Hidden rebellion: Medical students go underground in Afghanistan

The last time the Taliban inspected the hospital where she was secretly studying to become a nurse, Lima stayed at home.

After five years of medical training, 28-year-old Lima will complete a year of residency as a doctor, improving his diagnostic skills. Instead, he takes temperatures and administers injections, a task he has been doing for three months in an emergency room in Kabul. Although it’s not the kind of work he expected to be doing at this stage of his career, at least he’s happy to be able to do it.

“Living in the hospital means I can be closer to my work. It helps me stay connected,” Lima told Al Jazeera in several phone calls. For security reasons he is being identified only by name.

Lima was just weeks away from graduating from medical school in Kabul when the Taliban banned higher education for women last December, disrupting her studies and those of thousands of other women. Women who are already qualified as doctors, nurses and other health professionals can continue to work, but new women are not allowed to work or receive training in that role.

More than 3,000 women who had already graduated from medical school before the ban were denied the opportunity to take the exams required to practice, leaving a country already suffering from a severe shortage of medical professionals and a large number of new doctors. Necessity was denied.

For Lima, medicine was a lifelong dream. She aspires to become a surgeon, partly because she knows there is a shortage of them.

“My biggest hope is to help people,” he said.

Her family returned from Pakistan to Afghanistan so she could attend university in Kabul, where she flourished: she performed well in her classes and was named “leader” of her class by performing administrative duties.

The day she learned about the new restrictions on women graduating from medical school, Lima and her classmates were having lunch together. They cried together because of how it would affect their future and because they were worried they would never see each other again. The Taliban’s strict ban on women leaving the house without a male companion has made it almost impossible to meet up with friends.

After the news spread, Lima called one of his teachers and convinced him to let him and his classmates sit for one of the exams scheduled that week. This was not for formal assessment, just to let them know they could do it. The teachers agreed, but when Lima and her classmates arrived at the university to take exams, armed Taliban were already guarding the door.

Professor Leamy said, this is already dangerous.

Girls from Herat gather to demonstrate to demand the right to continue their education in schools and universities in Herat, Afghanistan, on September 20, 2021. (Anadolu Agency via Getty Images)

secret internship

About a year later, many women refused to abandon their chosen path and continued their education in person or online, in the hope that one day they would be allowed to return to formal college and medical school. Some women managed to circumvent the restrictions by secretly seeking housing and internships.

“It’s like a recovery of my studies, my knowledge. This is the best way to do something to achieve your goals,” says Noor*, whose name has been changed to ensure her anonymity. Like Lima, he was about to graduate from medical school when his studies were suddenly interrupted by Taliban restrictions. The order hit him hard.

He spent several months studying alone, considering medicine as his “sole goal” in life. He reviewed his notes, read thick English medical books and took online courses, focusing on what was lacking in his knowledge. But after working alone for weeks, she says she became depressed and had to listen to motivational speakers for an hour a day to muster the willpower to carry on.

In September, nine months into the ban, Noor gave up hope that the university would reopen and called the hospital, which offered her a two-month internship starting in 2020. They agreed to let him come over to finish it. Everyone treats it like a mystery.

When the two months were up, the hospital allowed him to stay to watch the operation for as long as he wanted. Noor says she is scared to even think what would happen if the Taliban found out that she was studying there. It’s not clear what would happen if it were discovered, but women studying medicine or doing internships would likely be kicked out of hospitals and, if not worse, barred from returning. Activists attempting to violate the ban on girls’ education have already been arrested.

Despite the risks, women never stop trying to break the ban on higher education.

“Never in the history of Afghanistan have we had so many educated women who know the world and their duties and rights well. You can’t silence them, you can’t push them away,” Fatima Ghaylani, a London-based women’s rights activist and former president of the Afghanistan Red Crescent Society, said in a WhatsApp interview.

Afghan nurses
Afghan nurses wait to be paid at Indira Gandhi Children’s Hospital in Kabul, Afghanistan, February 24, 2022. (Hussain Malla/AP Photo)

Women’s health is at risk

Despite the Taliban’s early promises of a liberal approach towards women’s rights after taking power in August 2021, the ban on higher education follows a number of measures taken by the armed group to further isolate the country and limit women’s role in society. Is one of.

