Skip to main content

Human Rights Watch presents this updated shadow report in advance of the 88th session of the Committee on the Rights of the Child to assess Afghanistan’s implementation of the Convention on the Rights of the Child.

Access to Health Care (Articles 6 and 24)

Over the past two decades, Afghanistan has depended on international donor support to fund essential services like health care; over 75 percent of the government’s budget comes from international aid.[1]  But this donor support has been falling for years. In 2013, for example, member countries of the Organisation for Economic Co-operation and Development's (OECD) Development Assistance Committee (DAC) contributed US$141 million to health and population assistance in Afghanistan.[2] In 2019, the latest year for which figures are available, that figure was $105 million—a drop of some $36 million, or 26 percent of total funding.  Aid will likely to continue to fall—perhaps precipitously—as all international troops withdraw ahead of the US-set deadline of September 11, 2021.

The decline in funding has already had a harmful—and life-threatening—impact on the lives of many Afghan adults, and their children, as it affects access to, and quality of, health care.  Many of those needing reproductive and sexual health care, including maternal health care, are girls. One factor contributing to Afghanistan’s high rate of maternal mortality is the prevalence of child marriage. Thirty-five percent of girls in Afghanistan marry before age 18, and 9 percent before age 15.[3] Child marriage is associated with early and closely spaced pregnancies, and accompanying health risks, including death. In 2017, the government launched a national action plan to end child marriage, but little progress has been made on implementing this plan.

In the years after the US-led military invasion and the defeat of the Taliban government in late 2001, the Afghan government and international donors gave priority to developing an effective health system, including extending access to basic health care to all parts of the country. The effort led to important achievements, including significant declines in maternal and infant mortality, and increases in provision of prenatal care, use of modern contraception, and attended births. But even with two decades of effort and the expenditure of hundreds of millions of dollars, delivery of health services for women and children remains far below international standards, and the progress that has been achieved is being eroded in important ways.

Currently, children, and in particular girls, struggle to access even the most basic information about health and family planning. There is an unmet need for modern forms of contraception; prenatal and postnatal care is often unavailable; and a large proportion of births are still unattended by a professional. Health facilities often lack sufficient staffing and essential supplies and equipment. Afghanistan has 4.6 medical doctors, nurses, and midwives per 10,000 people, far below the threshold for critical shortage of 23 healthcare professionals per 10,000 people as defined by the World Health Organization.[4] Girls also often struggle to access care due to costs, including for transportation to a health facility, and for medications and supplies for which patients are obliged to pay.

When they can obtain care, it is often of poor quality. Distance remains a problem for a significant proportion of the population; almost 10 percent of people cannot reach a health facility within 2 hours and 43 percent must travel more than half an hour.[5]  Lack of access to adequate care drives Afghans to spend $285 million a year on medical tourism, mostly to Pakistan and India, draining funds from the health sector.[6]  Progress on some key indicators, such as accessing prenatal care and skilled birth attendance, is now stagnating, or even reversing.  Corruption at all levels threatens the delivery of health services and demands for bribes drive people away from seeking care.

Women often have more children than they want because of lack of access to modern contraception; face risky pregnancies because of lack of care; and undergo procedures that could be done more safely with access to and capacity to use more modern techniques.

This is a moment of crisis in Afghanistan. Insecurity is increasing dramatically as international troops withdraw and Taliban forces rapidly expand their control. These developments endanger already declining aid, as donors confront difficulties in delivering services and may decide it is too difficult. This could lead to the collapse of the health system and other essential services. Insecurity and fighting make it difficult for some healthcare workers to do their jobs. As the Taliban gains control of an increasing proportion of the country they are often placing restrictions on girls’ and women’s freedom of movement and their ability to receive treatment from male healthcare professionals.

We encourage the Committee to pose the following questions to the government:

  • Is the government continuing to fund and deliver sexual and reproductive health services in Taliban-controlled and contested areas of the country? How many districts, if any, are not receiving government-funded health services?
  • Can the government provide annual data for the last five years on the overall budget—from both aid donors and government revenue stream—devoted to healthcare delivery, and a breakdown of how those funds have been allocated each year?

We encourage the Committee to recommend to the government to:

  • Continue delivering government health services in all areas of the country, including contested and Taliban-controlled areas.
  • When allocating government funds, ensure adequate funding for health care goes for children and women, including sexual and reproductive health care.

