Afghanistan | Four Years on From August 2021
Four years since August 2021, peace in Afghanistan has meant a formal conclusion to war, but not to its consequences.
Four years have passed since the international community withdrew from Afghanistan in August 2021.
In this time, the country has witnessed:
- The deepening of a profound economic crisis
- The population’s continued impoverishment amidst widespread unemployment and near-total bans preventing women from working, except in healthcare
- The collapse of a defunded and depleted health system
The situation is unlikely to improve, due in part to the lack of international recognition of the de facto authorities, the Trump administration’s 2025 decision to cut funding to the United States Agency for International Development (USAID), and the international community’s increasing disinterest.
The aftermath of forty years of conflict remains evident in the wards and waiting rooms of EMERGENCY’s hospitals and clinics across the country.
- Violent injuries from landmines and other unexploded ordnance, bombings, stabbings and shootings are regularly treated at the Surgical Centre in Kabul
- Admission criteria have shifted in Lashkar-Gah and Anabah, where the wards are filled with the victims of road traffic accidents, non-communicable diseases and malnourished children
- Women in increasingly worse conditions arrive at our Maternity Centre in the Panjshir Valley
“Afghanistan is the litmus test for what remains after decades of war: 22.9 million people – over half the population - in need of humanitarian aid, damaged infrastructure, limited access to healthcare, human rights compromised. But in the newer generations of young doctors, nurses and trainees, we still see hope for the future.”
Dejan Panic, EMERGENCY's Country Director in Afghanistan
The link between economic collapse and worsening health conditions
In its latest report on Access to Emergency, Critical, and Operative Care in Afghanistan (June 2025), EMERGENCY centres the perspectives of more than 1,600 Afghan patients, caregivers and healthcare workers across 11 provinces.
- More than 70% of respondents had no access to free or affordable care
- Three out of five could not afford treatment and often went into debt for healthcare services by borrowing money or selling their assets
- One in four were forced to postpone or cancel a surgical procedure due to costs
A new health burden
With the end of hostilities, new health needs have emerged. Cases of non-communicable diseases are increasing, from chronic conditions that require long-term treatment to acute illnesses that are often neglected due to a lack of economic resources or access to transport.
Kabul
At the Kabul Surgical Centre, 50% of patients are still considered “war-wounded”: they arrive in the emergency room with injuries from stabbings – which account for half of all violent injuries treated – shootings, explosions or landmines.
Violence and crime are the consequences of a war that has left the country riddled with weapons, unexploded ordnance and poverty.
Farid, 10 years old, lives in Kabul with his parents, younger sister and three older brothers. One day, his parents took the family on a trip out of the city, near a river. After lunch, Farid went for a walk and found an old piece of white metal. For fun, he hit it with a stone, causing an explosion that injured his left hand. It was a landmine. His father took him straight to EMERGENCY’s Kabul Surgical Centre, where Farid underwent an operation to treat the wounds on his hand.
"We see victims of robberies and assaults, family disputes, shootings. In 2025, 75% of all patients treated for landmine injuries at our Surgical Centres in Kabul, Lashkar-Gah and Anabah, have been children who were just playing."
Dejan Panic, EMERGENCY's Country Director in Afghanistan
Lashkar-Gah
The Lashkar-Gah Surgical Centre remains the major trauma hospital for Helmand province, where for years fighting and war-related injuries were dominant. Today, approximately 80% of admitted patients are treated for civilian trauma injuries, often caused by road traffic accidents, which have become frequent since 2021 as a consequence of greater mobility across the country and poor road maintenance.
Rohullah arrived with a deep stab wound in his abdomen caused by a kitchen knife. He was injured during a family dispute over an unpaid loan. He is married with four children, living in Kapisa, Panjshir. Due to the severe economic crisis, he is not employed. Immediately after the injury, he was taken to an emergency room not far from his home, where he was stabilised and then referred to EMERGENCY’s Surgical Centre in Anabah – one-hour away by car – where he underwent a laparotomy to suture his wounds.
Anabah
The increasing numbers of malnourished patients are being fuelled by poverty and food insecurity. In the most critical situations, maternal and neonatal malnutrition result in underweight babies, recurrent infections, and issues with mental and physical development, with long-term consequences.
In 2025, 20% of the children admitted to EMERGENCY’s Surgical and Paediatric Centre in Anabah have been malnourished.
"Women are often hesitant to disclose their health problems until the situation becomes serious, and their preference or obligation to be treated by women healthcare workers further reduces the options available to them. We continue to see mothers dying in childbirth because they do not reach the hospital in time, or because of serious complications that could have been avoided. Many pregnant women suffer from serious nutritional deficiencies that compromise safe, healthy pregnancies and childbirth."
Keren Picucci, gynaecologist at EMERGENCY's Maternity Centre in Anabah
Zahra, nine months old, arrived at EMERGENCY’s Surgical and Paediatric Centre in Anabah with acute malnutrition, severe pneumonia and heart problems. She was brought to the hospital by her aunt, because her mother died while giving birth at home due to excessive blood loss. The family comes from a remote village in the Panjshir valley, a few hours from the hospital. Upon returning home, she contracted a new infection: the immune systems of malnourished children, as well as their mental and physical development, are severely compromised.
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Training local healthcare workers
We continue to train local healthcare personnel, including women. Over 97% of all medical, nursing and non-medical staff employed in EMERGENCY’s facilities across the country are Afghan, 23% of whom are women.
"The next generations are our only real hope. We want to continue training young men and women who are capable of caring for their country. To do this, it is essential that everyone, including women, can have their place in society again, and that the international community does not abandon Afghanistan by cutting funding or remaining silent."
Dejan Panic, EMERGENCY's Country Director in Afghanistan
Samir is from Ghazni province and moved to Kabul at the age of 18 to study nursing. He has two wives and a son with disabilities. After graduating, he worked for 10 years in a government hospital. Five years ago, he applied to work at EMERGENCY’s Kabul Surgical Centre. When he was accepted, he was overjoyed. For Samir, working at this hospital is very important because it maintains high health standards and provides free care to the Afghan people:
“What impressed me most was the training I received during my first two years. It is very important to continue learning, even after you finish your university course.”
EMERGENCY’s Activities in Afghanistan
EMERGENCY began working in Afghanistan in 1999 and today is present with Surgical Centres in Kabul (since 2001) and Lashkar-Gah (2004), a Surgical-Paediatric Centre in Anabah (1999), and the Anabah Maternity Centre (2003).
The NGO also operates a network of more than 40 First Aid Posts and Primary Healthcare Centres throughout the country, alongside a 24/7 ambulance referral service.
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