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Afghanistan nightmare: a humanitarian crisis that threatens to dwarf all others

Following The U.S. Withdrawal, Desperation Amid Food And Medicine Shortages


It was the love of her parents that brought Ruqia all the way from northern Afghanistan to a Kabul hospital, as they sank themselves in debt to pay for a last effort to save their starving daughter.

But seeing Ruqia's motionless form in the emergency room, it was hard to believe she was still alive. Her ribs poked from her chest like rows of knives; her head was more of a skull. Where the eyes of an 11-year-old girl should have been, there was only a vacant darkness. And she weighed just 13 kg.

Her condition was complicated by diabetes, said the duty physician, Dr. Farid Ahadi. But the reason she was days from dying was simple. Ruqia's parents Massouma and Hussein could not afford the medicine she needs, or enough food for their whole family.

Their situation was already deteriorating before the cataclysmic events of August, when America abruptly ended its 20-year-long war and the Taliban swept back into power. With the economy foundering, the day-laboring jobs that used to earn Hussein around $3 a day dried up. Now, nearly three months after the U.S.-backed government imploded, their lives have, too. "We've been borrowing money for food," said Hussein. No meat or eggs, just "bread, potatoes and cauliflower," he said. Yes, he nodded shyly, when asked if he and his wife often go without so their other children can eat.

As Ruqia's condition worsened, her parents took her to hospital in the nearby city of Mazar-i Sharif. But doctors said their insulin supplies were exhausted. Critical World Bank funding for Afghan public health services was cut in August as part of a raft of sanctions imposed on the Taliban, led by the U.S. in the wake of its chaotic pullout. Bank officials cited concerns about the impact of Taliban takeover on "development prospects, especially for women." But without alternative funds, hospitals nationwide are now running out of drugs, and staff are working unpaid. 

Dr. Farid Ahadi treats Ruqia, 11, who is suffering from severe malnutrition and diabetes, at the Indira Gandhi Children's Hospital emergency room in Kabul. Her parents, Massouma and Hussein, had to borrow money to travel to the capital and are struggling to pay for her treatment. (Photo by Paula Bronstein)

The last hope for Massouma and Hussein was to borrow more money, to make the trip to the Indira Gandhi Children's Hospital in Kabul. They still had some insulin and a bed in the malnutrition ward, giving Ruqia a chance. Yet in taking this last gamble to save her, her parents have effectively dug themselves further into trouble. With no work, Hussein has no chance of paying off their debt even as the hardest months of winter approach.

The story of Ruqia and her family is a snapshot of the new crisis quietly enveloping Afghanistan. While the fighting is over for now, Afghans instead find themselves squeezed between their new rulers and the U.S.-led embargo. If nothing changes, the United Nations World Food Program predicts around half of Afghanistan's estimated 38 million people will be facing "acute hunger" over the upcoming winter months. More than 3 million under 5-year-olds are also expected to be facing acute malnutrition by the end of the year. "We are on a countdown to catastrophe," warns its Executive Director David Beasley.

The ravages of drought and COVID-19 have combined with the conflict to upend life across the country. But the humanitarian crisis now taking shape is essentially human-made and avoidable -- flowing directly from the policy decisions of the Taliban and the U.S. Each is preparing to blame the other for the early signs of famine that are emerging. Both hold it in their power to avoid further disaster for the Afghan people.

In the meantime, there is one solution in the minds of people across the country, even some Taliban fighters: to get out of Afghanistan. And that includes Ruqia's parents. Except that as he watched Dr. Ahadi adjust the IV in his daughter's arm, Hussein said: "we don't have the money to pay for the journey."

Not enough to go around 

When I visit the children's hospital, there is a crush of people around the outpatient department and the emergency ward, some with more routine problems like broken limbs, but also several severely underweight children. Upstairs in the malnutrition ward, 15 out of the 16 beds were already occupied with emaciated babies and toddlers tethered to drips. You do not see fidgeting children here. They just lie still.