Access to Education (Article 28)

Afghanistan was already facing an education crisis earlier in 2021, with the number of children in school falling in some provinces.

Although primary education is compulsory by law in Afghanistan through class nine, the government has neither the capacity to provide this level of education to all children nor a system to ensure that all children attend school.

Overcrowding, lack of infrastructure and supplies, and weak oversight mean that children who do go to school may study in a tent with no textbook for only three hours a day. There is a shortage of teachers overall, and the government’s failure to provide teachers in rural areas has undermined efforts to expand access to school in such areas.

Corruption and politically driven efforts to inflate the numbers of students have plagued efforts to expand education since 2001.  A 2016 report by the US Special Inspector General for Afghanistan Reconstruction found that teacher absenteeism ranged from 20 to 38 percent, and that a significant number of schools and teachers were so-called ghosts, meaning they were registered and funded, but did not actually exist.[7]

Girl’s Access to Education

Research by Human Rights Watch and others demonstrates a rising demand for education in Afghanistan, including a growing acceptance in many parts of the country that girls should study.  Nongovernmental organizations (NGOs) that support “community-based education”—schools located in homes in students’ communities—have often been more successful in enabling girls to go to school in areas where they would not have been able to attend government schools because of insecurity, family resistance, and community restrictions. But the government’s failure to integrate these schools into the state education system, combined with inconsistent funding for these schools, has deprived many girls of education.

In recent months, as the Taliban has significantly expanded the proportion of the country under their control, their approach to education, and especially to girls’ education, has become increasingly pertinent. It is clear that the Taliban continues to dramatically restrict access to education for women and girls in areas they control. The extent to which they do so is inconsistent and may be an evolving issue. 

Although the Taliban officially state that they no longer oppose girls’ education, very few Taliban officials actually permit girls to attend school past puberty. Others do not permit girls’ schools at all. Taliban officials claim that the differences in access to education between districts and provinces are due to security issues and varying levels of acceptance of girls’ education within the communities themselves. But individual Taliban commanders, shadow provincial governors, and district officials, many of whom have their own views on education, largely determine education policies in the areas under their control.

The Taliban have also implemented changes to the curriculum, giving priority to religious studies and in some cases removing classes on culture (including music) and “terrorism,” and modifying history lessons.[8] Taliban officials have in some cases threatened teachers for not paying part of their salaries to the Taliban as a “tax.”[9] In some Taliban-held districts, NGOs running community-based education programs have been able to provide education where no other schools are accessible. In some districts, the Taliban have imposed “taxes” on teacher salaries and threatened teachers and residents whose relatives teach in schools in nearby government-controlled areas.

As Taliban gains accelerated in 2021, there have been reports of them restricting the freedom of movement of women and girls in ways that cuts off their access to education, and there are reports that in some places they have closed girls’ schools.[10]

Falling donor funding is another risk to access to education, especially for girls. Overall development assistance to Afghanistan according to OECD DAC was $6,862 million in 2013, and $4,053 million in 2019. The US, an OECD DAC member, provided a total of $16,748 million in assistance in Afghanistan in FY 2010, versus $3,120 million in FY 2021. The Taliban’s views on girls’ education will become less relevant if the already faltering education system collapses due to lack of funding.

We encourage the Committee to pose the following questions to the government:

  • How many schools are currently closed and for what reasons?
  • Can the government provide annual data for the last five years on the overall budget—from both aid donors and government revenue stream—devoted to delivering education, with a breakdown of how those funds have been allocated each year?
  • Can the government provide data on the number of children enrolled in primary and secondary school in each province, the percentage of students who are girls in each province, and how each of those figures has changed, by province, in the last five years?
  • What steps has the government taken to ensure the sustainability of community-based education classes? 

We encourage the Committee to recommend to the government to:

  • Implement specific policies to ensure equal access to education for girls at both primary and secondary levels, including hiring and retaining more female teachers, increasing the number of coeducational and girls’ schools, and prioritizing infrastructure that is especially important to girls’ access to education such as safe and private toilets with running water and boundary walls.
  • Integrate community-based education classes fully into the government education system, consider expanding the number of community-based educations classes to reach underserved areas, and fund them as government schools.

