Veiled insurgency: Medical students go underground in Afghanistan

Lima stayed home one last time as the Taliban inspected the hospital where she is secretly studying to become a nurse.

After five years of medical training, Lima, 28, must complete a year of residency as a physician, improving his diagnostic skills. Instead, he takes temperatures and administers injections, tasks he has been performing in an emergency room in Kabul for three months. While it’s not the job he expected to do at this point in his career, it’s at least something he’s glad he can do.

“Being in hospital means I can stay close to work. It helps me stay connected,” Lima told Al Jazeera in several phone calls. Her name is only used for security reasons.

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

More than 3,000 women who had already graduated from medical schools before the ban were prevented from taking the exams required to practice, depriving a country already suffering from a severe shortage of medical professionals of a very large influx of need for new doctors.

For Lima, medicine was a lifelong dream. She dreams of becoming a surgeon, partly because she knows there are not enough of them.

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

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

On the day they learned about the new ban on women graduating from medical school, Lima and her classmates were having lunch together. They cried together because of what this would mean for their future and because they were afraid they would never be able to see each other again. The Taliban’s strict ban on women leaving the house without a male companion makes it almost impossible to meet friends.

After the news broke, Lima called one of her teachers and convinced him to let her and her classmates take one of the exams they were scheduled to take that week. This was not for a formal assessment, but simply to let them know that they could do it. The teacher agreed, but when Lima and her classmates arrived at the university to take the exam, the door was already guarded by armed Taliban.

“This is already dangerous,” said Professor Leamy.

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

secret internship

Nearly a year later, many women refused to give up on their chosen path and continued their education on their own or online, hoping to one day be allowed to return to formal college and medical school. Some women managed to circumvent the restrictions by secretly finding housing and internships.

“It’s like restoring my studies, my knowledge. This is the best way to do something to achieve my goals,” says Noor*, whose name has been changed to protect her anonymity. Like Lima, he was about to graduate from medical school when the Taliban ban abruptly interrupted his studies. The order hit her hard.

She spent months studying alone, considering medicine to be her “sole goal” in life. He reviewed his notes, read thick English medical books, and took online courses, focusing on what he felt were gaps in his knowledge. But after weeks of working alone, she says she became depressed and had to listen to motivational speakers for an hour a day to get the will to continue working.

In September, nine months after the ban, Noor gave up hope of opening a university and called the hospital, which offered her a two-month internship starting in 2020. They agreed to let her come and complete it. Everyone treats it like a secret.

When the two months were up, the hospital allowed him to stay and continue to observe operations for as long as he wished. Noor says she is too scared to even think about what would happen if the Taliban found out she studied there. It’s unclear what would happen if this were discovered, but women studying medicine or doing internships would likely be kicked out of hospitals and banned from returning, or worse. There have already been arrests of activists trying to break the ban on girls’ education.

Despite the risks, women refuse to stop trying to completely break the ban on higher education.

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

Afghan nurses
Afghan nurses wait for their salaries at the Indira Gandhi Children’s Hospital in Kabul, Afghanistan, February 24, 2022. (Hussein Malla/AP Photo)

Women’s health is at risk

Despite the Taliban’s initial promise of a moderate approach to women’s rights after taking power in August 2021, the ban on higher education is just one of many measures the militant group has taken to further segregate the country and limit the role of women in society.

Immediately after August 2021, the Taliban banned girls from attending school after sixth grade and imposed strict rules requiring women to wear the hijab and only travel when accompanied by a man. They 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 regard to women’s rights,” Roza Isakivna Otunbaeva, head of the UN Assistance Mission in Afghanistan (UNAMA), said in March, introducing the latest report of the Secretary of State. General for 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 clear law against it, many traditional Afghan families do not allow their relatives to visit male doctors. This is a particularly acute problem in rural areas, where women often have to travel hours to see a gynecologist. Once the current generation of doctors and nurses retires, even this will become impossible.

“Women here in Kabul and in the provinces are suffering from a shortage of female doctors. They suffer from (lack of) access to health facilities. They suffer from lack of access to the treatment they want,” says Aminulhak Mayel, deputy director of the Swedish Committee in Afghanistan, a foreign aid organization.

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

Now experts fear those limited gains could be dramatically reversed.

Since the Taliban took power two years ago, Afghanistan has lost billions of dollars in foreign aid and investment, including in health care. As of September 2021, 80 percent of the country’s health care facilities reported operating difficulties due to insufficient funding, staff shortages or shortages of medicines. The Red Cross and the UN were forced to step in and pay tens of thousands of workers.

Some hospitals were closed. Many doctors have left the country, increasing the workload of those who remain.

Afghan hospital
Afghan girls receive treatment at a hospital in Sari-Pul province in northern Afghanistan, Monday, June 5, 2023. In many parts of Afghanistan, girls and women may not receive treatment from male doctors. Now that women are banned from college, there are serious concerns about the future of women’s health care. (AP Photo)

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

“If universities are not allowed to train women, and women are not allowed to receive medical education, it will be an absolute disaster,” says Gailani. “The lack of female doctors will have a catastrophic impact on women’s health. Maternal mortality will increase. “He’s already up.”

Lima says she has already seen pressure on access to healthcare due to a shortage of female doctors. The hospital does not have a gynecologist, and they have to turn away women who come with problems during childbirth. They have midwives, but they need doctors to provide emergency care.

Lima doesn’t know what happened to the women who couldn’t be placed in 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 become a doctor, but even if she continues to work as a nurse, she lacks the formal certifications she could obtain after two years of specialized nursing education. Although her medical background was enough for the hospital to hire her informally, 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 the appropriate documents, you will not have employment opportunities after graduation. This also quickly becomes unavailable. He pays 10,000 Afghanis a month ($142) for living expenses, which is what he would pay if he were an official.

There are no official figures on the average salary in Afghanistan, although some private sources say it is around $180 per month, indicating the financial toll that internships in Lima take. Lima says doctors earn about $700 a month, which is considered a high salary. In 2021, the gross domestic product (GDP) per capita was only $356.

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

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

Lima is worried that if she gets married, her husband will forbid her to work; Some husbands do not allow their wives to pursue a career. Even knowing that his parents will allow him to choose between offers and demands that he be allowed to work is no guarantee that a man will keep his promise. She doesn’t think she can bear the pressure of getting married for more than a few months unless colleges open by then.

With enough money to get him through a few more months of his secret residency, Lima’s last hopes for a career in medicine depend on being allowed to resume his studies—officially—before his time is up.

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