Women in Afghanistan: a call for action

Abstract

Afghanistan is a landlocked country located between the Middle East, central Asia, and south Asia, with a population of more than 30 million people, composed mainly of ethnic Pashtuns, Tajiks, Hazaras, and Uzbeks. The Afghan conflict began in 1979 with the Soviet Union's invasion, followed by a Mujahedeen revolt. Following the defeat and withdrawal of Soviet forces, the Taliban movement began to end the civil war and to establish Sharia rule across the nation. By the end of the 1990s, the Taliban had succeeded in overthrowing the Mujahedeen administration. During their time in power, essential services and access to basic needs were depleted, and women were oppressed and marginalised.1Hartley-Blecic MM The invisible women: the Taliban's oppression of women in Afghanistan.ILSA J Int Law. 2001; 7: 553-572Google ScholarFollowing the attacks on the World Trade Centre in New York (NY, USA) on Sept 11, 2001, the Taliban regime was ousted by Western coalition forces, and the Taliban retreated to rural regions. After two decades of occupation, armed forces led by the USA withdrew completely from Afghanistan on Aug 30, 2021, and the Taliban has since taken over control of the country, with looming fears of an authoritarian regime that is unlikely to respect women's rights.2Kotokey A Borthakur A The ideological trajectory within the Taliban movement in Afghanistan.AJMEIS. 2021; 15: 205-219Google ScholarMental health surveys are limited in the current political context of the country, but a recent publication stated that 47% of women were found to have high psychological distress.3Kovess-Masfety V Keyes K Karam E Sabawoon A Sarwari BA A national survey on depressive and anxiety disorders in Afghanistan: a highly traumatized population.BMC Psychiatry. 2021; 21: 1-12Google Scholar The provision of health services, including psychiatric services, in Afghanistan has been substantially diminished by the armed conflict.4Mohd Saleem S Shoib S Dazhamyar AR Chandradasa M Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population.Asian J Psychiatr. 2021; 65102854Google Scholar Afghan women are exposed to severe trauma, interpersonal violence, and patriarchal attitudes in society.5Jewkes R Corboz J Gibbs A Trauma exposure and IPV experienced by Afghan women: analysis of the baseline of a randomised controlled trial.PLoS One. 2018; 13e0201974Google Scholar Traditional ways of living and customs, such as Pashtunwali, early marriage, and adolescent pregnancy, could further hinder opportunities for women to obtain an education, develop skills, and inherit properties.6Ginsburg T An economic interpretation of the Pashtunwali.Univ Chic Leg Forum. 2011; 89: 104-122Google Scholar Women have restricted opportunities to engage in employment or entrepreneurship, and to earn for themselves.7Mohsen A Ahmadzai A Modaser Z Women entrepreneurship in developing countries: the context of Afghanistan.in: Rezaei S Li J Ashourizadeh S Ramadani V Gërguri-Rashiti S The Emerald handbook of women and entrepreneurship in developing economies. 1st edn. Emerald Group Publishing, Bingley2021: 213-228Google Scholar Stigma around mental ill-health leads to deprived access to psychological support.4Mohd Saleem S Shoib S Dazhamyar AR Chandradasa M Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population.Asian J Psychiatr. 2021; 65102854Google Scholar Poverty, food insecurity, and starvation for women and their children occur in the context of extreme weather conditions. Women are oppressed by inconsistent and unpredictable changes in governmental rules and regulations, unavailability of legal counsel and advice, and the way in which the traditional justice system operates.2Kotokey A Borthakur A The ideological trajectory within the Taliban movement in Afghanistan.AJMEIS. 2021; 15: 205-219Google Scholar Afghan women are losing fundamental rights under the Taliban regime: girls are prevented from attending school, obligations are imposed to wear the Burqa, long-distance travelling has been banned, and access to public facilities has been curtailed.4Mohd Saleem S Shoib S Dazhamyar AR Chandradasa M Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population.Asian J Psychiatr. 