Afghanistan’s fragile healthcare system is at breaking point under the strain of hundreds of thousands of Afghans deported from Iran and Pakistan over the past few months, many in urgent need of medical care.

This follows the decision by both Pakistan and Iran to repatriate Afghans, even those with refugee status in the case of Pakistan. Earlier this year, the UN High Commission for Refugees estimated that there were over 3,5 million Afghan refugees in Iran and 1,7 million in Pakistan.

Between January and 13 August, some 1.86 million Afghans have been returned from Iran and over 314,000 from Pakistan, bringing the total returns to over two million people over the past eight months alone.

At Afghanistan’s Islam Qala border crossing with Iran, the human cost is stark: toddlers with sunken cheeks and dehydrated skin, elders bent over in coughing fits, heavily pregnant women staggering through the dusty camps, some giving birth amid chaos.

For the past many months, overwhelmed border Afghan health teams have confronted the same cycle of illnesses almost daily. Health workers say the illnesses surging through the camps are a predictable fallout of forced displacement colliding with an already overwhelmed healthcare system.

“Commonly reported health issues among returnees include trauma, malnutrition, infectious diseases such as acute watery diarrhoea and acute respiratory infections, and mental health problems,” according to the World Health Organization (WHO).

The sweltering camp for deportees reeks of over-flowing latrines and antiseptic, a grim reminder that these makeshift checkpoints have become the country’s first, and often only, line of defense against disease outbreaks.

In a torn tarpaulin’s thin shade, Zaher Qayumi, a father of five from Badghis Province, shields his children from the relentless sun. Just 10 days earlier, after five years in Iran, his nine-member family was abruptly expelled from Tehran. His children suffer from diarrhea and dizziness, their faces flushed with heatstroke.

“The situation here is terrible. Medicines, even for simple pain or diarrhea, are almost impossible to find,” Qayumi told Health Policy Watch. 

“Iranian authorities are expelling everyone. The elderly and children suffer the most. People have no means and resources. Everyone is sick.”

It is extremely difficult and complicated to navigate for returnees to access what little public health services there are, and Qayumi’s words reveal the human face of the slow-motion public health emergency playing out across the desert border.

Plea for immediate assistance

Stephanie Loose, UN Habitat head for Afghanistan, told a recent press briefing in Geneva that families are arriving after days of travel in blistering heat, enduring overcrowded tents and nights without enough food, water, or shelter. 

“The real challenge is still ahead of us… people need access to basic services, to water, to sanitation, and overall, they do need livelihood opportunities for having a long term perspective and for also allowing them to, you know, lead their lives in dignity and to support their families,” said Loose.

Afghanistan’s humanitarian system is in free-fall. The country’s 2025 aid plan, valued at around $2.4 billion, is only 12% funded, according to the UN.

Aid agencies warn they are already cutting food, health, and shelter support, leaving millions at risk. UN officials are urging donors to act immediately, stressing that without swift contributions, lifesaving operations could collapse, plunging vulnerable communities into further desperation.

“At [Islam Qala’s] zero-point clinic, returning families arrive dehydrated, malnourished, and sick with respiratory and diarrheal diseases,” said Dr Noor Ahmad Mohammadi, head of the WHO-supported clinic. “We treat hundreds of children daily, most never vaccinated. Immediate action is critical to prevent rapid outbreaks.”

The clinic provides outpatient care and polio vaccinations, seeing roughly 200 patients and vaccinating 100 children under 10 each day. But with thousands crossing daily, their modest resources are overwhelmed.

UNHCR has expressed concern that many Afghans, regardless of status, “face serious protection risks in Afghanistan due to the current human rights situation, especially women and girls”.

Forgotten crisis

Afghanistan’s health system, hollowed out by decades of conflict, chronic underfunding, and the exodus of medical professionals following the Taliban’s rise to power in 2021, was already on the brink of collapse before the deportations began.

