Afghanistan is often mentioned in the context of conflicts and political instability, but few people think about how ordinary people live in this country, torn apart by external forces and internal contradictions for many years.

Sincerely worried about the people of the country neighboring Turkmenistan, I did not miss the opportunity to get acquainted with information that I accidentally came across on the Internet. True and not so true. I read everything in a row, sometimes meaningfully, and sometimes intuitively, separating the wheat from the chaff.

And so, it continued until I saw with my own eyes Terra incognita called Afghanistan.

So, my media impressions were supplemented by personal observations during a visit to this country, as well as conversations with its inhabitants - representatives of different professions, nationalities, and social status. But I will tell you about this in detail another time.

...This is how my vision of Afghanistan and its people, with whom the Turkmen have lived side by side since ancient times, was formed. And today this country, despite decades of armed conflict and limited access to resources, has achieved certain positives in some areas of activity, including (you will most likely be surprised) - in healthcare.

It can't be! - the skeptic will exclaim. - That in a country where many years of military action briefly turned into fragile stability and sluggish peace, the healthcare system could be more or less developed!

But there are positive trends in the medical care of Afghans. And this is important, because healthcare is not just an industry. It is a matter of dignity, the right to life, trust in the future.

When doctors (not healers) help an Afghan woman in a remote mountain village give birth, when a child is vaccinated against measles, this is not just a medical fact. It is an act of faith that tomorrow will come. And that means there is something to live and work for.

It is through the prism of healthcare that we can see that Afghanistan is not only a country of problems, but also a country of incredible efforts, resistance, and ineradicable hope.

…But first, about the challenges and difficulties associated with them.

Healthcare under pressure from harsh realities

Despite minor steps towards renewal, problems in Afghan healthcare remain serious. They are provoked primarily by the financial crisis and strong dependence on foreign aid. Even taking into account the fact that the international community, having suspended direct funding of government agencies, still continues to provide humanitarian aid. But its volumes are unstable.

You will be surprised again, but Afghanistan, according to official statistics, annually purchases medical supplies and equipment on foreign markets for a total of more than $1 billion (according to UN data for 2023). But despite this, only 15% of all medical institutions in the country were fully provided with the necessary resources.

The difficult financial situation is exacerbated by a shortage of qualified personnel, since many specialists have left Afghanistan in search of a safer life.

The lack of access to healthcare in remote areas poses particular challenges. In mountainous and rural areas, patients still have to travel long distances to reach the nearest health center.

According to Oxfam (an international organization working in more than 90 countries), about 23 million people in Afghanistan do not have regular access to healthcare.

The depletion of resources is a concern; despite efforts, supplies of vaccines and medicines have been reduced. Hospitals lack equipment, electricity, and protective gear. However, in some regions, mobile clinics operate under the auspices of NGOs.

It should also be added that socio-cultural factors have a certain impact on the level of healthcare for women. Thus, many Afghan women still cannot seek medical help from a doctor without being accompanied by a male member of their immediate family – a mahram.

Successes achieved against all odds

According to the World Health Organization, since 2001, average life expectancy in Afghanistan has increased from about 45 to 64 years. This is significant progress, especially for a country with limited resources.

According to the UN Children's Fund, if in 2001 the mortality rate among children under 5 years old was at the level of 257 cases per one thousand newborns, then a decade later this figure dropped to 60.

And if in 2001 one in six women died in childbirth, then over the above period the maternal mortality rate has almost halved: from 1600 to about 620 cases per hundred thousand births.

With the support of international partners, including WHO, UNICEF, the World Bank, the National Basic Health Program (BPHS) was created, which covers about 90% of rural areas.

The measures taken have allowed the construction of thousands of feldsher-midwife stations, simplifying access to basic health care. New clinics have been opened in many areas, especially in rural areas. Vaccination and infectious disease prevention programs are working, at least to some extent, which has prevented mass outbreaks of diseases.

And all this gives Afghans access to basic but vital services.

Afghanistan's cooperation with Central Asian countries in healthcare

Historically, Afghanistan's cooperation with Central Asian countries (especially Turkmenistan, Uzbekistan and Tajikistan) in healthcare included a number of areas such as training Afghan doctors, supplying medicines and humanitarian aid in the form of mobile clinics, vaccines, and basic medicines.

This also includes support for projects through international organizations, where Central Asian countries acted as logistics hubs or donors.

Just the other day, during a meeting between Chairman of the Chamber of Commerce and Industry of Uzbekistan Davron Vakhabov and Minister of Health of Afghanistan Maulovi Nur Jalol Jaloli, the Afghan delegation proposed creating a Center for Training Dental Specialists in Termez, as well as opening about 20 (!) branches of Afghan dental clinics in Uzbekistan.