The pinched faces of their mothers told another part of the story. "Mothers are not getting enough to eat, so they don't have enough milk," said Dr. Sayed Sadaat, the hospital's head of diagnostics. Hygiene is also a growing concern, with the hospital seeing an uptick in cholera cases. Two more emaciated babies were brought while we were there. "We will have to set up beds in the corridor," says one of the nurses.

A fall in treatment capacity has coincided with greater demand, leading to longer waits at many Afghan hospitals. The outpatient department at Indhira Gandhi is crowded with parents and children waiting to be seen by health care workers, many of whom have gone unpaid. (Photo by Paula Bronstein)

Downstairs in the emergency room, Dr. Ahadi says: "Every day we are seeing more cases of child malnutrition." And the demand is rising at the same time as the hospital's treatment capacity is sinking. Ironically, the relative peace in Taliban-controlled Afghanistan is also a factor. "Most of our patients came from around Kabul in the past," Ahadi explained. "But now they come from provinces faraway because of better security on the roads."

Drugs are running so short that doctors regularly ask parents to find what they need in unofficial drug markets in the city, a practice that is also rife with corruption. Kabul hospitals like the Indira Gandhi have had some support from UNICEF, but not enough to make up for the shortfall. And from the doctors to the cleaners, no one has received their salaries since mid-July, their last pay day before the previous government collapsed. "We see staff coming in with things to sell to make money,"  said one doctor, "like eggs from their chickens."

Some staff have already stopped showing up. Dedication has a limit, said Dr. Ahadi. "We will leave our jobs, and we will leave this hospital because we have to support our family."

There are already reports of growing starvation in rural districts of western provinces such as Badghis, Faryab and Herat, which have been worst hit by the drought so far -- with accounts of families selling their youngest children to pay for food. But even in the better-resourced capital, the signs of impoverishment and hunger are spreading. 

Going it alone

The embargo is biting Afghanistan in several ways. Most significantly, the U.S. has frozen some $9 billion in Afghan central bank reserves held in U.S. accounts. And along with the Washington-based World Bank cutting off health and development funding, its International Monetary Fund counterpart has suspended loans to Afghanistan on the grounds that the Taliban do not have international recognition. This is throttling the Afghan economy. 

At the Azizi Bank in Kabul, men wait in line to withdraw money from their bank accounts. On top of an embargo imposed by the U.S., the IMF has cut off loans to Afghanistan, triggering a financial crisis. The shortage of money has led banks to limit cash withdrawals. (Photo by Paula Bronstein)

Until now, the economy has always been reliant on foreign aid, but that critical fuel has now been turned off and the car is sputtering on fumes. With foreign exchange deposits blocked, it is becoming ever harder to finance imports. Arrears are rising with no way to pay them off, and merchants are resorting to barter. The value of the Afghani, the Afghan currency, is sinking while prices are rising. The cost of gasoline has doubled since the fall of Kabul, causing knock-on effects on everything else.No one can get paid. There is not enough cash. 

Limits on dollar withdrawals mean long lines every day as customers keep going back."I'm sorry I have to be in the bank queue this morning," said a friend the other day, turning down my request to meet. Making time to line up in the hope of a branch receiving a new cash delivery has become a feature of life in Afghan cities these days. 

There are different exchange rates depending on the age and denomination of the dollar bills. "People don't want to take the 10s and 20s I have because they are not worth as much," says one bank teller, "But I tell them: 'soon dollars are going to vanish altogether.'" And meanwhile, there are signs of lives fraying everywhere.

Pop-up markets where people try to sell household belongings have become a common sight - but with the price they can get for pots and pans, carpets and furniture constantly falling because so many others are doing the same thing.


Over the same past few months, tens of thousands of people displaced by fighting or drought have arrived in the capital, most of them destitute. There has also been a new influx of children from around the country, trying to earn money to support impoverished families in the provinces. Samiullah, a 13-year-old from the northern city of Kunduz, told Nikkei Asia he had arrived in Kabul a month ago because of conditions back home, and was earning a small amount of cash from finding and selling recyclable garbage. There are probably thousands like him across this city of some 5-6 million people.