Shortly after in August 2021, the Taliban banned girls from attending school after the sixth grade and imposed strict rules that women must wear hijab and travel only with a man. He closed beauty salons and banned women from working with national and international non-governmental aid groups, sparking international outrage.

“Afghanistan, under Taliban rule, remains the most repressive country in the world with respect to women’s rights,” Roza Isaakivna Otunbayeva, head of the United Nations Assistance Mission in Afghanistan (UNAMA), said in March when presenting the secretary of state’s latest report. General on the country. To the Security Council.

Afghanistan urgently needs female doctors, as they are often the only health care providers available to women and children. Although there is no explicit law against it, many traditional Afghan families do not allow their relatives to visit male doctors. This is a particularly serious problem in rural areas, where women often have to travel for hours to see a gynecologist. Once the current generation of doctors and nurses retire, that too will no longer be an option.

“Here in Kabul and in the provinces, women are suffering from the shortage of female doctors. They suffer from (lack of) access to health facilities. “They are suffering from not being able to access the treatment they want,” says Aminulhak Mayal, deputy director of the Swedish Committee in Afghanistan, a foreign aid organization.

In 2020, the World Health Organization estimated that 24 women died every day in Afghanistan due to pregnancy or childbirth. Although this figure was one of the highest in the world, it was significantly lower than in 2001.

Now experts fear that these limited gains could be dramatically reversed.

Since the Taliban came to power two years ago, Afghanistan has lost billions in foreign aid and investment, including health services. As of September 2021, 80 percent of the country’s health facilities reported operational difficulties due to inadequate funding, staff shortages, or lack of medical supplies. The Red Cross and the United Nations were forced to intervene and pay the wages of thousands of workers.

Some hospitals were closed. Many doctors fled the country, increasing the burden on those who stayed.

Afghan Hospital
Afghan girls receive treatment at a hospital in Sar-e-Pul province in northern Afghanistan on Monday, June 5, 2023. In many parts of Afghanistan, girls and women are unable to get treatment from male doctors. Now that women are banned from attending college, there are serious concerns about the future of health care for women. (AP Photo)

Getting married under pressure is “the end of my dreams”

“If universities aren’t allowed to teach women, and women can’t get a medical education, that’s absolutely devastating,” says Gelani. “The shortage of women doctors will have a devastating impact on women’s health. Maternal mortality rate will increase. “He’s already up.”

Lima says she has already seen pressures on access to health care due to the shortage of female doctors. The hospital does not have a gynecologist and they have to reject women who come with delivery-related problems. They have midwives, but they need doctors to deal with emergencies.

Lima doesn’t know what happened to the women who couldn’t be admitted to other hospitals, but she fears for their well-being.

“If this is happening here in Kabul, what is happening in the villages? “I can’t imagine it,” he said.

Lima still wants to be a doctor, but even if she pursues the nursing path, she lacks the official certifications she would earn after two years of specialized nursing education. Although her medical education was enough to employ her unofficially at the hospital, it was not enough to officially work as a nurse.

Lima doesn’t know how long she can continue her secret training, even if the Taliban don’t catch her. Without relevant documents, you will have no employment opportunities after graduation. This is also becoming increasingly unavailable. He pays 10,000 Afghanis ($142) per month for residence, which is the same amount he would pay if he were an officer.

There is no official figure for the average salary in Afghanistan, although some private sources say it is around $180 per month, which reflects the financial toll on an internship in Lima. Lima says doctors earn about $700 per month, which is considered a high salary. Per capita gross domestic product (GDP) in 2021 was only $356.

With no clear path to becoming a medical professional, she also faces increasing pressure from her parents to marry.

“I’m just thinking about how I can help women and become a doctor,” Lima said. “If I get married, everything will end. “My dreams will be shattered.”

Lima worries that if she marries her husband will prevent her from working; Some husbands do not allow their wives to pursue a career. Even knowing that her parents will make her choose between offers and demanding that she be allowed to work is no guarantee that the man will keep his promise. She does not think that if colleges do not open by then, she will be able to bear the pressure of marriage for more than a few months.

With enough money to endure a few more months of clandestine residence, Lima’s last hopes for a career in medicine depended on being allowed – officially – to resume his studies before time ran out.

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