Restrictions on Women Healthcare Workers: Access to Healthcare Services for Women on the Verge of Collapse
By: Amin Kawa
The Taliban’s restrictive measures have severely hindered women’s access to healthcare services, leaving them in a state of devastation. According to Taliban orders, male doctors are prohibited from treating female patients unless their male guardians are present. In cases where a guardian is absent, women are directed to seek treatment from midwives at healthcare centers. Recently, the Taliban’s Ministry of Public Health canceled final exams for female doctors, resulting in the inability of final-year medical students and female specialists to defend their theses. Another barrier to women’s access to doctors in medical centers is the requirement of a religious guardian and the presentation of a guardian card to healthcare staff. Moreover, the exodus of specialized doctors from the country due to insecurity, abductions, lack of freedom, and Taliban-imposed restrictions has exacerbated the situation. Challenging factors for women’s access to healthcare services include a decrease in humanitarian aid, a lack of clear policies, and a flawed understanding of the healthcare system in the country.
The Taliban’s control over Afghanistan has led to the imposition of extensive restrictions on women, resulting in their complete isolation across various aspects of social life. These restrictions not only deny women the right to education, study, and work but also severely limit their access to healthcare services. Under Taliban orders, women and girls are denied free access to healthcare services. Over the past 21 months, the Taliban has enforced stringent regulations on female healthcare workers in different provinces, with the group’s Moral Police conducting religious exams for doctors in most areas of the country.
Deprivation of Women from Completing Specialization Programs
During the second week of May this year, the Ministry of Public Health, under Taliban control, issued a press release stating that only male doctors are eligible to take part in the specialization exams. The ministry specified that male doctors must complete their registration by May 14. The successful completion of these exams enables medical school graduates to pursue further studies in their respective fields.
Under Taliban control, the Ministry of Public Health has issued a list of specialized fields exclusively available for male doctors. According to this list, educational and professional activities in these fields are restricted to male doctors, and women are not allowed to participate in the specialization exams. The list specifically includes programs in surgical and general internal medicine fields and their related departments, while completely excluding the gynecology and maternity department.
Obliging Male Guardian and a Guardian Card for Women
The Taliban have issued instructions to female healthcare workers, stating that they are not allowed to perform their duties unless accompanied by a religious guardian. These instructions have been verbally conveyed to female healthcare workers in certain provinces. According to reliable sources cited in the Hasht-e Subh Daily, the Department of Promotion of Virtue and Prevention of Vice in Kandahar province has specifically informed female healthcare workers that they cannot carry out their duties without a religious guardian. This directive was communicated orally to department employees on Sunday, January 29, 2023. Additionally, the department has distributed guardian cards to women, and it is required that female healthcare workers possess a religious guardian and carry their guardian cards at all times, as per the sources.
However, a female doctor, speaking on the condition of anonymity, has confirmed to the Hasht-e Subh Daily that officials from this group have instructed them to be accompanied by male guardians when visiting the hospital. She describes the working conditions as challenging, stating, “Two people are required for one person to work, which is both expensive and impractical. Some doctors do not have a male figure in their lives, such as a father, brother, or husband. How are they expected to comply with this prohibition? And even if they have a male guardian, is it realistic to expect a man to sit with his wife every day and witness how women are treated?”
Obligated Religious Exam and License: Ministry of Promotion of Virtue & Prevention
Female doctors, in particular, face a significant obstacle in their professional careers, as they are required to undergo a religious exam and pay 10,000 Afghanis for a work license issued by the Taliban’s Ministry of Promotion of Virtue and Prevention of Vice. Earlier reports from the Hasht-e Subh Daily revealed that the Taliban’s Moral Police verbally instructed healthcare center employees that passing a religious exam is mandatory for doctors and female doctors and nurses must pay a cash fee of 10,000 Afghanis to obtain a work license.
In Ghazni province, the Taliban have imposed a requirement for healthcare workers to obtain a work license from the Ministry of Promotion of Virtue and Prevention of Vice. According to reports from healthcare workers in the province, the Taliban has instructed them not to examine or treat female patients unless they possess a work license issued by the Department of Promotion of Virtue and Prevention of Vice in the province. Sources indicate that healthcare workers are obliged, as per the Taliban’s directive, to pass a religious exam and pay a fee of 10,000 Afghanis to the Department of Promotion of Virtue and Prevention of Vice in order to obtain the work license.