2021; 65102854Google ScholarAfghan women have experienced a volatile environment for decades and they are resilient to never-ending obstacles. They show the desire for achievement, wealth, and independence.7Mohsen A Ahmadzai A Modaser Z Women entrepreneurship in developing countries: the context of Afghanistan.in: Rezaei S Li J Ashourizadeh S Ramadani V Gërguri-Rashiti S The Emerald handbook of women and entrepreneurship in developing economies. 1st edn. Emerald Group Publishing, Bingley2021: 213-228Google Scholar However, after the Taliban takeover and as a result of economic collapse, aggravated by the armed conflict, drought, and the COVID-19 pandemic, people are selling their assets and resorting to child labour and child marriage.4Mohd Saleem S Shoib S Dazhamyar AR Chandradasa M Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population.Asian J Psychiatr. 2021; 65102854Google Scholar Afghanistan has remained one of the world's poorest countries, with the health system and economy substantially dependent on foreign aid; 80% of the national budget is provided by the international community.8The LancetAfghanistan: the international community must act.Lancet. 2021; 3981851Google Scholar Since the international support has terminated, the majority of the population is being driven to starvation.Children who experience harassment from a parent are highly likely to experience and perpetrate intimate partner violence as adults. Afghan women's own experiences of witnessing their mother being physically abused, enduring extreme poverty and ongoing food insecurity, their father using corporal punishment, and domestic violence are all associated with increased likelihood of them perpetrating violence on their offspring.9Ndungu J Jewkes R Ngcobo-Sithole M Chirwa E Gibbs A Afghan women's use of violence against their children and associations with IPV, adverse childhood experiences and poverty: a cross-sectional and structural equation modelling analysis.Int J Environ Res Public Health. 2021; 187923Google Scholar This situation perpetuates a cycle of violence in the context of transgenerational trauma.10Cypress BS Collective trauma: an evolutionary concept analysis.Nurs Forum. 2021; 56: 396-403Google ScholarAs psychiatrists from Afghanistan and regional countries, we urge international intergovernmental organisations, associations for psychiatrists, aid agencies, philanthropists, and mental health advocates to identify the challenges influencing Afghan women's emotional wellbeing. We call for support for recommendations to mitigate this crisis (panel).PanelRecommendations to improve women's emotional wellbeing in Afghanistan•Appoint a committee comprising experts in women's health and mental health including Afghan, south Asian, and international specialists•Allow participation of representatives from local rulers, global funders, and non-governmental agencies•Develop simple, understandable, and accessible material promoting mental health that is targeted at women (eg, TelemedAF)•Establish a toll-free telephone number to obtain psychological first aid and support from counsellors in Iran, Pakistan, and Tajikistan who speak local Afghan languages and dialects (eg, Dari)•Train teachers, nurses, and volunteers to provide outreach psychological support and telepsychiatry support for first-contact physicians•Adapt psychometric instruments to local dialects and develop culturally acceptable psychotherapeutic interventions•Encourage international collaboration to urge the Taliban to modify their policies towards women's rights and to increase funding for food provisions and health careThis online publication has been corrected. The corrected version first appeared at thelancet.com/psychiatry on March 11, 2022 Afghanistan is a landlocked country located between the Middle East, central Asia, and south Asia, with a population of more than 30 million people, composed mainly of ethnic Pashtuns, Tajiks, Hazaras, and Uzbeks. The Afghan conflict began in 1979 with the Soviet Union's invasion, followed by a Mujahedeen revolt. Following the defeat and withdrawal of Soviet forces, the Taliban movement began to end the civil war and to establish Sharia rule across the nation. By the end of the 1990s, the Taliban had succeeded in overthrowing the Mujahedeen administration. During their time in power, essential services and access to basic needs were depleted, and women were oppressed and marginalised.1Hartley-Blecic MM The invisible women: the Taliban's oppression of women in Afghanistan.ILSA J Int Law. 2001; 7: 553-572Google Scholar Following the attacks on the World Trade Centre in New York (NY, USA) on Sept 11, 2001, the Taliban regime was ousted by Western coalition forces, and the Taliban retreated to rural regions. After two decades of occupation, armed forces led by the USA withdrew completely from Afghanistan on Aug 30, 2021, and the Taliban has since taken over control of the country, with looming fears of an authoritarian regime that is unlikely to respect women's rights.2Kotokey A Borthakur A The ideological trajectory within the Taliban movement in Afghanistan.AJMEIS. 