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May 13, 2020

By Tabasum Akseer

Afghanistan has endured decades of political instability and chaos. The country remains exceedingly fragile despite nearly 20 years of international support, and the disputed presidential election in February, in which long-time rivals Ashraf Ghani and Abdullah Abdullah both declared themselves the winner, has left the Afghan government on the verge of imploding. As punishment for the countrys failure to resolve this dispute, the U.S. government has cut a billion dollars of aid and vowed to cut a billion more in 2021.

Added to botched elections and donor fatigue are stalled U.S.-led peace talks, which may now be derailed by Covid-19. The war-torn and impoverished nation has already been significantly affected by the spread of the virus, which has forced border closures, disrupting commercial and humanitarian deliveries and further stressing an already fragile healthcare system. As the pandemic bears down, travel restrictions and flight suspensions will make seeking care outside the country difficult or impossible.

Abandoned tanks from the Soviet era in Bamyan, Afghanistan. The country has endured decades of political instability and chaos. (Photo: Sayed Rashid Sadat / The Asia Foundation)

Amid these considerable challenges, Afghans living with disabilities are uniquely vulnerable. Afghanistan ratified the Convention on the Rights of Persons with Disabilities in 2012 and adopted the Law on Rights and Privileges of Persons with Disabilities the following year, but to date there have been few concrete steps to provide services to individuals living with disabilities. Assistance for Afghans with disabilities has never been a high priority for the government or the donor community, and political instability, insecurity, poor economic conditions, and weak governance have undermined efforts by the government to address their needs.

A 2020 report by Human Rights Watch notes that four decades of war have left Afghanistan with one of the worlds largest populations per capita of people with disabilities, including many with amputations, vision or hearing problems, and post-traumatic stress disorder. But the true size and circumstances of Afghanistans disabled population are uncertain, and policymaking is hindered by the lack of reliable empirical data.

In 2019, The Asia Foundation moved to fill this empirical void with the Model Disability Survey of Afghanistan. Implemented with technical support from the World Health Organization, the MDSA is the first such survey in Afghanistan in 15 years, and the first ever to collect representative data both on the prevalence and distribution of disabilities across the country and on the broader context of underlying health conditions, supportive environments, and other determinants of health and well-being of Afghanistans disabled population.

An enumerator collects data for the Model Disability Survey of Afghanistan, the first comprehensive survey of disabilities in Afghanistan in 15 years. (Photo: Jim Huylebroek / The Asia Foundation)

The MDSA is a complex survey using multistage sampling, administered to adults (18+ years) and children (217 years), with separate survey tools for each group. A total of 14,290 households were surveyed from April 14 to May 6, 2019, representing 111,641 Afghans across the country. Three core tools were developed, covering: (1) household characteristics, (2) adult disabilities (including health conditions, ability to function, healthcare support, availability of personal help and assistive products, well-being, and empowerment), and (3) childhood disabilities (including health conditions and ability to function). Importantly, the results are representative at both the national and regional levels.

The MDSA paints a disturbing picture of Afghanistans disabled population. Almost 80% of adults aged 18 and over have some form of physical, functional, sensory, or other impairment (24.6% mild, 40.4% moderate, and 13.9% severe). Severe disability is more prevalent among females (14.9%) than males (12.6%). Among children aged 217 years, 17.3% have a mild, moderate, or severe disability. The incidence of severe disabilities among adults and children, which stood at 2.7% in 2005, has risen steeply to 13.9%, putting Afghanistan in unprecedented healthcare territory.

The prevalence of severe disabilities increases with age, from 8.7% of those 1825 years old to 12.0% of those 2635, 15.2% of those 3645, 18.3% of those 4655, and 26.2% of those 56 and older. The prevalence of severe disabilities varies across ethnic groups, with Turkmen and other ethnic groups experiencing the highest incidence, at 16.5% and 16.1%, respectively. Among the other major ethnic groups, severe disability is more common among Pashtuns (14.4%) than Tajiks (13.7%), Hazaras (13.0%), or Uzbeks (11.8%). Severe disability is also more common among females, divorced or widowed adults, and the uneducated or unemployed.

The incidence of severe disability is particularly high in the South East region (20.5%), the West (25.4%), and the Central Highlands (25.4%), indicating the need for focused interventions in these areas to support health, education, and social integrationprograms.

Moderately or severely disabled adults report that their greatest challenges are physical mobility, community participation, employment, and education, suggesting these as potential policy and program areas.

Physical disabilities and mental health problems among adults are less likely to be congenital and more likely to be caused by the ongoing conflict and warfare in the country, pointing to the huge toll that thewar has taken on Afghans and underscoring the importance of peace and reconciliationefforts.

Remarkably, the MDSA found that roughly half of Afghans surveyed did not make use of assistive deviceseyeglasses, walkers, or other equipment or appliancesbecause they were not aware that such devices existed. This is a sobering finding in the 21st century, and there is obviously a dire need for essential equipment and devices, as well as education and awareness campaigns to better inform Afghans.

Children with disabilities struggle with transportation, lack opportunities for interpersonal engagement, and face difficulties learning at school. They are also far more likely to suffer from conditions such as muscular dystrophy, depression/anxiety, and migraines. Appropriate community- and school-based interventions will be critical to prevent these disabilities from lingering into adulthood.

The MDSA provides up-to-date, objective, and comprehensive data that should be used to make policy and measure progress toward improving the health and well-being of disabled populations in Afghanistan. The Afghan government, as well as the donor community, United Nations partners, nongovernmental organizations, and civil society, can use this data to develop cross-sectoral action plans to meet the needs of those living with disabilities.

The Model Disability Survey of Afghanistan can be found here. As we work to address the many challenges in Afghanistan, let us not lose sight of the most vulnerable, including those living with disabilities.

Tabasum Akseer is director of policy and research for The Asia Foundation in Afghanistan. She can be reached at tabasum.akseer@asiafoundation.org. The views and opinions expressed here are those of the author, not those of The Asia Foundation.

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Disability Survey Is Afghanistan's First in 15 Years - The Asia Foundation - In Asia