“Afghanistan is facing a deepening humanitarian crisis fuelled by a deteriorating human rights situation, prolonged economic hardship, recurring natural disasters and limited access to critical services. The large-scale returns of over 2.1 million Afghans from Iran and Pakistan in 2025 have further exacerbated the situation,” said UNHCR in a statement.

Aid agencies warn that as many as three million Afghans could be pushed back by the year’s end, raising the risk of a preventable public health disaster without urgent scale-up of clean water, vaccinations, and emergency care.

“The crisis is forgotten by much of the world,” said Nicole van Batenburg of the International Federation of Red Cross and Red Crescent Societies in a statement. “Local health systems are simply not equipped to cope.”

Many families were given mere hours to leave homes in Iran or Pakistan, abandoning belongings, medication, and any sense of security. Children arrive with fevers, diarrhea, scabies, and trauma; parents carry the weight of uprooted lives.

By spring 2025, more than 200 health facilities across Afghanistan had closed or suspended services due to lack of funds, the WHO reports. 

Dr Edwin Ceniza Salvador, WHO’s Afghanistan representative, warns that 80% of supported health services could shut down without fresh funding.

“Mothers are unable to give birth safely, children missing lifesaving vaccines, and more preventable deaths every day,” he said.

In a corner of the border camp, Zohra*, a 28‑year‑old pregnant woman, lay on a thin mat, clutching her stomach. She was seven months pregnant when her six-member family was forcibly expelled from Mashhad in Iran.

“We were told to leave within hours. I couldn’t procure the medicines I needed even before this ultimatum as I feared arrest going to the hospitals,” she said in a faint voice. “The journey was long and hot. I thought I would lose my baby on the road.”

By the time she reached the Afghan border, Zohra was severely dehydrated and showing signs of early labour. Border clinic staff managed to stabilise her, but they warned that complications could turn deadly if she cannot access a proper hospital in time.

“I wish my daughter comes to this world alive and healthy, but I worry what kind of place my children would live and grow in Afghanistan”, Zohra said.

An earlier wave of deportations from Pakistan has already strained the Afghan healthcare system. Since late 2023, tens of thousands of Afghans, many of whom had lived in Pakistan for decades, have been forced to cross back to Afghanistan with little more than what they could carry.

The UN estimates that in this year alone, at least 314,000 Afghans had been returned from Pakistan by the end of July, often arriving with untreated chronic conditions, respiratory infections, and severe malnutrition, while vaccination records are frequently missing.

No medicine or food

Halima Bibi, an elderly diabetic woman, had lived as a refugee in Pakistan for years before she was expelled from the outskirts of Islamabad with her son’s 10-member family. Her health situation embodies the health crisis in Afghanistan.

“My feet are swollen, and I can barely stand,” she said. “I haven’t had my medicine or proper food for days. We had to wait anxiously for days to get an extension for our stay in Pakistan, but they forced us to leave without any consideration or time to prepare.” 

Across Afghanistan’s border, in provinces like Nangarhar where Bibi lives, clinics and hospitals are swamped, lacking the resources to meet the urgent needs as well as management of chronic diseases like diabetes. 

Halima is fearful that insulin medicine would not be easily available for her in Afghanistan and this will cause her serious health complications. 

The Taliban’s deputy minister for refugees and repatriation, Abdul Rahman Rashid, has publicly rebuked host countries for the mass expulsions, describing the removal of Afghans as a “serious violation of international norms, humanitarian principles, and Islamic values.”

“The scale and manner in which Afghan refugees have been forced to return to their homeland is something Afghanistan has never before experienced in its history,” Rashid told a press conference in Kabul last month.

Back at Islam Qala border crossing, the transit clinic operates 24/7 where the returnees arrive with health conditions that are manageable in a well-resourced hospital, but often life-threatening here. Women and girls face particular concerns over movement restrictions and access to healthcare.

As summer heat intensifies and thousands continue to arrive daily, aid workers warn the window to prevent a full-blown humanitarian and public health catastrophe is closing fast.

Image Credits: UNHCR/ Oxygen Empire Media Production, UNHCR, WHO Afghanistan.