Moving forwards in Afghanistan

We write this Editorial in the week that last US troops left Afghanistan and a new era of Taliban rule began. Scenes panic despair, women losing their jobs withdrawing from streets whilst Western powers sought to deflect blame, have been painful see. What progress does most beleaguered nations stand lose what future hold for its people's health? In past 5 years, we published several major studies on bellwether health systems: maternal child survival. The first (and only) Countdown 2015 case study found that, between 2003 2015, under-5 mortality declined by 29% neonatal 27%. Stunting about third. Findings death were conflicting, but given an observed concurrent increase coverage relevant interventions—eg, antenatal care attendance, skilled at birth, facility-based births—there was reason conclude deaths had also declined. RAMOS-II capital Kabul remote rural town Ragh further showed declines 71% 84%, respectively, 2002 2011. However, it is worth noting emerged appalling baseline. latest UN estimates still show rate around 60 per 1000 livebirths ratio 638 100 000 livebirths, suggesting Sustainable Development Goal targets 25 70 likely be unachievable even without current threat. And threat real manifold. factors independently contributed increases birth attendance facility births literacy, deployment community midwives, proximity facility. Clearly continued ability learn, seek employment sector, access services they need are fundamental basic levels health. would not happened team educated female interviewers who went door-to-door administering questionnaire. If women's rights education, employment, autonomy as endangered must assume under Taliban, historic precedent despite group's vague protestations contrary, then only vulnerable Afghans threat, recording it. All touch disruption humanitarian medical imports caused chaos Hamid Karzai International airport, withdrawal Monetary Fund World Bank support, freezing central bank assets held USA, all which will put pressure citizens already paying substantially out pocket care. Nor consider uncertainty surrounding dedicated non-governmental organisations (NGOs) whose support desperately fragile system relies. Those NGOs delivering contraception, interventions reduce gender-based violence particularly unlikely able negotiate service provision regime. Many left. Given such dire outlook, despondency inevitable. Yet Afghan people, with justified feelings abandonment betrayal, deserve more than sympathy. Countries, those played key role 20 years Afghanistan's history, should domestic politics aside commit evacuating eventually granting asylum those, women, legitimately fleeing safety, many whom risked lives families assist foreign overseers. For find themselves stateless country may struggle them, aid agencies donors rapidly surge assistance countries Pakistan Iran, taken millions refugees over year. remain, providing—or funding—humanitarian abide principles neutrality, independence, impartiality, operate strictly needs-based ethics-driven agenda.