The Independent

‘We cannot be separated’

Since taking power in Afghanista­n, the Taliban has barred girls from schools and shut women out of most profession­s, writes Claire Parker. But they need more female doctors


After the Taliban took control of Afghanista­n last year, nearly a third of the resident doctors in Omeida Momand’s class at a Kabul women’s hospital fled the country, she says, leaving the staff stretched thin.

Momand decided to stay, to finish the last step in her 11 years of training to care for Afghanista­n’s women. By day, she examines

gynaecolog­y patients and monitors mothers with high-risk pregnancie­s in a room sometimes so crowded that patients lie on the floor. Night shifts are spent performing emergency Caesareans.

Her determinat­ion to practice medicine in her home country has aligned, ironically, with the Taliban’s own interests. In the highly conservati­ve Islamic society the Taliban hopes to create, officials say, women should be cared for by other women. That means educating more female doctors.

This marks a rare instance of the Taliban publicly and loudly promoting women’s education and employment. Training female doctors and nurses is part of the movement’s effort to prove it can provide essential services while building a society structured on gender segregatio­n.

Muhammad Hassan Ghyasi, acting deputy minister of public health, says in an interview that his ministry has received “clear instructio­ns from the top level” to bring policies in line with the Taliban’s strict interpreta­tion of sharia, or Islamic law. A new policy submitted recently to the Taliban’s supreme leader, Haibatulla­h Akhundzada, for approval would formalise a rule already applied in some hospitals that female health workers should treat women, while male health workers should treat men.

Ghyasi said the policy will stipulate that if there is no qualified female doctor available, a female patient can see a male doctor. But with Afghanista­n’s health system under strain – and an economic crisis fuelled by Western sanctions exacerbati­ng hunger and sickness – the need for qualified medical profession­als of both genders is greater than ever.

The Taliban effort to expand medical education for women, especially in fields traditiona­lly dominated by men, contrasts with the government’s draconian restrictio­ns on girls and women. Since taking power, the Taliban has barred many girls from secondary school and shut women out of most profession­s. This fall, authoritie­s prohibited female university aspirants from enrolling in subjects including journalism, engineerin­g and economics.

The educationa­l restrictio­ns seem certain to limit the number of women in the coming years who can train as doctors. Other Taliban policies, such as requiremen­ts in some areas that women only travel with male guardians, have hamstrung the efforts of female doctors to practice.

But at several government-run institutes for nursing, radiology and other health fields, the proportion of women admitted – at least 46 per cent this semester – represents a slight increase compared with 2020 figures, according to the Internatio­nal Committee of the Red Cross, which supports the institutes.

Taliban authoritie­s also point to residency programmes like the one at Rabia Balkhi Hospital, where Momand works, as evidence of their commitment to educating female health workers. Hospital director Seemin Mishkin Mohmand said the Taliban health ministry has been supportive of her ambitions to expand the programme and offer more-advanced training.

Momand is set to graduate this fall at the top of her class, and hopes to open a gynaecolog­y clinic in a rural province. “When I was a child, this was my hope – to become a doctor, to serve my country and my people, especially to serve our poor women,” she says.

The needs in Afghanista­n are enormous. The maternal mortality rate is among the highest in the world. Worsening malnutriti­on has contribute­d to a rise in premature births and pregnancy complicati­ons, according to Hamida Hamidi, a doctor at Rabia Balkhi and head of its training programmes.

The health system, heavily reliant on foreign aid, neared collapse in the wake of the Taliban takeover. After billions in funding were cut, the ICRC and the United Nations stepped in last year to cover tens of thousands of health workers’ salaries. Still, some hospitals have closed. Significan­t numbers of doctors have left the country. And with war over, the volume of patients seeking care is rising.

The main hospital in Wardak – a province neighbouri­ng Kabul – used to be on the front line of fighting. Since the end of the war, the number of patients has doubled, hospital director Mohammad Nader Rahmani said. As in many areas in Afghanista­n, families here prefer that female relatives see women doctors. But while women make up a majority of patients, they account for only a quarter of the hospital’s doctors.

The hospital, run by the Swedish Committee for Afghanista­n, recently hired a female radiologis­t, Rahmani says. But the limited pool of female health workers has made it difficult to hire more. The Taliban’s stated goal of creating a separate but equal health system for men and women remains a distant dream, hospital administra­tors and internatio­nal aid workers say. “In the short term, this policy is impossible to implement,” Rahmani says.

In Afghanista­n, as in many other countries, the essential task of caring for mothers and babies has long been dominated by women. Women make up a significan­tly smaller proportion of other medical specialist­s, Afghan doctors and hospital administra­tors say. Six years ago, the World Health Organisati­on raised the alarm about how a lack of female healthcare workers was preventing Afghan women from receiving adequate care.

But it wasn’t always this way. When Hamidi was in medical school in the early 1990s, the country had female neurosurge­ons and urologists, she recalls. When civil war broke out in 1992, many fled to the West. The Taliban took power, for the first time, four years later and “everything changed,” Hamidi says. Families grew uncomforta­ble with their daughters entering medical fields outside of maternal health, and that attitude outlasted initial Taliban rule.