2021; 15: 205-219Google Scholar Mental health surveys are limited in the current political context of the country, but a recent publication stated that 47% of women were found to have high psychological distress.3Kovess-Masfety V Keyes K Karam E Sabawoon A Sarwari BA A national survey on depressive and anxiety disorders in Afghanistan: a highly traumatized population.BMC Psychiatry. 2021; 21: 1-12Google Scholar The provision of health services, including psychiatric services, in Afghanistan has been substantially diminished by the armed conflict.4Mohd Saleem S Shoib S Dazhamyar AR Chandradasa M Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population.Asian J Psychiatr. 2021; 65102854Google Scholar Afghan women are exposed to severe trauma, interpersonal violence, and patriarchal attitudes in society.5Jewkes R Corboz J Gibbs A Trauma exposure and IPV experienced by Afghan women: analysis of the baseline of a randomised controlled trial.PLoS One. 2018; 13e0201974Google Scholar Traditional ways of living and customs, such as Pashtunwali, early marriage, and adolescent pregnancy, could further hinder opportunities for women to obtain an education, develop skills, and inherit properties.6Ginsburg T An economic interpretation of the Pashtunwali.Univ Chic Leg Forum. 2011; 89: 104-122Google Scholar Women have restricted opportunities to engage in employment or entrepreneurship, and to earn for themselves.7Mohsen A Ahmadzai A Modaser Z Women entrepreneurship in developing countries: the context of Afghanistan.in: Rezaei S Li J Ashourizadeh S Ramadani V Gërguri-Rashiti S The Emerald handbook of women and entrepreneurship in developing economies. 1st edn. Emerald Group Publishing, Bingley2021: 213-228Google Scholar Stigma around mental ill-health leads to deprived access to psychological support.4Mohd Saleem S Shoib S Dazhamyar AR Chandradasa M Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population.Asian J Psychiatr. 2021; 65102854Google Scholar Poverty, food insecurity, and starvation for women and their children occur in the context of extreme weather conditions. Women are oppressed by inconsistent and unpredictable changes in governmental rules and regulations, unavailability of legal counsel and advice, and the way in which the traditional justice system operates.2Kotokey A Borthakur A The ideological trajectory within the Taliban movement in Afghanistan.AJMEIS. 2021; 15: 205-219Google Scholar Afghan women are losing fundamental rights under the Taliban regime: girls are prevented from attending school, obligations are imposed to wear the Burqa, long-distance travelling has been banned, and access to public facilities has been curtailed.4Mohd Saleem S Shoib S Dazhamyar AR Chandradasa M Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population.Asian J Psychiatr. 2021; 65102854Google Scholar Afghan women have experienced a volatile environment for decades and they are resilient to never-ending obstacles. They show the desire for achievement, wealth, and independence.7Mohsen A Ahmadzai A Modaser Z Women entrepreneurship in developing countries: the context of Afghanistan.in: Rezaei S Li J Ashourizadeh S Ramadani V Gërguri-Rashiti S The Emerald handbook of women and entrepreneurship in developing economies. 1st edn. Emerald Group Publishing, Bingley2021: 213-228Google Scholar However, after the Taliban takeover and as a result of economic collapse, aggravated by the armed conflict, drought, and the COVID-19 pandemic, people are selling their assets and resorting to child labour and child marriage.4Mohd Saleem S Shoib S Dazhamyar AR Chandradasa M Afghanistan: Decades of collective trauma, ongoing humanitarian crises, Taliban rulers, and mental health of the displaced population.Asian J Psychiatr. 