The Taleban’s Deadly Toll on Women Midwives and Doctors

Humaira*, a single mother-of-three, is a midwife in a hospital in Kandahar province. But each time the Taleban adds another layer of edicts directed at working women, it makes it harder for her to continue helping others navigate the dangers of childbirth in a country with a shockingly high rate of maternal mortality.  

Her experience is echoed across Afghanistan as female medical personnel struggle to do their jobs under increasingly draconian rules directed at them because of their gender.   

In December 2022, when the Taleban banned women from working in NGOs, Humaira – employed by a healthcare charity – found her job at risk.  After a visit by UN humanitarian relief chief Martin Griffiths in January 2023, the UN said that “the Taleban have made exceptions for women’s participation in the health and education sectors”.   

This meant that women such as Humaria could still work, but they continued to be subject to other oppressive rules. The hospital where she worked demanded that all female staff be accompanied by a mahram - a close male relative - when on duty.   

For Humaira, 38, this rule made it nearly impossible to continue working. She has no such male relative. She divorced her husband before the Taleban took over, when he asked her to put her father’s property in his name. Now, living with her three children and paralysed father, she cannot comply with the order.  

To see how Taleban restrictions have affected female health workers, Zan Times interviewed 23 women in ten provinces of Afghanistan: Kabul, Kapisa, Sar-e-pul, Uruzgan, Herat, Bamyan, Samangan, Ghor, Jawzjan and Kandahar. They unanimously reported that their ability to serve their patients was becoming increasingly difficult, with the insistence on having a mahram accompany them a key problem. Several female doctors said that they were forced to leave their jobs because they did not have an appropriate mahram; others face dismissal as they cannot always have a close male relative with them at work.    

Afghanistan faced the world’s largest humanitarian crisis in 2023 and suffers from a shortage of female doctors and health workers. The situation is expected to worsen as the Taleban have banned almost all areas of public life to women.   

In February 2023, Doctors Without Borders/Médecins Sans Frontières (MSF) published a report on how access to healthcare had changed under the Taleban. MSF spoke to 200 patients and caretakers as well as healthcare workers in Kabul, Kandahar, Khost, Helmand, and Herat provinces between May and August 2022.  

“A broken healthcare system, widespread poverty, and increased restrictions placed on women are fueling the current humanitarian crisis in Afghanistan,” the report found.  

“It is already difficult in some of our projects to fill the necessary positions, including gynaecologists,” said Filipe Ribeiro, MSF’s representative in Afghanistan. “If women are not allowed to study, where will the next generation of doctors, midwives, and nurses come from?” 

Several women told Zan Times that some government hospitals were attempting to fill the gap by hiring junior female doctors or medical students. A health worker in Aibak city, Samangan province, reported that women who had not even graduated high school were working as midwives in village clinics.  

With such inexperienced workers on duty, it’s easy for something to go wrong.  

In mid-September 2022, Habiba* went to a government hospital in Kandahar city to give birth to her fourth child. During delivery, the midwife on duty sped up the delivery by using forceps.  

As soon as her baby daughter was born, Habiba knew something was wrong.  

“When I touched my daughter’s head, it was very soft, as if I were touching a bag full of water,” she said. “She would not breastfeed and vomited constantly. When we went to the specialist doctor, the doctor said that my baby’s head was badly damaged during delivery.”  

Her daughter is now eight months old and receiving treatment, but Habiba has no idea if her condition will improve.   

In attempt to get round the Taleban directive, Humaira hired the son of a relative to pretend to be her brother and accompany her to work. In exchange, Humaira paid him 500 afghani, almost half of what she was earning. The solution didn’t last long.   

In March 2023, Taleban officials in Kandahar ordered that female employees and their mahrams verify their relationships bringing their tazkiras (national identity cards) to the hospitals. The female workers and their mahrams had to sign daily attendance records and carry ID with them at all times. 

In addition, a source at the Taleban health department told Zan Times that official policy required women to pay for the travel costs and other expenses of their mahrams.  

While mahrams can sometimes sleep in empty beds at the government hospital, that option is not available at private hospitals, which charge their employees a fee when their mahrams use the waiting room.   

Even those who obey the Taleban rules on identity cards and mahram can still end up in trouble.  

For five years, Nabila Javid* has worked as a gynaecologist and obstetrician in a hospital in Trinkut, the capital of Uruzgan province. Even though her brother accompanies her, she still faces Taleban harassment, she told Zan Times.  

In late March 2023, she was riding home with her brother on his motorcycle after completing a shift at the hospital when they were stopped by the Taleban. Javid and her brother showed their identification cards to prove that they were siblings but were nonetheless arrested.   

“Taleban are not literate enough to read documents, or they say that you forged them and made fake tazkiras,” she said. “I wanted to call my father so that he would come and mediate, but they took away my cell phones and did not allow any contact with my father or any other member of my family.”  

Taleban harassment means she now refuses to work nights, meaning that less experienced midwives have to take those shifts.   

Humaira now lives in fear that the hospital and the Taleban will discover her situation and sack her – and probably pressure her to marry.  

“I wear a hijab and a burqa, but now I cry at night because, if I don’t have a mahram, I will be fired,” she explained.    

The stress has taken its toll. Humaira suffered a stroke, which left one of her legs partially paralysed.  

Some health workers have found the Taleban restrictions so onerous that they were forced to leave the country.  

Dil Afroz* was an internal medicine doctor who worked for a decade in government hospitals in Kabul. Her husband had travelled to Iran for work and she continued to go to her clinics alone. Then, after Taleban officials visited her hospital in October 2022, the rules changed: all female employees without a mahram had to resign.  

Dil Afroz eventually left Afghanistan for Pakistan, but life is still difficult.  

“We are in uncertainty in Pakistan,” she told Zan Times. “My husband works in Iran and, with difficulty, sends some money for our food. I don’t know what the future holds for us.”  

Women in Afghanistan are also disproportionately affected by lack of access to health care. The MSF report found that 88 per cent of respondents “delayed, suspended, or decided not to seek medical care” in 2022 due to barriers such as cost, and nearly two-thirds said women faced worse obstacles than men. MSF’s teams in Afghanistan report rising pregnancy complications over the last three years as women are forced to travel increasingly long distances to obtain care.  

The Taleban also strictly enforce the mahram requirement on women needing healthcare, making it impossible for most women-led households to access medical services.   

The result is a shockingly high death rate for women. In 2020, even before the Taleban seized power, the World Health Organisation (WHO) reported  that 8,700 women had died in childbirth in Afghanistan, making it one of the most dangerous places on earth to give birth.  

Health care workers see a bleak future for women in Afghanistan.  

“With the daily decrease of female doctors, a great disaster will happen to female patients in the villages,” said Humaira, “and the Taleban will be responsible for it.”    

*Names have been changed to protect the identity of the journalists and interviewees. 

This article was first published by Zan Times.