- Mohammad S Razai,
- NIHR In-Practice, fellow in primary care1,
- Alisina Mahmood, JF-GJS research fellow2,
- Bismellah Alizada, doctoral researcher3,
- Sally Hargreaves, associate professor of global health1
1Population Health Research, St George’s University of London, UK
2Institute for Advanced Studies on Asia, University of Tokyo, Japan
3School of Oriental and African Studies, University of London, UK
- Twitter: @mohammadrazai@mahmoodalisina@BismellaAlizada@sal_hargreaves
On the second anniversary of Kabul’s fall to the Taliban, Afghanistan finds itself entangled in an increasingly profound crisis. The situation is extremely difficult for all Afghans, but particularly women and girls who are being deprived of essential rights, such as access to education and employment. However, the ramifications of this crisis are far reaching, especially for religious and ethnic minorities. The Hazara people in Afghanistan face multiple health challenges stemming from a complex interplay of historical, socioeconomic, political, and environmental factors. Marked by pervasive and prolonged structural violence, systemic discrimination, and socioeconomic inequalities, the community has been decimated by successive regimes over a century.12 However, since the 2021 Taliban takeover, targeted violence and widespread human rights abuses against the Hazara community have rapidly escalated, culminating in a humanitarian crisis and human rights tragedy that demands urgent global attention.345
Stark warnings have been issued recently—including by Genocide Watch, Amnesty International, the US Holocaust Memorial Museum, and cross-party members of the UK parliament—about the risk of genocide facing the Hazaras of Afghanistan.367 Despite being one of the main ethnic groups in the country, primarily residing in the central regions, the community has long endured systemic violence, marginalisation, and religious persecution as they are predominantly Shia Muslims.
In the late 19th century, a devastating genocide occurred, resulting in a fundamental demographic change (according to some estimates, over 60% of the Hazara population were killed, sold into slavery, or exiled).12 In the late 1990s, under the Taliban regime, the Hazaras were subjected to widespread atrocities, including mass killings, torture, rape, and forced displacement.8 The community has also endured violence from armed nomadic groups and been subjected to terrorist attacks by the Taliban as early as 2010 and Islamic State—Khorasan Province (ISKP) since 2014.2
These acts of targeted persecution, violence, and systemic discrimination have had far reaching consequences, severely curtailing the community’s access to essential elements of daily life, such as safety and security, education, employment opportunities, and basic healthcare services. Although they experienced some improvement in civic and political rights and economic opportunities in the post-Taliban period between 2001 to 2021, the distribution of international aid and benefits, such as development projects, was notably less concentrated in Hazara areas than in other regions of the country.2
While health indicators for the general population in Afghanistan showed improvement at the time, one analysis in 2019 found that conflict and terror were some of the leading causes of death and disability across the population.9 Additionally, neonatal disorders and cardiovascular diseases, including ischaemic heart disease and hypertension, posed considerable health challenges.9
After the fall of the “Republic,” the already dire situation worsened dramatically. The World Health Organisation reports that over 28 million people, representing about 73% of the population, are in urgent need of humanitarian assistance.10 Health facilities remain understaffed and under-resourced, grappling with shortages of essential medicines and supplies, impeding the delivery of critical healthcare services. In many rural areas, the absence of healthcare facilities compounds the problem.10
The situation is catastrophic for everyone, but is particularly grave for the Hazara population, as they predominantly reside in the country’s most deprived and least developed regions. The geographical remoteness of these areas, coupled with the lack of healthcare infrastructure and inadequate transportation systems, exacerbates the challenges they face. Compared with other regions, Hazara areas that are beyond major urban centres often lack basic amenities, resulting in limited access to essential resources such as nutritious food, clean water, sanitation facilities, and adequate healthcare services. Hazaras regions are also severely affected by the region’s frequent cycles of drought and climate change. Consequently, malnutrition and dietary risks are considerable risk factors contributing to higher rates of mortality, morbidity, and disability. These intersecting factors likely lead to a higher burden of maternal and child mortality, infectious diseases, and mental health trauma among Hazaras compared with the overall population of Afghanistan.
The health of Hazaras is deeply intertwined with structural injustices and the collective burden of historical trauma.11 Tacking these complex issues requires a multifaceted approach involving international support, initiatives, and interventions. It is crucial to recognise that health outcomes are primarily shaped by social determinants, encompassing the conditions in which individuals are born, grow, age, and die. The social determinants of health are inherently linked to fundamental human rights, including the right to life and freedom from violence, persecution, and torture. Therefore, research is imperative to assess the impact of these determinants on health and propose effective strategies for tackling them.
In order to overcome these health disparities, achieve health equity,12 and meet the health-related targets of the Sustainable Development Goals,13 it is essential to redouble efforts in safeguarding the rights of Hazaras. International laws and conventions should be applied to stop systematic violence against the community, support for healing and redress provided, and the perpetrators brought to justice. This necessitates facilitating safe humanitarian passages for the resettlement of Hazaras outside Afghanistan and compelling the international community to exert pressure on the Taliban and other groups to recognise and respect their rights. To this end, due consideration should be given to measures such as targeted sanctions against Taliban officials. There is also an urgent need for collaborative and participatory research to assess the health status and needs of the Hazara population in Afghanistan and resettled countries, as little is known about these crucial issues.
Finally, providing targeted aid and support that is sensitive to the community’s ethnic, religious, and gender-specific needs through non-governmental organisations is vital. Efforts should be concentrated on enhancing healthcare infrastructure, particularly in remote areas, promoting education, combating systemic discrimination, and ensuring equitable access to healthcare services for the community, especially Hazara women.
Competing interests: All authors report having nothing to declare.
Funding: MSR has an In-Practice fellowship in primary care funded by the National Institute of Health (NIHR 302007). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Acknowledgments: We are immensely grateful to Professor Rebecca Cook for her invaluable feedback and suggestions.
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