2021; 65102854Google Scholar Afghanistan has remained one of the world's poorest countries, with the health system and economy substantially dependent on foreign aid; 80% of the national budget is provided by the international community.8The LancetAfghanistan: the international community must act.Lancet. 2021; 3981851Google Scholar Since the international support has terminated, the majority of the population is being driven to starvation. Children who experience harassment from a parent are highly likely to experience and perpetrate intimate partner violence as adults. Afghan women's own experiences of witnessing their mother being physically abused, enduring extreme poverty and ongoing food insecurity, their father using corporal punishment, and domestic violence are all associated with increased likelihood of them perpetrating violence on their offspring.9Ndungu J Jewkes R Ngcobo-Sithole M Chirwa E Gibbs A Afghan women's use of violence against their children and associations with IPV, adverse childhood experiences and poverty: a cross-sectional and structural equation modelling analysis.Int J Environ Res Public Health. 2021; 187923Google Scholar This situation perpetuates a cycle of violence in the context of transgenerational trauma.10Cypress BS Collective trauma: an evolutionary concept analysis.Nurs Forum. 2021; 56: 396-403Google Scholar As psychiatrists from Afghanistan and regional countries, we urge international intergovernmental organisations, associations for psychiatrists, aid agencies, philanthropists, and mental health advocates to identify the challenges influencing Afghan women's emotional wellbeing. We call for support for recommendations to mitigate this crisis (panel). •Appoint a committee comprising experts in women's health and mental health including Afghan, south Asian, and international specialists•Allow participation of representatives from local rulers, global funders, and non-governmental agencies•Develop simple, understandable, and accessible material promoting mental health that is targeted at women (eg, TelemedAF)•Establish a toll-free telephone number to obtain psychological first aid and support from counsellors in Iran, Pakistan, and Tajikistan who speak local Afghan languages and dialects (eg, Dari)•Train teachers, nurses, and volunteers to provide outreach psychological support and telepsychiatry support for first-contact physicians•Adapt psychometric instruments to local dialects and develop culturally acceptable psychotherapeutic interventions•Encourage international collaboration to urge the Taliban to modify their policies towards women's rights and to increase funding for food provisions and health care •Appoint a committee comprising experts in women's health and mental health including Afghan, south Asian, and international specialists•Allow participation of representatives from local rulers, global funders, and non-governmental agencies•Develop simple, understandable, and accessible material promoting mental health that is targeted at women (eg, TelemedAF)•Establish a toll-free telephone number to obtain psychological first aid and support from counsellors in Iran, Pakistan, and Tajikistan who speak local Afghan languages and dialects (eg, Dari)•Train teachers, nurses, and volunteers to provide outreach psychological support and telepsychiatry support for first-contact physicians•Adapt psychometric instruments to local dialects and develop culturally acceptable psychotherapeutic interventions•Encourage international collaboration to urge the Taliban to modify their policies towards women's rights and to increase funding for food provisions and health care This online publication has been corrected. The corrected version first appeared at thelancet.com/psychiatry on March 11, 2022 This online publication has been corrected. The corrected version first appeared at thelancet.com/psychiatry on March 11, 2022 This online publication has been corrected. The corrected version first appeared at thelancet.com/psychiatry on March 11, 2022 We declare no competing interests. Correction to Lancet Psychiatry 2022; published online March 7. https://doi.org/10.1016/S2215-0366(22)00039-6Shoib S, Saeed F, Dazhamyar AR, et al. Women in Afghanistan: a call for action. Lancet Psychiatry 2022; published online March 7. https://doi.org/10.1016/S2215-0366(22)00039-6—In this Comment, the corresponding author's email address should have been [email protected] This correction has been made to the online version as of March 11, 2022, and will be made to the printed version. Full-Text PDF