Afghanistan has been beset by 40 years of conflict and multiple climate shocks and natural disasters. Severe drought and crop failure in 2018 led to the internal displacement of thousands of people. Covid-19 struck an already vulnerable population, who are dealing with many life-threatening problems and are fatalistic about what happens to them. Gregoire Borgoltz, acting country director for DEC member Concern Worldwide, says: “There’s an attitude of ‘I’ve survived the war; I’ll survive this’.”
The UN says Covid-19 has had “catastrophic consequences for people’s health, incomes and levels of debt”.37 The number of people in need of humanitarian assistance has almost doubled from 9.4 million at the start of 2020 to 18.4 million at the outset of 2021.
Danielle Parry, Humanitarian Affairs Officer for UN OCHA in Afghanistan, says: “Covid has supercharged all of the other risks and vulnerabilities that already existed in Afghanistan. People have had 40 years of conflict, natural disasters and climate impacts to cope with, and their coping capacity was already low to start with. They have very little room financially or emotionally to cope with another shock.”
Ian Ridley, UN OCHA’s Head of Office in the country, says Afghanistan is so vulnerable that “the effects of Covid-19 are going to be greater, and they're going to last longer.”
The Afghan government has acknowledged that the country has experienced its second wave this winter which has been very cold, going down to -15C in Kabul.
Official figures show there were 55,664 Covid-19 cases and 2,436 deaths recorded by late February 2021, but these are believed to be significant underestimates due to low testing capacity. Random sampling suggests that by June 2020 more than 30% of the population may have already been exposed to the virus.38
Most of the official confirmed cases and deaths are men because they are much more likely to get tested. Access to healthcare is more difficult for women as they can only be treated by female doctors.
There is no data on excess mortality as there are no formal death registers. Information is anecdotal from grave diggers, who say they are two or three times busier than normal, but this may be localised. Stigma is also a factor and families will sometimes hide the reason for deaths saying instead the person “had breathing problems or other diseases, but won’t name it as Covid,” says Zohal Malekzay, a programme manager for DEC member Christian Aid.
Hospitals are overwhelmed, with many healthcare workers contracting Covid-19 or dying from the virus. The DEC’s Response Review said that the health system is under extreme strain, with the pandemic increasing demand in terms of beds, technical skills, equipment and management capacity.
Fear of catching the virus has led to a “disturbing trend” not to take children to malnutrition feeding centres for treatment, interruption of which the UN’s Ian Ridley says is very dangerous: “You have to start again, and the risks of mortality are higher the second time you have the treatment.” In addition to mother and child appointments, routine immunisation uptake has also decreased, according to the DEC’s review.
Jessica Durant, Save the Children’s deputy country director for Afghanistan, says that, since March 2020, many projects have been delayed and child friendly spaces were closed, so they haven’t been able to hold community gatherings or deliver training or education sessions.
The DEC’s Response Review described the economic impact as “disastrous”. Save the Children’s Jessica Durant explains: “In a country like Afghanistan, the impact of Covid is so much more life changing. If you’re not impacted by the virus, you are impacted in so many other ways.”
UN OCHA says that, in many ways, the economic impact of Covid-19 is probably more concerning than the virus itself in Afghanistan. Pre-Covid, the Afghan people were already living on very little, with World Bank figures saying 90% of people lived on less than $2 a day. Many work in the informal economy which has been devastated by the pandemic.
Many families also rely on male relatives working in Iran but this year the International Organization for Migration reports that a much higher percentage than usual is returning home with nothing.
In the past, humanitarian aid has been concentrated on rural areas, but now urban environments are also in need.
People are resorting to negative coping strategies such as debt, with the scale of indebtedness, and the number of people newly in debt, increasing. No crisis-affected population groups had a positive average net income in 2020. Other coping strategies include sending children out to work and child marriage. Gender-based violence appears to be increasing, caused by economic stress and depression, according to the DEC’s Response Review.
The main reason people go into debt is to buy food. There is not a shortage of food in the country – people just can’t afford to buy it.
Hunger and malnutrition have spiked amid the ongoing conflict and economic downturn, leaving Afghanistan with the second highest number of people in emergency food insecurity in the world. Between August and October 2020, it is estimated that a total of 11.2 million people (42% of the population) were facing high levels of acute food insecurity (IPC Phase 3 or above), including 3.6 million in the Emergency category.39
According to the DEC’s Response Review, food aid distribution has been needed in urban areas for the first time in some years. Around 3 million children under the age of five are acutely malnourished which means that almost one in two young children in the country needs nutrition assistance.
