Will the international humanitarian system repeat its mistakes by overlooking the capabilities that Afghan professionals have built over the last two decades? There are already worrying signs.
The fall of Kabul to the Taliban almost immediately triggered international humanitarian mechanisms and a series of funding appeals by UN agencies. This is a well-known drill, as if the first and loudest call has a better chance of being heard by donors.
On social media, international aid agencies share ever-rising financial estimates for emergency responses. The figures they quote are now so enormous that they have lost their meaning: One UN agency, for example, is requesting $192 million.
Calls for urgent donor funding will echo in the days and weeks after the 13 September aid summit, which is backed by the UN and meant to galvanise support for Afghanistan.
International support is desperately needed. But in its rush to help Afghanistan, the humanitarian world risks superimposing costly, parallel systems that ignore what already exists: a functioning public health sector, Afghan NGOs waiting for support, and aid agencies that have operated amid a complex crisis for years.
This same story repeats again and again: In an emergency, the humanitarian sector feels obligated to send goods and personnel into a country in turmoil, as if this is the only option.
The consequences can be seen in countries like Lebanon, where the relief response targeting different communities – the Lebanese population, Palestinian refugees, Syrian refugees – means that each group now has access to a different healthcare system. Creating parallel humanitarian systems weakens national structures and capacities: Hiring local staff for emergency operations, for example, undermines the services and organisations that already exist.
This is also the danger in Afghanistan. When relations with the Taliban are clearer, some international relief agencies will see a new opportunity to send their teams and create offices in Kabul – even if they have minimal experience in the country.
“This same story repeats again and again: In an emergency, the humanitarian sector feels obligated to send goods and personnel into a country in turmoil, as if this is the only option.”
What the flashy social media appeals seem to ignore are the Afghan professionals – health workers, local NGOs – who remain in Afghanistan and want to continue working. The Ministry of Public Health – one of the few government systems still functioning – has held brainstorming meetings on how to coordinate aid and make use of what already exists.
Today’s health system is a unique, hybrid model: In most of the country’s 34 provinces, the government uses donor funds to contract Afghan NGOs to deliver essential services.
Years of donor investments in Afghanistan's health sector have produced results. Maternal mortality, child mortality, rates for neonatal deaths – all have dropped significantly over the last 20 years.
In 2018 and 2019, the health sector saw donor investments totalling more than $1 billion each year, which helped run a network of some 3,600 health facilities and more than 32,000 health professionals.
As the humanitarian sector prepares to scale up, we offer four key recommendations aimed at preserving Afghanistan’s health gains:
Protect what has already been built: Our Afghan colleagues on the ground are pleading for continuous support to the existing health system and its strong network of health facilities. These include provincial hospitals, health centres, and mobile clinics – many located in the country’s most remote areas. The humanitarian response should not supplant what already exists.
Prioritise aid organisations that know Afghanistan: Many humanitarian groups have been working in Afghanistan for the last 20 years and have established strong relationships with Afghan actors, including the Taliban. It is essential that humanitarian investments prioritise these well-established organisations, which have experienced security mechanisms in place and knowledge of the complexities on the ground.
Fund Afghan NGOs: Humanitarian donors should sub-contract and fund the Afghan health NGOs that have been delivering healthcare for the last 20 years. They can continue to bring essential care to the most remote parts of Afghanistan, where populations have been interacting with these professionals and have trust in the system.
Use the existing health programme: An emergency health plan already exists. The health ministry has clearly defined its health priorities for the coming years through the Integrated Package of Essential Health Services, which was finalised in July. This should serve as the basis for all humanitarian action trying to respond to the most acute and permanent health needs.
Afghanistan faces an uncertain future, and the international aid system an important decision. If the immediate response needs to be a shorter-term humanitarian intervention, then it must also aim to protect the health gains Afghanistan has achieved over the last two decades. This means supporting the Afghan health professionals and the system already in place.
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