Samiullah, 13, moved to Kabul to support his family back in the northern province of Kunduz. He makes a little money selling garbage for recycling. (Photo by Paula Bronstein) 

Attempts to fill the gap

Local charities and international agencies such as WFP have been trying to fill the hole left by the withdrawal of foreign aid, organizing food disbursements in conjunction with the Ministry for Refugees and Repatriations, which is now under Taliban control. At one distribution point in west Kabul, 500 families were preselected for a handout of flour, rice, sugar, beans and cooking oil. "I haven't eaten in three days," said Mohammadin, a 45-year-old man who looked like he could be 70, as he sat on his sack of rice, waiting for his name to be checked off a list.

A leg injury he suffered several years ago prevents him from working, but he had been able to rely on friends and neighbors for help. "Now no one has a job," Mohammadin said. "How can they help us?" He had hired a man with a wheelbarrow to carry his allocation to a taxi to take it home. 

A man searches through garbage in Kabul, hoping to find scraps of metal or plastic to sell. Many Afghans are struggling to feed themselves and their families since the Taliban takeover in August. (Photo by Paula Bronstein)

Mohammad Ali Shahab, head of German Aid for Afghan Children, the charity organising the food distribution, said they had given similar assistance to some 4,000 families so far. "As an Afghan I am happy that I can help my people," he said, "even if it is kind of a drop in the ocean."

He was clear in his own mind where ultimate responsibility for the crisis lies: "When they left Afghanistan, the Americans dropped us like a glass and now they are making things worse."

A representative of each family selected for help had to show a stamped card at the compound gate to be allowed inside. But word spread in the neighborhood even before the handout process started, with armed Taliban fighters wielding lengths of thick rubber hose and bamboo poles to push the crowd back.

Even ad hoc distributions like this may not last long. Shahab had borrowed most of the $23,000 cost of the food and transportation, because he could not get enough cash from the charity's own accounts. Businessmen and friends had rallied round, he said, "and when the money comes, I will pay them back."

Sanctions or aid: A balancing act

Reading the signs from Washington, his creditors could be waiting a long time. Late last month, Deputy U.S. Treasury Secretary Wally Adeyemo effectively ruled out any change in policy, including granting access to the frozen dollar reserves.

"We believe that it's essential that we maintain our sanctions against the Taliban, but at the same time find ways for legitimate humanitarian assistance to get to the Afghan people. That's exactly what we're doing," Adeyemo told the U.S. Senate banking committee. The Biden administration has also made clear that recognition for the Taliban's interim government is off the table for the foreseeable future. 

The U.S. government recently pledged $144 million in aid, which it said would be channelled to Afghans "through independent humanitarian organizations."  But even if it is possible to target such assistance without some going to the Taliban -  unlikely - it is no substitute for easing the embargo and resuscitating normal economic activity. 

In a recent statement, Taliban spokesman Zabihullah Mujahid turned up the pressure. "Our message to America is, if unrecognition continues, Afghan problems continue, it is the problem of the region and could turn into a problem for the world."

A major sticking point for the White House was the inclusion in the Taliban administration of several people whom Washington considers global terrorists. Most prominent among them is the leader of the Haqqani network, the Taliban faction whose fighters killed scores of U.S. troops and were linked to the most deadly suicide attacks during the U.S. occupation. So Washington was infuriated when Sirajuddin Haqqani was named as interior minister in the Taliban's interim government. 

But by maintaining its embargo against the Taliban, the U.S. risks "sentencing the Afghan people to absolute misery," says Obaidullah Baheer, a lecturer in peace studies at the now-shuttered American University in Kabul. And all the gains of the past 20 years may crumble in tandem.

 A burqa-clad woman receives a donation of bread from a local bakery in Kabul on Oct. 27. The IMF predicts 55% of Afghanistan's population will face critical food insecurity during the November-March period. (Photo by Paula Bronstein)

Lack of funding is already crippling Afghanistan's previously vibrant media scene, with at least 70 percent of its outlets already closed down. Next to go could be the health sector, warns Dr. Ahadi. "If we don't get help soon, we are going back to 1999," when the Taliban was last in power and Kabul had been ruined by civil war.