Children Involved in Armed Conflict (OPAC Articles 1, 3, 4, and 6)

All Afghan parties to Afghanistan’s armed conflict have recruited and used children, including the government’s Afghan National Police (ANP), Afghan Local Police (ALP), and Afghan National Army (ANA), and the Taliban and the Islamic State of Iraq and the Levant-Khorasan Province (ISIL-KP). In 2020, the UN verified the recruitment and use of 196 boys for use in combat, including in attacks with improvised explosive devices (IEDs), intelligence gathering, and staffing checkpoints. At least nine boys were killed or injured in combat.[11]

Detention

Government authorities, including security forces, are detaining hundreds of children for alleged involvement with the Taliban, Islamic State, or other non-state armed groups.[12] Children are often held in military facilities in violation of Afghan law, and often sign documents involuntarily, including confessions, that they do not understand. They are charged with vaguely worded “terrorism offenses” and may be subject to long prison sentences.[13] An official of Afghanistan’s National Security Council told Human Rights Watch that many of the children in custody have been detained solely because of their parents’ alleged involvement with insurgent groups.[14]

Since 2015, an average of 180 children per year have been detained in juvenile rehabilitation centers on national security charges, including for association with non-state armed groups, while hundreds more have been detained in facilities run by different government security forces.[15] The UN Secretary-General’s most recent annual report on children and armed conflict, released June 21, 2021, states that as of the end of December, 165 children were detained on national security-related charges in juvenile rehabilitation centers for periods of up to 3.5 years, and that an additional 318 children were in prison with their mothers who were detained for alleged or actual association with armed groups. However, the report does not reflect that hundreds more children, some as young as 10, are likely held in facilities run by government security forces.

Under Afghan law, children under 18 are meant to be detained only in juvenile rehabilitation facilities and their cases investigated by the Special Juvenile Prosecution Office, which is required by law to deal with all cases involving children.[16] In practice many are detained by the police or intelligence services either before finally being transferred to a juvenile center or for the duration of their sentence. For example, in 2019-2020, UNAMA documented the detention of 85 children (82 boys and 3 girls) by the ANA, ANP, and National Directorate of Security (NDS) based only on a sample of interviews, meaning the actual number is larger. The youngest said they were 10 years old.[17] Many were detained in multiple facilities.[18]

Because many Afghan children lack proof of age, older children may be sent to adult prisons after being sentenced, such as Pul-e Charkhi, a large prison complex on the eastern outskirts of Kabul where many conflict-related prisoners and detainees awaiting trial are held. If children turn 18 before their sentence is up, they are sent to adult prisons to serve out the rest of their sentences.

Torture and Mistreatment

From interviews in 2019-2020, the United Nations Assistance Mission in Afghanistan (UNAMA) found that children in detention for conflict-related charges were more likely than adults to report torture, with nearly 44 percent of children interviewed providing credible accounts of torture or ill-treatment, including severe beatings and threats (compared with roughly 32 percent for all detainees).[19] In 2021, the Afghanistan Independent Human Rights Commission documented frequent ill-treatment of children in detention.[20]

Legal Services

According UNAMA reports, only about 7 percent of children in juvenile rehabilitation centers had seen a lawyer before being questioned, but nearly half had access to a lawyer at some point during their detention.[21] Most children come from very poor families and have no means to pay legal fees. Afghan legal aid organizations have told Human Rights Watch that while they are aware of the need, they do not have the resources to help the majority of children in detention.  Even those who have representation have lawyers who may lack adequate training or knowledge of the case to represent them well. As a result, the children’s case files are not always accurate, meaning longer time in detention, no access to alternatives to detention, or even being tried for the wrong crimes. Human rights observers collected some 200 allegations of children detained several months longer than their sentences.[22]

Lack of rehabilitation and reintegration assistance

Unlike other conflict-affected countries, Afghanistan has no reintegration programs for children formerly associated with armed groups. Although Afghanistan’s revised penal code and juvenile code provide for alternatives to detention and incarceration, these are made available to a limited number of children accused of ordinary crimes, and rarely if at all for those accused of security crimes.

