Many human rights and health gains have been made in Afghanistan over the past two decades. The international community must ensure that these are not reversed under Taliban rule, says Mohammad Razai
As I landed at Kabul Airport, there was a palpable sense of hope in the air. The city, like much of the country, echoed to music and the tricolour Afghan flags fluttered in the summer wind. My three nieces Kamila, Zuhal, and Sumia—like 8.2 million Afghan children—went to school. It was 2009, almost a decade after the removal of the Taliban regime that ruled most of the country between 1996-2001.
In the two decades since, the country has made enormous progress in healthcare, education, life expectancy, child mortality, and economic growth. Life expectancy has increased by 10 years, infant and child mortality has dropped by about 70%. This is the fastest reduction in under-five child mortality among low-income countries. The rate has dropped from 191 deaths per 1,000 live births in 2007 to 49 in 2018. Child malnutrition has halved, maternal mortality declined by 50% (from 1100 deaths per 100,000 live births to 396 deaths per 100,000 live births), and access to healthcare and sanitation has also dramatically increased across the population. 
Afghan women have been one of the biggest beneficiaries. Their living standards have improved hugely with women comprising one-fifth of Afghan civil servants. Girls’ education increased by 60% compared to the period under the Taliban. Similarly, with better access to contraception and education, fertility rates declined across all age groups from an average of 7.3 children born per woman to 4.6 between 2002 and 2017, with a similar reduction in adolescent fertility from 146 births per 1,000 women to 69 between the ages of 15-19. 
The median age in Afghanistan is 15.6 years and nearly two-thirds of the population is below the age of 25. The country’s young made the most of the opportunities offered by a double-digit economic expansion. Between 2002 and 2018 real incomes per capita increased by 75%.  Afghanistan’s dependence on agriculture declined as the services sector expanded. Access to the internet and mobile phones increased, providing a lifeline for many people in a landlocked country with rugged terrain. 
For me, as a Hazara minority, one of the biggest achievements was constitutionally enshrined equal rights for all minorities. Ethnic and religious minorities enjoyed unprecedented freedoms and rights under the new democratic order. Additionally, civil liberties, freedom of the press, and the right to protest and vote were guaranteed and largely respected. 
Yet, there were serious problems brewing. Even a decade ago I could sense the beginning of a disaster with increasing insecurity and corruption. Afghan state was one of the most corrupt in the world. It ranked 165 out of 185 in 2020. Its corrupt, conflict-ridden, and ineffective institutions largely squandered the international goodwill and aid money. Poverty has remained rampant with more than half the population living below the poverty line, and one of the lowest standards of living compared to other countries in the region.[1-2] However, even the most critical observer will not deny the huge progress made, which transformed Afghanistan from harbouring fundamentalism and terrorism to becoming a rapidly developing democratic nation-state.
For those of us deeply invested in Afghanistan and its future, we watch the unfolding disaster numb with shock and grief. The hard-won fragile gains of the last two decades have been reversed overnight or are seriously threatened. The country is now under Taliban control, and they have lynched artists—including a folk singer and a comedian—severely curtailed the ability of women and girls to work and study, and have promised to impose their version of Sharia law in a new “Islamic Emirate of Afghanistan.”  The cost of abandoning Afghanistan and the ensuing catastrophe will undoubtedly be high for the Afghan people and the rest of the world. The political and security crises have also exacerbated the effects of climate change and covid-19 pandemic. Drought has ravaged broad swathes of the country, precipitating mass internal displacements. As the security situation deteriorated and the government collapsed, the pandemic was completely ignored. However, people are still dying from covid-19 and spreading the infection without any mitigation measures in place.
It is easy to despair. However, it is still possible to avert the worst consequences of the Taliban rule. Unlike the 1990s, the group is desperate for international recognition. They are also aware that governing the country, which is heavily dependent on international aid, would not be possible without access to foreign reserves. This leverage could be used effectively in salvaging the socio-economic gains made, especially in health and education. Any political recognition and aid money must be tied to a genuine commitment by the Taliban to respect human rights—especially the rights of women and minorities—basic civil liberties, freedom of the press, and adherence to democratic norms and an inclusive broad-based government.
Mohammad Razai is an NIHR In-Practice Fellow in Primary Care at St George’s University of London.
Competing interests: none declared
Acknowledgements: The views and opinions expressed are those of the author and do not necessarily reflect those of the NHS, the NIHR or the Department of Health.
- The World Bank. Afghanistan’s Development Gains: Progress and Challenges. 2019. Available from: https://openknowledge.worldbank.org/bitstream/handle/10986/33209/Afghanistans-Development-Gains-Progress-and-Challenges.pdf?sequence=1&isAllowed=y
- The Financial Times. The Afghan economy in charts: what has changed in two decades? August 2021. Available from: https://www.ft.com/content/bfdb94a5-654b-4286-8da9-34c0ff3b88aa
- John Simpson, BBC World Affairs Editor. Afghanistan: A country abandoned. Available from: https://www.bbc.co.uk/news/58377984