A new report offers a sobering look at Afghanistan’s fragile healthcare system, revealing that essential emergency and surgical care remains inaccessible for many, particularly in rural and impoverished areas.
Published by the medical humanitarian group EMERGENCY in partnership with Italy’s Università del Piemonte Orientale, the report draws on the testimonies of more than 1,600 Afghan patients, caregivers, and healthcare workers across 11 provinces. It outlines the deep and persistent barriers facing a country long battered by war, underfunding, and a growing burden of disease.
“For this report, the research team spoke to patients, their families, and colleagues across our surgical hospitals and primary care clinics, as well as staff at government-run hospitals, in order to understand, first-hand from the Afghan people, exactly what barriers are preventing them from accessing the healthcare services that could save their lives,” said Rossella Miccio, president of EMERGENCY.
Although improved mobility following the end of major conflict has allowed more people to seek care, the system remains incapable of meeting urgent health needs, especially in cases involving trauma, obstetrics, and intensive care.
Among the most striking findings: fewer than 3 percent of respondents said they had access to a public ambulance. Nearly half reported traveling on foot — often from remote or mountainous areas — to reach a clinic or hospital. When they arrived, many encountered additional challenges: a lack of staff, intermittent electricity, or missing equipment.
“Sometimes the power goes out in the middle of surgery,” said a doctor at a government hospital in Helmand Province. “We use phone flashlights or wait until the generator starts. It’s dangerous for the patient.”
Access to surgical care remains severely limited. Seventy-nine percent of those surveyed said they had to travel to another city, province, or country for treatment. Among women seeking maternal care, that figure was 76 percent. Two-thirds said they were forced to leave their communities to find basic obstetric services — a striking statistic in a country where maternal mortality remains among the highest in the world.
The report also notes that Afghanistan faces a shifting disease landscape. Rates of noncommunicable diseases are climbing, while trauma-related injuries remain widespread. At the same time, a prolonged economic crisis is eroding what limited health infrastructure remains.
“There are communities or households, according to my experience, that can’t even afford the money for fuel or a car to reach the hospital,” said a chief surgeon in Kabul. “How can they do so during an emergency?”
Delays in care are routine. One in four patients reported having to postpone surgery at least once. One in five missed a follow-up appointment. More than a third of respondents said disability or death had resulted from such delays.
Gender-based and cultural barriers also continue to restrict access. Women — especially widows — often delayed seeking care due to fear or social stigma. A persistent shortage of female doctors in emergency settings further limits treatment options.
“We have a lot of emergencies, but often there’s no female doctor available, especially at night,” said the chief gynecologist at a provincial hospital in Laghman. “Families sometimes prefer to wait until morning rather than let their daughters be seen by a male doctor.”
The report concludes with 10 recommendations, including a call for a comprehensive, integrated health system that provides free referrals and ensures access to trained personnel and physically reachable facilities.
“It’s important to adopt a whole-of-health-system approach,” said Ms. Miccio. “And taking a longer perspective, the bans on girls’ and women’s rights to education and work not only threaten the future of women’s healthcare in Afghanistan, but the future of the entire country.”
She called on the international community to invest in a sustainable strategy that bridges humanitarian response with development and peacebuilding. “We cannot forget Afghanistan.”
EMERGENCY currently operates three surgical hospitals, a maternity center, and more than 40 clinics throughout the country, integrated within the national referral system. The report includes insights from 1,551 patients and 52 healthcare professionals across 11 of Afghanistan’s 34 provinces.