Women without male guardians are not allowed to go to healthcare Centers
The Ministry of Promotion of Virtue and Prevention of Vice of the Taliban has recently issued a statement regarding the entry of women into healthcare centers without a male guardian. According to this institution, sick women are not permitted to be accompanied by female family members for transfer to hospitals. The ministry deems the presence of sick women with a female companion in healthcare centers as both “immoral and illegal.” A notification from the Taliban, widely circulated in the district of Muqur, Ghazni, emphasizes the prevention of women without a male guardian or accompanied by another woman from entering healthcare centers. The Department of Promotion of Virtue and Prevention of Vice in Ghazni province further asserts that the movement of women without a male guardian outside the house, including their presence in healthcare centers, is considered a “sin.”
Furthermore, the Ministry of Promotion of Virtue and Prevention of Vice of the Taliban has issued a directive, widely disseminated in Nangarhar province, concerning the prohibition of women entering healthcare centers without a male guardian. This directive was communicated to the Taliban authorities in the Nari district of the province on Tuesday, May 17, 2022. As per the directive, sick women without a veil and a male guardian are not permitted to be present in healthcare centers.
What is the reaction of Doctors to the Prohibitions by the Taliban?
Meanwhile, several doctors, speaking on the condition of anonymity due to fear of Taliban interrogation, have informed the Hasht-e Subh Daily about the adverse impact of these prohibitions on women’s access to healthcare services and the multitude of challenges they have created. According to these doctors, the prolonged conflicts and instability in the country have resulted in many women being either the sole providers for their families or lacking male companions at home to accompany them to healthcare centers. One doctor expressed their concerns, stating, “They claim that a male doctor cannot examine an unaccompanied female patient. But what should a woman do when there are no female doctors available and she has no male relatives? Should she simply die? Apparently, according to the Taliban’s perspective, her death is preferable to being seen by a male doctor. This is deeply distressing.”
Moreover, doctors express their disappointment over the cancellation of specialization exams for female doctors. They point out that the Taliban not only prohibit female patients from seeking treatment from male specialist doctors but also prevents female doctors from pursuing specialization. This situation is highly concerning and devastating.
Speaking to the Hasht-e Subh Daily, Shamsia (pseudonym), a doctor, highlights the adverse consequences of prohibiting female doctors from specializing, which ultimately hinders access to healthcare services. The cancellation of specialization exams in the gynecology and maternity field poses significant challenges. Moreover, the government’s national entrance exam is also inaccessible for female doctors. The absence of female specialists for the next two years will severely impact the healthcare system.
A reliable physician, speaking to the Hasht-e Subh Daily, reveals the challenges faced by female medical students in their final year. Despite completing their coursework, they are denied the opportunity to defend their thesis as the thesis defense has been suspended. This situation creates a significant impediment to the quality and quantity of healthcare services, which is irreparable. The source further explains that in most healthcare centers, the Taliban’s policy prohibits male doctors from treating women who arrive without a male guardian, directing them to be examined by midwives instead. However, midwives lack the qualifications to diagnose certain diseases, thereby greatly compromising the quality and accessibility of healthcare services. In essence, women’s access to healthcare is being unjustly denied.
Despite Afghanistan’s high maternal mortality rate, these restrictions are imposed on women. The United Nations Population Fund (UNFPA) predicts that by 2025, there will be 51,000 maternal deaths in Afghanistan caused by childbirth complications. This data indicates an average of 12,750 women lose their lives during childbirth each year.
In a report, Médecins Sans Frontières (MSF) characterized the Afghan healthcare system as “ineffective.” According to their findings released on February 6, the combination of an inefficient healthcare system, widespread poverty, and restrictions imposed on women has resulted in a humanitarian crisis in Afghanistan. Filipe Ribeiro, the MSF representative in Afghanistan, raised concerns about the difficulty of filling necessary positions, including midwives, in their projects. He emphasized the importance of women’s education for the future generation of doctors, midwives, and nurses. MSF has urged the Taliban to ensure women’s access to education and employment.
Ensuring timely healthcare services is a major challenge for the people of Afghanistan, particularly women and children. The scarcity of midwives, doctors, and female nurses in specific districts and provinces has led to limited access to adequate medical care for many women. Presently, Afghanistan’s healthcare centers heavily depend on foreign aid. If the level of aid decreases or ceases altogether, the health situation in Afghanistan will reach a critical state of deterioration.
In its third-quarter report for the solar year 1401 (2022/23), the Central Statistical Organization of Afghanistan, under the Taliban administration, revealed that the data they collected indicates the presence of 199 government hospitals and 530 private hospitals across the country. The report also stated that during the same period, there were 454 comprehensive health centers, 1,077 primary health centers, and 1,102 secondary health centers operating in Afghanistan. Additionally, the report highlighted the existence of 1,263 government laboratories and 1,544 private laboratories in the country during the third quarter of the solar year 1401 (2022/23).