Children have also been excluded from prisoner releases in the context of the Afghanistan peace talks or in response to Covid-19. In 2020, approximately 5,000 Taliban prisoners were released as a result of the peace talks, but none were children. [23] According to official figures, 284 children detained on criminal charges were released in response to the Covid-19 pandemic, but none were children detained for conflict-related reasons.[24]

We encourage the Committee to pose the following questions to the government:

  • How many children are currently detained for alleged association with armed groups, including both those in juvenile rehabilitation centers, as well as those detained in facilities run by government security forces?
  • How many children have been convicted for involvement with armed groups, and what were their sentences?

We encourage the Committee to recommend to the government to:

  • Release children detained for alleged association with armed groups and transfer them to civilian child protection authorities for reintegration.
  • Work with UN agencies and other donors to establish, as an urgent priority, appropriate reintegration programs for children associated with armed groups to facilitate their reintegration into society.
  • Ensure that child protection is high on the agenda of negotiations among the parties to the conflict, including the release and reintegration of children detained for alleged association with armed groups.
  • Work with the UN to negotiate and sign a formal handover protocol to ensure the swift and direct transfer of children apprehended by or in the custody of armed forces or armed groups to civilian child protection authorities for rehabilitation and reintegration.
  • Ensure that children should not be detained, prosecuted, or punished solely for membership in nonstate armed groups and that children who committed crimes during their association with parties to the conflict should be treated in accordance with international standards for child justice.
  • Ensure that detention conditions meet international standards, and are only used as a last resort and for the shortest appropriate period of time.
  • Amend the Criminal Procedure Code to require that any child detained be brought in front of a judge within 24 hours to examine the legality of detention, the need for further detention, and any ill-treatment during arrest or subsequent detention.
 

[1] World Bank, “AFGHANISTAN: Public Expenditure Update,” July 28, 2019,

http://documents1.worldbank.org/curated/en/696491564082281122/pdf/Afghanistan-Public-Expenditure-Update.pdf (accessed August 9, 2021); OECD DAC, “Top Ten Donors of Gross ODA for Afghanistan, 2018-2019 average, USD million,”https://public.tableau.com/views/OECDDACAidataglancebyrecipient_new/Recipients?:embed=y&:display_count=yes&:showTabs=y&:toolbar=no?&:showVizHome=no (accessed August 9, 2021).

[2][2] Organisation for Economic Co-operation and Development (OECD), Geographical Distribution of Financial Flows to Developing Countries 2021: Disbursements, Commitments, Country Indicators (Paris: OECD Publishing 2021) https://read.oecd-ilibrary.org/development/geographical-distribution-of-financial-flows-to-developing-countries2021_a50961e5-en-fr#page217 (accessed August 8, 2021), p. 217.

[3] “The State of the World’s Children 2019 Statistical Tables,” UNICEF,

https://data.unicef.org/resources/dataset/sowc-2019-statistical-tables/ (accessed August 7, 2021)

[4] Najibullah Safi, et al., “Addressing health workforce shortages and maldistribution in Afghanistan,” Eastern Mediterranean Health Journal, vol. 24, no. 9 (2018), https://www.emro.who.int/emhj-volume-24-2018/volume-24-issue9/addressing-health-workforce-shortages-and-maldistribution-in-afghanistan.html. The World Health Organization has taken note of some experts subsequently endorsing a new benchmark of 35 healthcare workers per 10,000 people. World Health Organization (WHO) and Global Health Workforce Alliance, “What are the latest statistics on health workforce availability?” undated, https://www.who.int/workforcealliance/media/qa/05/en/ (accessed April 14, 2021).

[5] Ibid.

[6] SIGAR, “SIGAR 17-22 Audit Report: Afghanistan’s Health Care Sector USAID’s Use of Unreliable Data Presents Challenges in Assessing Program Performance and the Extent of Progress,” January 2017, https://www.sigar.mil/pdf/audits/SIGAR-17-22-AR.pdf (accessed August 8, 2021).

[7] Special Inspector General for Afghanistan Reconstruction, “Schools in Herat province: observations from site visits at 25 schools,” November 2016, pp.4-5, https://www.sigar.mil/pdf/special%20projects/SIGAR-17-12-SP.pdf (accessed May 27, 2020).

