At around midnight on the last night in August, a powerful earthquake destroyed homes and villages in Afghanistan – but the Taliban-controlled government’s restrictive policies have exacerbated the suffering of women and girls caught in the disaster.

Women and girls living in eastern Afghanistan are bearing the heaviest burden after the 6.0-magnitude earthquake killed and injured people and livestock and destroyed homes.

Across the broken villages of Kunar’s mountainous Nurgal district, women and girls were trapped inside damaged homes or in flimsy shelters.

Many did not receive medical care as health workers in the area are men. Strict Taliban rules on gender interaction forbid females from being treated by male health workers – either entirely in some states or only in the presence of a male relative in others. 

“Many women survivors were left untreated because male rescuers could not examine them and female health workers were not available,” Fasihuddin Mukhlis, a local aid volunteer in Kunar, told Health Policy Watch.

“Amid the unfolding chaos, (women and girls) were just silently suffering and waiting for help,” he said.  

There were 1,992 fatalities, 3,631 injuries, and 8,489 houses were destroyed, the United Nations International Organization for Migration (IOM) reported this week.

Lack of women doctors

The World Health Organization (WHO) estimates that about 90% of the health workforce in quake-hit provinces are men, with the number of female doctors and midwives shrinking each year under Taliban restrictions.

Last December, Taliban leader Hibatullah Akhundzada issued a directive banning women from studying at medical institutions. Since December 2022, women have been excluded from universities and for the past three years, girls have been excluded from secondary schools.

Ironically, some aid agencies reported being asked to provide female health workers to assist in the aftermath of the earthquake, according to NPR.

However, the Taliban ignored appeals from the UN and WHO to ease its restrictions to enable that female aid workers to operate in emergency zones.

Dr Mukta Sharma, WHO’s deputy representative in Kabul, confirmed that in the initial phase of rescue and relief operations that there were no female doctors who could treat long-term injuries. 

“A very big issue now is the increasing paucity of female staff in these places,”  Sharma told Reuters.

For survivors like 22-year-old Zar Mena, pulled from the rubble after losing her husband and two children, the consequences were devastating. She suffered shrapnel wounds across her legs and back but waited days for treatment.

“She was so shocked and anxious, seeing only men around. Now, she doesn’t have any other family members left. I, along with some aid workers, moved her to a safer place,” her uncle, Hejran Ullah, told Health Policy Watch via phone.

“Had a female doctor been present, the treatment would have been immediate and her recovery less complicated,” he added.

The WHO estimates that at least 11,600 pregnant women were caught up in the quake, which affected districts across Kunar, Nangarhar, Laghman and Nuristan provinces

Afghanistan already has the highest maternal mortality rate in Asia and without sufficient female doctors and midwives, many pregnant women are delivering their babies in unsafe conditions.

Afghan media outlets have reported that pregnant women have died in hospitals due to a lack of female medical staff and facilities.

Taliban officials insist that women’s rights are respected “in line with Islamic law,” but it has refused to change the requirement that women may only travel with a male guardian.

Aid groups say this translates into real harm as widows cannot leave home without a surviving male relative, hospitals lack facilities for gender-segregated care, and girls drop out of school if fathers or brothers are lost.

Local media report that across Afghanistan, households with women heads often face debts and destroyed farmland, forcing families to sell assets or arrange early marriages for their daughters to survive.

Before 2021, women made up much of Afghanistan’s primary health workforce. Since the Taliban’s return in August 2021, decrees on female employment and male-guardian rules have sharply reduced the number of female doctors, midwives and aid workers across the country.

Cuts in international aid

“Women and girls are facing not only the immediate devastation but also a long-term disaster if urgent, gender-sensitive assistance is not provided,” said Susan Ferguson, UN Women’s Special Representative in Afghanistan.

Ferguson told a briefing in Geneva that Afghan women themselves had been present in relief efforts “from day one,” making up to 40% of some assistance teams. 

But funding shortages and Taliban restrictions mean there are far too few female workers in the field. 

Since the Taliban took over in 2021, foreign aid has plummeted. Some 15 million Afghans face “severe hunger”, according to the World Food Programme (WFP). However, the WFP had cut its aid to the country as it is facing a funding crisis.

“Two-thirds of female-headed households cannot afford a basic diet – nearly 20% higher than their male-headed counterparts,” according to WFP Deputy Country Director Harald Mannhardt.

Indrika Ratwatte, the UN’s Deputy Special Representative for Afghanistan, described the situation as “a crisis within a crisis,” noting that 22.5 million Afghans already need humanitarian aid and more than 1.9 million Afghans have been sent home from Iran and Pakistan this year alone.

Taliban face international criminal case

In the earthquake-affected areas, many survivors are living in tents as are those sent home from neighbouring countries. But as winter approaches, their survival is threatened.

UN Women has warned that temporary shelters also expose women and girls to sexual violence and exploitation.

UN Women has launched a $2.5 million appeal to support recovery over the next year.

The Office of the High Commissioner for Human Rights has also condemned the Taliban’s ban on female UN staff entering compounds, calling it unlawful and a breach of Afghanistan’s international obligations.

Earlier this month, the UN resolved to establish an independent investigative mechanism to “collect, consolidate, preserve and analyse evidence of international crimes and the most serious violations of international law, including those that may also amount to violations and abuses of international human rights law, committed in Afghanistan, including against women and girls”.

The purpose is to prepare for independent criminal proceedings against the Taliban government.

Richard Bennett, UN Special Rapporteur on Afghanistan, described the resolution as “a decisive step to ensure that those responsible for serious international crimes will be held to account.”

Image Credits: UN Women, Ahmadi/ UNICEF, International Organization on Migration.