Long road ahead for Afghan earthquake survivors, especially women

When Sonita Bahram arrived in Herat on 12 October, it had already been five days since the first of several earthquakes that have left unparalleled devastation across the western province, flattening dozens of villages and displacing tens of thousands of people.

Aid was trickling in from the Taliban government and from international NGOs, but the sheer scale of the destruction, affecting six of the province’s districts, meant the response work was really just beginning: At least 1,482 people were killed by the earthquakes, another 2,100 have been injured, and an estimated 114,000 people are in need of humanitarian assistance.

Bahram, a medical doctor based in Kabul, had come as part of a team of 22 female doctors, midwives, and nurses looking to assist survivors. Although their team had the full support of both the Afghan Ministry of Public Health and the World Health Organization (WHO), she was struck by the immensity of the challenge as they drove along the unpaved dirt and gravel roads in badly hit Zinda Jan district.

“There was only one health centre that survived in the entire district, and even that was only partially standing,” Bahram told The New Humanitarian. 

The response from Afghan society has been swift and concerted, with both blood and money donations streaming in from across the country, including the nation’s star cricketer Rashid Khan, and the Afghanistan Cricket Board after their historic World Cup win against England.

But despite this outpouring of support, relief efforts still suffer from major challenges, especially for vulnerable groups such as women and children, and, with winter coming, an urgent rebuilding programme is needed to provide survivors with proper shelter.

Bahram was particularly troubled by a UN statement saying up to 90% of deaths were women and children as she knew the province suffered from a shortage of female medical doctors, and that the remoteness of the villages would present a further obstacle for longer-term care.

“The sheer distance from the city makes it impossible for a well-trained woman to commit to working in these villages,” she said. “A woman would have to leave her home in the city early in the morning and arrive back home after dark along a difficult, unpaved road. That’s just not realistic.”

‘A constant state of fear’

When she spoke to women and girl survivors, Bahram realised that the eight days of relentless earthquakes and aftershocks – including three with a magnitude of 6.3 – had taken a serious toll on their mental healt

“I saw dozens of women and girls each day, and I can tell you that 99.9% of them were suffering from some sort of psychological trauma,” she said. “They are living in a constant state of fear.”

“Even people who come from what you would think are very well built, sturdy apartment buildings in the city are too afraid to be inside,” Bahram said, adding that this fear was warranted as “the ground was always shaking”.

“It has been 10 days and there are still families that are in need of tents. They take their scarves and whatever blankets they can find and use them to cover themselves and create privacy barriers in a sea of hundreds of other people.”

The team of female doctors had been prepared to treat physical injuries and ailments, of which there were plenty, but they didn’t have the expertise to properly address the feelings of unease and paranoia that had spread across the villages and the city of Herat, the provincial capital.

Apart from one psychologist travelling with the team, “we can only provide the women with advice and guidance on their mental trauma,” Bahram explained. 

Herat’s more remote areas are highly conservative, and Bahram said the earthquakes would add to pre-existing mental health concerns for women and girls in a province where female self-immolation had previously been an alarming phenomenon.

“These women were already dealing with years of mental issues and trauma from their daily home lives, and now they have to deal with the constant worry of earthquakes on top of that,” Bahram said.

Makeshift healthcare, and shared tents

As one of Herat’s least developed and least secure districts, the lack of infrastructure in Zinda Jan was already affecting the ability of women to obtain even basic health services before the earthquakes.

Bahram pointed to one woman who – because of the lack of clinics in remote areas – had given birth in a taxi while trying to reach the city after her home was destroyed by the earthquakes. Like tens of thousands of other survivors, she was now living in a tent.

Najmussama Shefajo, head of the Afghanistan Society of Obstetricians and Gynaecologists, told The New Humanitarian that local medical workers had shared many similar stories with her when she visited last week.

“There are still makeshift emergency rooms, treatment centres, and maternity wards all operating outside, in the open air,” Shefajo said, adding that at least 100 births have taken place outside across the destroyed villages since the earthquakes began.