Sanctions may also end up backfiring, bolstering Taliban support, Baheer warns. "Being as desperate as they are right now, [Afghans] are going to learn to depend on the Taliban regime."

At the same time, Baheer also faults the Taliban for not doing more to win hearts and minds in urban areas and beyond its core rural Pashtun support base. His background gives his criticism extra credibility. His father was incarcerated at the U.S. prison at Bagram airbase and his grandfather is a well-known jihadi leader now working with the Taliban.  

Baheer says the spate of reprisal killings of people linked to the previous government has been especially damaging - contradicting statements that they would be safe. "It doesn't matter if the central leadership says you have amnesty when your neighbor two doors down has been shot," said Baheer. "Gaining trust is very difficult. Losing it is very easy. And the Taliban have been choosing the easy path since they've come to power."

Sticking point: Women's rights 

One of the benchmarks for easing the embargo that the international community is watching most closely is whether the Taliban will moderate the way they treat Afghan women and girls. The fear is that they will repeat the draconian restrictions on female education and movement that they imposed when they were first in power between 1996 and 2001, under their rigid interpretation of Islamic law. 

The early signs have not been good, with most girls still not going to school. That has prompted frequent protests by women braving Taliban fighters wielding their trademark lengths of rubber hose as batons and their rifles as clubs.

A woman wearing a niqab enters a beauty salon, in Kabul on Oct. 6, where advertisements featuring women's faces have been defaced by a shopkeeper: The Taliban's policy on women's education and other rights remains unclear, leaving many countries unwilling to drop sanctions.    © Reuters

Give us time to provide the right conditions for female education -- this is the message from many Taliban officials on the subject. "We have done so much for women by bringing peace," argues Qari Abdul Matin Rahimzai, head of the Kabul office for the Ministry of Refugees. He was overseeing the food distribution in west Kabul, but was keen to talk about other issues as well. "It used to be that every day, women were receiving the bodies of their dead husbands, or they were injured. Now that is all over, thanks to us. Next we need to sort out the economic situation, and then it will be possible for girls to go to school everywhere."

It is not the monolithic clampdown that many expected when the Taliban swept into Kabul in mid-August. While female staff have been dismissed from government jobs, including in the now-disbanded Ministry of Women's Affairs, some women continue to work. And you still see many going out alone in full view of Taliban fighters - not in head-to-toe blue burqas but with long coats and a simple scarf to cover their head. But for those with longer memories, this looks like window-dressing aimed at blunting international criticism.

Mahbouba Seraj, founder of the Afghan Women's Network, stayed in Kabul after the Taliban took over and has held several meetings with its officials to talk about women's rights. But she points out that the Taliban have not followed through on past commitments to permit female education.

"What worries me is that they made the same promise [of allowing girls' education] 20 years ago when they were last here,"she said. "They said we are going to get buses to take the girls to school. But in the six years they were in power, it never happened."

Deadlock and decline

An added complication is the Taliban's internal divisions and competition for the radical mantle from the Islamic State group's Afghan affiliate, ISIS-K. Clearly stated concessions on rights for women risks alienating more hardline elements in the Taliban, says Baheer, the university lecturer.  "The Taliban movement is stuck between a rock and a hard place. If they are seen to give in to the demands of the international community over every issue, they end up losing support. And their fighters, trained and armed, can easily be recruited by their alternative, which is ISIS."

The continued risk of extremist violence was highlighted by a suicide attack on Kabul’s main military hospital on Nov. 2, for which ISIS claimed responsibility. At least 19 people were killed in the attack, with dozens more injured. 

That all implies deadlock and inexorable decline. The IMF, while acting on U.S. instructions to suspend its support, has predicted the Afghan economy will contract by 30% this year. That could undermine cohesion in the Taliban movement as well. Many of their young fighters complain that they, too, are not getting paid.