And before that, the Afghan Ministry of Health, given that medical care in remote parts of the country is difficult, announced the construction of state clinics in 300 districts of the country. According to the same ministry, in 2023, more than 4 thousand hospitals operated in the country, in which women made up 22% of the staff.

As for Turkmenistan specifically, our country has been providing humanitarian aid to Afghanistan for many years, which includes supplies, along with medicines, as well as fuel, construction and other materials aimed at supporting the population of Afghanistan in times of crisis.

Such assistance is provided on the principles of good neighborliness and humanism. But not only that. It is also an element of regional sustainability - the more stable Afghanistan is, the stronger the peace on its borders!

In September 2024, Turkmenistan sent humanitarian aid to Afghanistan, including medicines, baby food, wheat, food and industrial goods, carbamide, diesel fuel, gasoline and cement.

Earlier, in May 2023, Turkmenistan sent a humanitarian caravan to Afghanistan with a cargo weighing about 125 tons. It included medicines and medical supplies, food and textile products, etc.

Turkmenistan's humanitarian initiatives are aimed at improving the living conditions of the Afghan population, especially in border areas. They also contribute not only to strengthening bilateral relations, but also, as already mentioned, stability in the region.

On September 11, 2024, a ceremony was held on the border of Turkmenistan and Afghanistan with the participation of delegations from the two countries to launch the construction and commissioning of a number of large energy and transport infrastructure facilities, as ORIENT wrote.

Positive changes in healthcare in Afghanistan

Many observers note that, despite the existing difficulties, positive changes have emerged in the Afghan healthcare system, opening up new opportunities for the development of medicine.

Key trends: private medicine is developing steadily; government support and investment in the Afghan healthcare system has increased; assistance from international partners continues to be provided (albeit intermittently); Central Asian states are actively assisting in the stabilization process in their southern neighbor.

And what are the prospects for all this?

Many believe that a flexible humanitarian policy can improve the situation. Experts highlight several possible scenarios.

According to one of them, the national healthcare system can improve significantly if there is final stabilization within the country and humanitarian organizations are widely admitted. However, long-term international support aimed at ensuring the sustainability of the system, and not just emergency aid, will be required.

A less optimistic scenario states that without large-scale funding, the system will exist only in fragments, relying on small mobile clinics, small groups of volunteers and modest local initiatives. And a completely gloomy scenario paints a picture of the degradation of the health care system, since with increasing restrictions and a reduction in assistance, its collapse is possible, which will lead to an increase in mortality and outbreaks of epidemics such as measles, polio, cholera...

What can change the situation?

Afghanistan needs not only humanitarian, but also strategic support. Today, the international community needs to think not only about emergency aid, but also about its systemic transformation: investments in basic areas of practical medicine, training Afghan specialists, supporting local initiatives.

And all this is possible. Already now, individual NGOs are demonstrating how maximum efficiency can be achieved with a minimum of resources.

Investments in telemedicine and remote consultations would be very useful. In the context of difficult geography, telemedicine is a chance for remote communities. And in this regard, there is positive experience - in 2023, UNICEF conducted similar pilot projects in a number of mountainous regions of Afghanistan.

The development of local initiatives also needs support. Some local organizations, for example, the Afghan Midwives Association, despite the difficulties, continue their activities. Supporting such structures is a direct way to maintaining basic assistance to those in dire need of it.

The international community is looking for formats of interaction that allow assistance to be provided without existing barriers. It is possible to work on a model "beyond politics" - directly through international and local NGOs.

Currently, the healthcare sector in Afghanistan is going through one of the most difficult periods in its history. However, recent years have shown that with the right strategy, support and courage on the ground, even in the most difficult conditions, progress is possible.

Afghanistan is not a death sentence. It is a challenge, on the one hand, and an opportunity, on the other. In a world rapidly polarizing, the history of Afghan healthcare is a reminder that humanity is not measured by budgets or ratings. It is measured by the noble willingness to support people when it is really needed.

And if we invest in the healthcare sector in Afghanistan today, we are investing in peace, stability and the future. In our common future.

Healthcare in Afghanistan is a story of survival and hope. And today, the health of millions of Afghans, especially women and children, depends on international solidarity and flexibility.

Support for the people of Afghanistan, its economy and social sphere (and not least, healthcare) remains extremely important.

After all, we are talking about the most important thing – the health and lives of millions of people.

The same as us...

Only a little different... But very similar.

Bekdurdy AMANSARYEV