Shefajo said the continued risk of earthquakes and aftershocks makes it impossible for health workers to treat patients with complete confidence indoors.

Rahima, from Siya Ab village in Zinda Jan, was one of many women now being forced to share a tent with other families.

At first, Rahima, who preferred to give only one name, considered her family of seven to be fortunate: Their mud home was damaged but not destroyed in the initial earthquake.

“We had a few cracks in the walls, so we were definitely afraid, but still, we counted our blessings,” Rahima told The New Humanitarian as she and her husband Naeem peeked out from the tent they shared with two other families.

Their luck ran out in the early morning hours of 11 October, when the second 6.3-magnitude earthquake struck. “It all came tumbling down,” Rahima said.

Bahram was still running into families who were having to create makeshift shelters. “It has been 10 days and there are still families that are in need of tents,” she said. “They take their scarves and whatever blankets they can find and use them to cover themselves and create privacy barriers in a sea of hundreds of other people.”

Bahram highlighted women’s privacy as a key challenge that the local and international aid responders should address. “Women, in particular, require clean, proper bathroom facilities, but in most villages, they’re still lacking,” she said.

Although they praised the quick response generally to the earthquakes, both Bahram and Shefajo said the lack of proper sanitary and bathroom facilities was a sign of the myopic focus. “Everything is very immediate and short-sighted,” said Bahram. “But these people have longstanding issues that need to be addressed at this time when so much of the world’s attention is on them.”

Shefajo and Bahram said they had raised the lack of proper roads and basic sanitation services – and the need to rebuild health facilities – with both the Taliban-led Islamic Emirate government and international organisations, but they weren’t optimistic.

“The government says they understand the needs are great, but the fact remains that they lack the money to fully address the scale of the problems,” Bahram said.

The Taliban government has been plagued by cutbacks in international aid, crippling sanctions, billions of dollars of losses in asset seizures, banking restrictions, diplomatic challenges and a lack of official recognition since it returned to power in August 2021.

Bahram said raising the same issues with local and international organisations led to equally frustrating responses: “They all say the same things, ‘We need to create a proposal’ or ‘We need to fundraise’.”

‘We need shelter’

Volunteers who went to Herat in the days after the earthquake told The New Humanitarian they feared the international aid cuts would mean that earthquake survivors may not receive what they needed most: sturdier homes to replace their destroyed mud houses.

“The harsh winter is approaching, and prolonged displacement will increase health risks for already vulnerable communities.”

Emran Wadan, a social media influencer, drove 19 hours from Kabul with two other friends to assist in relief efforts. He said everyone they spoke to said the same thing: “They all said, ‘Even if it’s just a room, we need shelter that can last us for the rest of our lives’.”

Bahram and Wadan said the tents provided to families by local and international organisations were insufficient for villages built in dusty fields known for sandstorms and high winds. “We could see tents flying from one village to the other,” said Bahram.

In a tweet, the Taliban government said the process of building 2,146 houses in earthquake-affected areas has started, but with temperatures dropping across much of the country, the clock is ticking.

“The harsh winter is approaching, and prolonged displacement will increase health risks for already vulnerable communities,” WHO said in its latest update. “The poor, overcrowded environment with limited access to water and winter essentials like warm blankets and clothes will likely lead to an increase in the incidence and severity of infectious diseases.”

Major aid organisations say they realise the response has been affected by a lack of funding. The World Food Programme, which has already cut 10 million Afghans from food assistance this year, asked for $19 million in additional funds in order to help 100,000 people in Herat. WHO has also appealed for $7.9 million in order to provide “essential health services in the next six months”.

Dayne Curry, country director at Mercy Corps, told The New Humanitarian he fears for the survivors in the coming months. “The current humanitarian funding and capacity issues in Afghanistan will create an even more challenging situation for both the Afghan people and humanitarian organisations trying to assist them in the wake of this natural disaster,” he said.

Curry said the aid cuts will have a real impact on the longer-term earthquake response: “Despite the international community’s pledges to never forget the people of Afghanistan, the humanitarian response simply cannot keep pace with the worsening crisis in the country”.