Taliban fighters stand at the entrance of the currency exchange market in Kabul on Oct. 7: Many fighters are in their late teens or early 20s, and many are looking for a way out of the country.    © Reuters

We got an insight into these tensions on a visit to a Kabul police station. While we waited for a meeting with the police chief inside, we talked with the Taliban guard at the entrance. The compound is still encased in the concrete blast walls that were set up around all government buildings, to defend against Taliban bombs. 

Now, the police are a group of Taliban fighters from nearby Wardak Province. But he complained of being hungry, and that his family were also short of food. Everywhere the signs are ominous, says Baheer. "The trajectory that we have right now is not healthy. What I fear is that the grievances are piling up, and it's always linked to grievances." 

Wanting out

In the meantime, everyone is looking for a way out. It rarely gets media coverage, but in the faraway southwestern province of Nimroz, thousands of Afghans try to leave every day, putting themselves at the mercy of smugglers, hoping to find a way through Pakistan and Iran, and then on to Turkey and Europe.

Women and children, hungry and crying, wait in line for hours at the passport department in Kabul. Passports can be expensive, and border controls and visa restrictions make it very difficult to get out of the country.  (Photo by Paula Bronstein)

The passport office in Kabul has been swamped with people trying to get travel documents or update old ones since it reopened. And the corruption the Taliban railed against under the previous government is back. One acquaintance was forced to pay $3,000 to get seven passports for himself and his family. 

On a visit to another Kabul hospital, doctors kept returning to the same question: How could they get out of Afghanistan? It is a microcosm of a pent-up brain drain, held back for now by the border closures and visa rules that effectively lock Afghans in, even if they have money.

"We fear that it will become like Syria," said Kamil, one of the doctors, who asked that his real name not be published. "That is why everyone is thinking of how to leave the country, even the people that have no passports. There is no hope." Asked if he had hope before the Taliban came, he answers simply: "Yes, before I did."

The other night, a friend gave me a lift back to my guesthouse, and we were stopped at a mobile Taliban checkpoint. Like so many of the Taliban fighters seen on the streets, they were young -- in their late teens or early 20s. They are the next generation, taking the place of the tens of thousands of older Taliban fighters killed in US air strikes over the past two decades. When they saw there was a foreigner in the car, they crowded around, keen to talk, their American weapons balanced in their arms.

Where was I from? What was my religion? Was I married? The questions came quick and fast. A taller one in the group, his face covered by a scarf, turned out to speak good English. He had been studying computer science at Kabul University, he said, and then had joined the Taliban. 

So you were studying and fighting? I asked. 

"Multitasking," he laughed. And then he said:  "Can you take me to America?"

An uncertain future

Back in the emergency ward at the children's hospital, there was some hope for Ruqia. Her name means "to rise," and after a few days of treatment she stabilized and started to put on some weight. But earlier this week, when we called her father Hussein to find out how things were going, we learned that the family's situation had tumbled back into crisis. They were back home in northern Afghanistan. 


While in the hopsital in Kabul, Ruqia's condition began to improve, but with her parents no longer able to pay for her treatment, she has returned home with them to Mazar-i Sharif. Her future remains uncertain. (Photo by Paula Bronstein)

"We ran out of money," he said. The cash-strapped hospital had asked them to pay for the next dose of insulin she needed. And while her mother Massouma was allowed to sleep next to Ruqia in the ward, Hussein was having to find a bench in the yard outside and cover himself with a blanket -- with nighttime temperatures now just above freezing.

"They were making me pay 5 Afghanis to use the toilet, and I could not even afford that," said Hussein. The only option, they decided, was to return home, borrowing yet more money to pay for the bus. They were given a prescription for more insulin to take with them. And then they borrowed more money to pay for that. "I do not know what we are going to do next," he said.

Andrew North is a journalist who covers Afghanistan and was previously based in Kabul as a correspondent for the BBC. With additional reporting by Habibullah Barakzai.