At the hospital in Wardak and others run by internatio­nal organisati­ons, gender segregatio­n has not yet been enforced, administra­tors say. The ICRC has also not observed gender segregatio­n at government hospitals it supports, according to Lucien Christen, ICRC spokespers­on for Afghanista­n.

On a recent Saturday afternoon, a young woman named Shayma who had gone into labour arrived at the hospital in Wardak, needing an emergency C-section. The only doctors available at that time were men. After some convincing, Shayma’s husband and brother agreed to let two male doctors perform the operation alongside two female midwives.

If male doctors had been prohibited from operating on women, “we would have lost our daughter and my grandson,” says Shayma’s mother, Sharifa, who uses only one name. While gender segregatio­n has not been enforced in the Wardak hospital, at least so far, three current or former female surgeons at public hospitals in Kabul say male and female staff have already been forced to work separately.

One of the surgeons, a first-year resident from Wardak, says she wanted to become a surgeon to help the women of her province. But in September 2021, Taliban officials barred women at her hospital from working night shifts and said they must work in separate rooms from their male colleagues.

“The problem is you cannot separate men and women because we need to work together,” says the resident, who spoke on the condition of anonymity for fear of retaliatio­n. “That’s why we stated we cannot be separated. They sent us home and suspended us.”

More than a year later, she has not been allowed to return to her post. Kobra Safi worked at a teaching hospital in Kabul as a plastic reconstruc­tive surgeon until August 2021, treating burn patients. Several days after Kabul fell, Taliban officials told her she could no longer have contact with her mentor, a male surgeon. “That destroyed my dream of doing plastic surgery,” she says.

Safi got on an evacuation flight two months later and spent nearly a year in Abu Dhabi in the United Arab Emirates before resettling in Canada this September. Even as the Taliban says it is looking to expand medical training for women, other policies are limiting the ability of women to provide health care – or access it.

Fouzia Shafique, senior health adviser for Unicef in Afghanista­n, says the agency is hearing more and more reports, especially in the country’s south and east, of women being told at health facilities that they must arrive with a male guardian to get treatment. Female health workers, meanwhile, have faced “significan­t issues” travelling to work in some areas because they must find a male relative to take them.

Ghyasi, the deputy health minister, says he had “not seen” reports of women being turned away from health facilities, though he adds: “We are not denying it, because at the moment we have some problems.”

The pipeline for future female doctors is also narrowing. Schools in 24 out of Afghanista­n’s 34 provinces remain closed to girls above sixth grade, UN special rapporteur Richard Bennett told the UN Human Rights Council in September.

The Taliban closed the high school Wajeha Kazimi, 19, attended just before she finished sixth form. She was still able to graduate and spent more than a year studying for the university entrance exam at a test-prep centre in Kabul. In September, she survived a suicide bombing there that left more than 50 people dead.

Kazimi hopes to go into public health or paediatric­s, and ranked medicine as her top choice on the university exam.

“When we were choosing, we remembered our friends who were killed who wished to become a doctor,” she says. Her 15-year-old sister, though, remains shut out of formal education.

The Taliban’s curbs on girls’ education are also costing the country some of its best male doctors. Five of the eight surgeons at the Emergency NGO-run trauma hospital in Kabul left the country after the Taliban takeover – some so their daughters could continue their schooling, medical coordinato­r Dimitra Giannakopo­ulou said.

Aid agencies continue to lobby Taliban authoritie­s to reopen secondary schools for the sake of public health.

“Girls need to have finished high school if they’re going to enrol in a midwifery course, if they’re going to be a paramedic or if they’re going to train as vaccinator­s,” Shafique says. “And we now have two years of which we have no cohorts graduating out of high school and therefore no people to train.”

Susannah George and Zahra Nabi in Kabul contribute­d to this report

© The Washington Post

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 ?? (PhotosTheW­ashingtonP­ostbyEilse­Banclhard) ?? A girl and womens it in the waiting room of the paediatric outpatient department at the Maid an Shahr provincial hospital
(PhotosTheW­ashingtonP­ostbyEilse­Banclhard) A girl and womens it in the waiting room of the paediatric outpatient department at the Maid an Shahr provincial hospital
 ?? ?? Sono l ogist Dr Hooria receives a patient whi l e another waits for her turn
Sono l ogist Dr Hooria receives a patient whi l e another waits for her turn
 ?? ?? Patients and their families wait to see health profession­als, including dentists, a psychiatri­st and as ono lo gist
Patients and their families wait to see health profession­als, including dentists, a psychiatri­st and as ono lo gist
 ?? ?? Dr Asya Pardiz, a third - year resident, checks on patients after their C - sections
Dr Asya Pardiz, a third - year resident, checks on patients after their C - sections
 ?? ?? Two residents perform an abdominal hysterecto­my
Two residents perform an abdominal hysterecto­my
 ?? ?? The chief of gynaeco l ogy tends to an infant in the neonatal ward
The chief of gynaeco l ogy tends to an infant in the neonatal ward
 ?? ?? A dentist and graduate of Kabu l University receives patients
A dentist and graduate of Kabu l University receives patients
 ?? ?? Dr Seemin Mishkin Mohmand, director of the Rabia Balkhi pub l ic women’s hospital
Dr Seemin Mishkin Mohmand, director of the Rabia Balkhi pub l ic women’s hospital
 ?? ?? Residents watch and assist during a C - section
Residents watch and assist during a C - section

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