessed Taliban members marry very young girls who resemble their daughters or granddaughters. With high schools closed for Afghanistan’s teenage girls and women’s access to higher education and employment restricted, Fatana says it is “utterly difficult” to watch women “lose all their dreams".
Even though Fatana’s job provides some semblance of normality, signs of the Taliban’s rule are visible everywhere, she says. The hospital guards, previously members of the former Afghan army, have been replaced by Taliban fighters.
"The way they look at female hospital employees is like they want to kill [them] and get rewarded for it," Fatana says, panic in her voice. “There is no hope in this situation, I wanted to continue studying, but I don’t want to do it now.”
Fatana says she feels she no longer has a choice on how to dress, either. In May, the Taliban’s supreme leader ordered the country’s women to cover their faces in public.
"I used to wear clothes that I liked, but now I fully cover my body because I am afraid – I see Taliban every day at the doorsteps of the hospital where I work," she adds.
However, Fatana stresses that she is one of the lucky ones: the hospital she works in is funded by foreign aid, and therefore, her salary and job have not been disrupted. When the Taliban took over and foreign reserves were frozen, some full-time doctors and other healthcare staff were not paid their salaries. Earlier this year, the International Committee of the Red Cross (ICRC) took over salary payments for thousands of health staff across Afghanistan. Fatana blames the political and economic situation for the exodus of medical experts and staff.
"A heart surgeon in our hospital could not stay and left the country – his patients were crying," Fatana recalls. At this point in the conversation, her thoughts turn quickly to August 15, 2021 – the day Kabul fell to the Taliban: "our hopes and dreams were all buried,” she says. “My eyes are full of tears every time I remember that dark day.”
The toll on mental health
The situation looks bleak, but Fatana finds it hard to imagine an alternative – she knows how important her job is. "If I leave, how can I help my patients?” she replies when asked if she would leave Afghanistan. “I know very well how female patients desperately need female doctors.”
With the Taliban intent on building a society where men and women are segregated, women’s healthcare is one of the few areas where women’s education and employment have continued somewhat – according to the Taliban, female patients should be treated by female staff. However, the Taliban’s educational restrictions on girls and women could impact the number of qualified female doctors and other healthcare workers in the near future, while requirements in some areas that women only travel with male guardians has further limited women’s access to healthcare.
Fatana sees the knock-on effects of these restrictions in her daily work: she says many of her new patients are schoolgirls who lost hope after their schools were closed.
"It is truly painful for those girls,” she says, adding that it is equally hard for their families and the staff who are assessing them. “We cannot do anything.”
Afghanistan had a particularly high female suicide rate even before the Taliban’s return, but media have widely reported how the Taliban’s policies have impacted girls’ mental and psychosocial well-being, with medical professionals in the country warning that they are seeing a rise in depression among teenage girls. As Fatana puts it: “female students are losing their minds”, and healthcare staff feel helpless. She adds that her female co-workers are also struggling with their deteriorating mental health.
"As women, we only want freedom and the right to education,” Fatana says. “If we live in hunger, it's not as painful as being deprived of our rights and living in fear – this situation is a slow and painful death.”
Interview by Afghan Witness