It was September 2011, and the Arab Spring in Libya was in full swing.
Cars lined up outside the apartment complex where I held clinic as a volunteer woman physician with International Medical Corp.
A man appeared with his wife. Muhammad, my translator, told me she was near term; I could not tell, her hijab hid her belly. “They need a pass to Misurata.”
The woman heaved her body onto the exam table. Muhammad said, “I’ll wait outside.”
I gestured to the woman to remove her hijab. She stared at me. I tried to lift her robe, but she resisted, opening a slit to let me see her belly. Her fingers were poised to pull her hijab down.
Outside there was an air of urgency. The rebels were closing the checkpoints to Misurata. Frantic male relatives drove their pregnant women to the clinic requesting travel passes to conflict-free zones for the delivery of their babies.
In many areas of the world where there is a quick transition of power, as in Afghanistan, or after a period of years of civil war, such as in South Sudan, health care and women’s rights become the victims of ongoing neglect and erosion. After retaking power in Afghanistan in August 2021, the Taliban abolished the Ministry of Women’s Affairs, a key body promoting women’s rights. In its place, the new regime set up the notorious Ministry for the Propagation of Virtue and the Prevention of Vice, a public morality watchdog that enforces the Taliban’s interpretation of Islamic law. This ministry has been systematically eroding the rights of Afghan women.
Recently the Taliban handed down a decree banning women from working in national and international nongovernmental organizations. They have already stopped girls from attending secondary school and women from universities and banned women from public places.
These rulings set back the advances that Afghan women have made over the last two decades, essentially eliminating their human rights and fundamental freedoms.
Amnesty International reports that the ban has resulted in the shutting down of service providers supporting survivors of gender-based violence and women’s shelters for fear of retribution. The ruling denies women who seek medical help from providers of the same gender their basic human rights to safe health care.
The Asian Foundation surveyed Afghan people in 2015 and found that 22.6% of Afghans nationwide reported that women contributed to their household income, up from 13.6% in 2009. The rate was as high as 49.3% in the country’s central region. There are 19.4 million women in Afghanistan, almost 50% of the population. Barring women from working outside their homes will mean more hungry children and poverty in Afghanistan. Sima Bahous, executive director of U.N. Women, has said that barring women from working in NGOs is in effect cutting off humanitarian aid to half of the Afghan population, which includes 11.6 million women and girls.
The Humanitarian Access Working Group conducted a quick survey of 87 NGOs and found that 83% have suspended their operations. Afghanistan’s Ministry of Public Health has said female NGO workers in the health sector are exempt from the decree, but Afghan women are involved in areas other than the health sector, in women’s empowerment and girls’ education.
In humanitarian disaster areas where women and girls often experience gender-based violence, they require care from other women. It is inconceivable that they want to be cared for by men, further compounding their trauma. How do the Taliban expect Afghan women who are today covered from head to toe in their hijabs to be willing to be examined by men, especially if they experience gender-based violence?
For over a decade, I volunteered as a physician with various humanitarian organizations in many regions of the world, including Muslim nations. Women always play a major role in the health sector. Even in the U.S., three-quarters of the workforce in the health sector are women. Women employed by NGOs run programs providing maternal and reproductive health services, nutrition among children and vaccination. These women are midwives, social workers, medical assistants, nurses and doctors; their roles will be hard to fill if women are banned from working with NGOs. By preventing women from working in aid organizations that address women’s issues that depend heavily on women, the Taliban is using humanitarian aid as a misogynistic weapon.
There has been progress in the eradication of polio in Afghanistan, as reported by the Global Polio Eradication Initiative. The number of wild poliovirus cases dropped from 56 cases in 2020 to four in 2021, representing a 93% decrease. As of October 2022, CDC had reported only two wild poliovirus cases. The decree, however, will affect the eradication effort, in which women play an instrumental role in raising awareness of polio and in the vaccination program. Given the success of GPEI, two days after the edict banning women from working with humanitarian organizations was issued in December 2022, GPEI went ahead with sending women vaccinators in their campaign in the eastern provinces of Afghanistan.
In 2021, the numbers of measles cases and deaths in the country were 31,379 and 106, respectively, and these jumped to 77,808 with 392 deaths in 2022. The average number of suspected measles cases over three years, from 2019 to 2021, was low — about 300 cases per week — compared to 2022, when the number jumped to 1,600 cases per week. This was due to many outbreaks, and the cases only decreased with the implementation of measles immunization at week 10 of 2022. Afghanistan has a large susceptible population including children under the age of 5 with low measles vaccination coverage, high rates of malnutrition and vitamin A deficiency; a large number of internally displaced people; and difficult access to health facilities in the rural areas and during the cold winter. It will need all the health care workers, men and women alike, to combat this infection.
Afghanistan is confronting one of the greatest humanitarian crises. The country is dependent on aid from NGOs. To exclude women from working with them, when the NGOs depend on women to run many of their programs to care for other women, will tie their hands further, and they may not be able to offer the kind of services needed by Afghanistan society.
Limiting girls’ and women’s access to education and employment will further increase their illiteracy and economic dependence, causing them to lose control over their lives and destinies. The repercussion will affect their children, families, communities and Afghanistan.
In Libya during the Arab spring, even as many pregnant women came to see me, a woman physician, they remained modest and were unwilling to pull off their hijabs to be examined.
Back in the clinic, I handed the travel permit to the pregnant woman, and she let her husband take it. They hurried off before the sunset and curfew began.