Jessica Durant from DEC member Save the Children says basic staples like cooking oil and pulses have seen large rises of 45% and 23% respectively. “That’s a huge additional cost for a family that lives on a daily wage. So, we’re seeing an increase in child labour, child marriage, an increase in malnutrition, parents giving children fewer meals and less diverse meals and even hearing about people selling their children.”
Recent peace talks between the government and the Taliban have led to a flare up in violence and more restrictions on NGO access and programmes in Taliban-controlled areas. The talks have dominated government and media attention, at the expense of the pandemic.
The violence is ongoing and civilian casualties are common. People live in a constant state of fear and have become fatalistic, which has affected how they deal with Covid-19. They were unable to stop going to the shops to buy food during times of conflict despite the risk of an explosion and they have maintained that mentality with Covid-19, when they were unable to socially distance or self-isolate living in home with 10 or 15 others.
UN OCHA says that, despite the escalating needs, there was not a commensurate increase in funding in 2020, resulting in “substantial unmet needs with consequences for 2021” with $1.3 billion required for the year ahead.40 The country’s 2020 Humanitarian Response Plan was 49% funded against a target of $1.1 billion. The UN’s Ian Ridley says: “I don't think it's as simple as funding has gone down. I think it's more funding hasn't risen in line with the increased demand.”
This is supported by the DEC’s Response Review which found the pandemic caused a funding gap in the provision of water and sanitation services which was not anticipated: “The lack or absence of extra/additional funding has limited aid agencies’ options. Instead [they] have adjusted existing projects and proceeded to reallocation of resources.”
The UN’s Danielle Parry says assistance reached in the vicinity of 9-10 million people in the country in 2020, but it has often been redirected to lower-cost, higher-reach Covid-focused activities and not the more complex and durable solutions that had been planned pre-pandemic such as transitional shelter and resilience building.
Jessica Durant from Save the Children agrees: “The decrease in funding has been a big challenge at a time when needs are increasing; also, the sudden shift in priorities has made it very difficult for us to plan. A lot of the Covid funding we are getting is relatively short term as it’s seen as emergency response.
“But the impact of Covid is going to be very long term – we’re going to see the impact for decades. What we need is longer-term funding and stability for our funding.”
Humanitarian needs have grown substantially in Afghanistan over the past year with the number of people needing assistance rising from 9.4 million in 2020 to an estimated 18.4 million people in 2021.
Despite the ceasefire, the UN’s Ian Ridley predicts deteriorating security and possibly substantially higher displacement, a worsening Covid-19 outlook, with a similarly worsening economic outlook and a continuing high number of returns of workers from abroad. “None of the indicators are going in a positive direction.”
The DEC’s Response Review noted that one positive from 2020 was that there had not been any natural disasters, but DEC members are concerned that the country may be less fortunate in 2021. Christian Aid’s Zohal Malekzay says: “We also worry about natural disasters, as well as security and conflict, because that’s a reality of everyday life in Afghanistan and maintaining Covid restrictions during a disaster will be a major problem.”
Afghanistan was allocated 15% of the funds available for the first phase of the DEC’s coronavirus response. In the first three months of the response (up to the end of October 2020), six DEC charities – ActionAid, Christian Aid, Concern, Oxfam, Save the Children and Tearfund – used most of the funds spent to date on providing food (35%), supporting nutrition (27%) and water, sanitation and hygiene projects (21%).
DEC members worked across the country, including in hard-to-reach areas such as Baghdis province in the northwest. Messages on hygiene promotion were communicated to more than 36,000 individuals through various channels, ranging from TV and radio programmes, billboards, posters, door-to-door campaigns and sermons preached in mosques. ActionAid and Concern Worldwide constructed 32 handwashing stations, which were placed in mosques, schools, bus terminals and bazaars.
More than 6,800 households were provided with essential items to protect themselves against Covid-19, such as masks, jerry cans and soap. ActionAid and Tearfund supported health services by distributing PPE to 209 frontline health workers
Gender-based violence is a key problem in Afghanistan and DEC members conducted awareness raising on this subject with 11,320 individuals; Save the Children addressed child protection risks through community dialogue involving 600 people.
DEC charities provided food or cash vouchers for food benefitting around 4,700 people, prioritising pregnant women, lactating mothers and disabled and elderly people.
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