On 11 March 2020, the World Health Organisation (WHO) declared COVID-19 a pandemic. According to the Afghan Ministry of Public Health’s “Public COVID-19 Dashboard,” 223,832 people in all 34 provinces tested positive for COVID-19 as of July 2023, with Kabul, Herat, Kandahar, and Balkh being heavily affected. Low vaccination rates have made Afghanistan especially vulnerable to COVID-19, with several waves impacting the country, including in 2022. The clinical case mortality rate exceeded 3%, with a significant increase among patients over 80 years old, according to WHO. Since the change of government in mid-August 2021, the COVID-19 response from the de facto authorities has been weak, relying on a fully funded health system and implementing partners. From 3 January 2020 to 31 May 2023, there were 221,332 confirmed cases of COVID-19 and 7,914 deaths reported to WHO. As of 21 May 2023, a total of 17,479,379 vaccine doses had been administered in a country with a population exceeding 41 million. Approximately 36% of the population received at least one dose, well below the WHO global target of 70% COVID-19 immunization coverage by mid-2022, with some provinces performing much lower than the national average.

The limited capacity to handle health emergencies, combined with a large community of vulnerable people and a fragile health system, has severely impacted the country. Additionally, the limited ability to conduct and analyze specific testing, particularly in rural and remote areas, resulted in a certified relatively low level of COVID-19 cases, while the death rate increased (MoPH: “Public COVID-19 Dashboard”).

Several conditions could lead to potential morbidity and mortality due to the COVID-19 pandemic in Afghanistan. Over 55% of the population lives below the poverty line, with more than 400,000 Internally Displaced People (IDP) in 2019 alone, and over 300,000 refugees returned from Iran and Pakistan in the first months of 2020 (UNHCR End Report 2020). Additionally, the health system remains fragile, affected by insufficient funds and understaffing. These factors, along with internal insecurity, urban density, malnutrition, poor hygiene, and sanitation conditions, left the country unprepared for the health emergency crisis generated by the pandemic. The MoPH estimated that 25 million Afghans could be infected with COVID-19, with an estimated 110,000 deaths.

Since the Taliban takeover in August 2021, there have been critical developments in Afghanistan, including the temporary suspension and reduction of development aid by many donors and international agencies, heavily affecting the health sector reliant on external support.

The Intervention is funded by the Development Cooperation Instrument for Asia & Central Asia, under Special Measures, through a Grant Contract awarded to the Aga Khan Foundation (United Kingdom), in partnership with the Aga Khan Foundation-Afghanistan, Stichting Cordaid (Netherlands), the Humanitarian Assistance and Development Association for Afghanistan (HADAAF), the French Medical Institute for Mothers & Children (FMIC), and the Aga Khan Agency for Habitat (AKAH).