Afghans in Pakistan struggle to access health care

Dost Muhammad left Afghanistan with his family in 2007 and now makes a meager living selling vegetables in the Pakistani capital, Islamabad. Even though he has lived in Pakistan for many years and struggles to manage a heart condition, Muhammad said he is not entitled to universal health coverage.

Last year, Muhammad told DW, he was forced to sell a valuable rickshaw to pay for an expensive heart surgery. He continues to spend part of his family's earnings, or borrows money from relatives and neighbors, for medicine and medical visits.

Nazneena Bibi, a 29-year-old Afghan woman, faces a similar problem. She escaped Afghanistan to Pakistan after the Taliban takeover in August 2021 on a six-month visa. Some of Bibi's family members had worked for the United States before the withdrawal, and they are waiting for a resettlement in the US. However, their applications have been held up, and Bibi is stuck in limbo.

Bibi said she sought treatment at a government hospital in Pakistan for COVID-induced liver damage, but was turned away because she wasn't registered as a refugee.

No health care policy for Afghans

Faridullah Jan Khan, commissioner at the office of the chief commissioner for Afghan refugees in Islamabad, told DW there's no formal government health care policy for Afghan nationals living in Pakistan. However, he said "registered refugees" can consult doctors at government health centers "without hindrance."

Dost Muhammad, however, pointed out that many Afghans "have got illegal Pakistani identity cards to claim free treatment at hospitals."

Dr. Mohammad Naeem Malik of the Pakistan Institute of Medical Sciences, a large government hospital in Islamabad, said Afghan patients are examined in emergency rooms free of charge.

However, he told DW that Afghan patients cannot receive other services including medicines and medical supplies, or admission, as the government didn't allow that. He claimed the hospital couldn't take risks due to security reasons amid growing militant attacks in the country.

Nazneena Bibi, who can only speak Pashto, said after the denial of the checkup slip at the government hospital, a Pashtun doctor took her to his room, examined her and guided her on testing and treatment.

"We have acquaintances in Nowshera [a city in Pakistan's Khyber Pakhtunkhwa district — Editor's note], who just walk into local hospitals to claim free examination and treatment without trouble. That should happen here, too," she said.

Afghans in Pakistan living in limbo

Qaiser Khan Afridi, a spokesperson for the UN refugee agency, UNHCR, in Pakistan, recommended that all Afghans be catered to by Pakistani hospitals on humanitarian grounds, irrespective of their status.

Pakistan is home to millions of Afghans, both documented and undocumented. They began arriving after the Soviet invasion of Afghanistan in 1979, and during subsequent conflicts.

More recently, a large number of Afghans fled to Pakistan after the Taliban takeover in August 2021. Many have applied for resettlement or asylum in Western countries.

Afridi said that 1.3 million Afghans hold Proof of Registration cards, which grant them a temporary legal stay in Pakistan and prevents their forced return.

However, many Afghan refugees in Pakistan are undocumented. Afridi said up to 600,000 Afghans live in Pakistan "without valid documents to do business, earn a livelihood, access educational and health facilities, or visit relatives."

Many documented and undocumented Afghans live in refugee settlements around Pakistan. Men find work baking flatbread in tandoors or in restaurants, while others sell vegetables and grains in markets for very little money.

Some families are supported by relatives living in Western countries. However, most Afghan refugees in Pakistan live a hand-to-mouth existence and only borrow money from relatives or their employers in times of need, especially during medical emergencies.

Mohammad Nabi, who oversees 25 refugee camps in Pakistan's northwestern Mardan district, told DW that refugees receive no cash handouts from the government and NGOs.

Some Afghans told DW under request of anonymity that extending Pakistani visas involves many bureaucratic hurdles. Many people, especially women, children and the elderly, have expired visas and they try to stay out of sight to prevent being caught by authorities.

The US Department of State told DW by email that its capacity to process applications of Afghans in Pakistan for the US Refugee Admissions Program was limited, and that applicants are subject to "rigorous screening and security vetting prior to being admitted to the United States."

"We are actively pursuing all potentially viable options to process USRAP applications as quickly as possible in Pakistan," it said, while adding that acceptance to the program does not guarantee entry to the US. 

Edited by: Wesley Rahn 

Correction, August 16, 2023: A previous version of this article misspelled the name Qaiser Khan Afridi. DW apologizes for the error.