[8] Khan Wali Ahmadzai, “Taliban imposes changes on Afghan curriculum,” Institute of War and Peace Reporting, January 13, 2018, https://iwpr.net/global-voices/taleban-impose-changes-afghan-curriculum (accessed December 8, 2019). Barnett Rubin and Clancy Rudeforth, “Enhancing Access to Education: Challenges and Opportunities in Afghanistan,” New York University: Center on International Cooperation (CIC), May 2016, https://cic.nyu.edu/sites/default/files/enhancing_access_education_may23_final.pdf (accessed January 4, 2020)

[9] On January 28, 2019, Taliban officials in Parwan province abducted 49 teachers and held them until community elders negotiated their release two days later. Farid Tanha, “Seized 2 days ago, Taliban release Parwan teachers,” Pajhwok, January 31, 2019, https://www.pajhwok.com/en/2019/01/31/seized-2-days-ago-taliban-release-parwan-teachers, (accessed April 10, 2020). United Nations Assistance Mission in Afghanistan, Afghanistan: Protection of Civilians in Armed Conflict 2019, pp. 26-27, https://unama.unmissions.org/sites/default/files/afghanistan_protection_of_civilians_annual_report_2019_- _22_february.pdf (accessed February 20, 2020).

[10] Ezzatullah Mehrdad and Saphora Smith, “Taliban sweep through Afghanistan, imperiling girls school,” NBC News, July 15, 2021, https://www.nbcnews.com/news/world/taliban-sweep-through-afghanistan-imperiling-girls-school-n1273510 (accessed August 8, 2021). Adam Nossiter, “In Taliban-Controlled Areas, Girls Are Fleeing for One Thing: an Education,” New York Times, May 17, 2021, https://www.nytimes.com/2021/05/17/world/asia/afghanistan-taliban-girls-school.html (accessed August 8, 2021).

[11] United Nations, Secretary-General’s annual report to the UN Security Council on children and armed conflict, May 6, 2021, A/75/873-S/2021/437, para 11.

[12] Human Rights Watch, “Forgotten Children: Children Detained in Afghanistan for Alleged Association with Armed Groups,” June 2021, https://www.hrw.org/sites/default/files/media_2021/06/afghanistan-forgotten-children-06222021.pdf

[13] Government of Afghanistan, Juvenile Law (Juvenile Code) - Official Gazette No. 846, published 2005/03/23 (1384/01/03 A.P.), https://www.refworld.org/docid/5b0fffbe4.html.

[14] Human Rights Watch interview with National Security Council official, Kabul, October 14, 2020.

[15] Secretary-General’s annual reports to the UN Security Council on children and armed conflict. See also, UNAMA, Preventing Torture and Upholding the Rights of Detainees in Afghanistan: A Factor for Peace, February 2021, p 20. https://unama.unmissions.org/sites/default/files/treatment_of_conflict_related_detainees_report_feb21.pdf.

[16] UNAMA, Treatment of Conflict-Related Detainees in Afghanistan: Preventing Torture and Ill-treatment under the Anti-Torture Law, October 2019, https://unama.unmissions.org/sites/default/files/afghanistan_-_report_on_the_treatment_of_conflict-related_detainees_-_17_april_2019.pdf.

[17] UNAMA, Preventing Torture and Upholding the Rights of Detainees in Afghanistan: A Factor for Peace, February 2021, p 20. https://unama.unmissions.org/sites/default/files/treatment_of_conflict_related_detainees_report_feb21.pdf.

[18] Ibid.

[19] UNAMA, Preventing Torture and Upholding the Rights of Detainees in Afghanistan: A Factor for Peace, February 2021, p 20. https://unama.unmissions.org/sites/default/files/treatment_of_conflict_related_detainees_report_feb21.pdf

In 2017 and 2018, UNAMA randomly interviewed 618 detainees in 77 facilities; 82 (13 percent) were children.  

[20] Human Rights Watch interview via email with human rights official, Kabul, May 19, 2021.

[22] Human Rights Watch interview via email with human rights official, Kabul, May 19, 2021.

[23] US Department of State, “The Agreement for Bringing Peace to Afghanistan between the Islamic Emirate of Afghanistan which is not recognized by the United States as a state and is known as the Taliban and the United States of America, February 29, 2020,” https://www.state.gov/wp-content/uploads/2020/02/Agreement-For-Bringing-Peace-to-Afghanistan-02.29.20.pdf.

[24] Ibid.

Your tax deductible gift can help stop human rights violations and save lives around the world.

Region / Country