2020 IN REVIEW
AFGHANISTAN HUMANITARIAN FUND AT A GLANCE
HUMANITARIAN CONTEXT
Armed Conflict
Conflict continues to cause extreme physical and psychological harm to the people of Afghanistan. Despite three temporary ceasefires in 2020, a significant reduction in the number of civilians injured in attacks by non-state armed groups (NSAGs) and a drop in the number of air strikes carried out by international military forces over recent years, the continued use of improvised explosive devices (IEDs), asymmetric attacks, targeted killings and attacks on schools and hospitals have been devastating for the people of Afghanistan. In 2020, 8,820 civilians were killed (3,035) or injured (5,785), 15 per cent fewer than in 2019, and the lowest number in one year since 2013. But civilian casualties from pressure-plate IEDs were 34 per cent higher than the previous year, and civilian casualties from non-suicide vehicle-borne IEDs by NSAGs were three times higher. UNAMA recorded a marked increase in civilian casualties in the last quarter of 2020, which coincided with the formal start of the Intra-Afghan Negotiations.
For the fifth year in a row, the conflict in Afghanistan was listed as the world’s deadliest for children in the 2020 Report of the Secretary-General on Children in Armed Conflict. More than four in every 10 civilian casualties were women or children.
As of December 2020, UNAMA recorded 89 attacks affecting health-care delivery, including attacks in which medical facilities were damaged (11), destroyed (2), looted (2) or closed (57), denying approximately 1.4 million people access to life-saving medical care.
The World Health Organisation (WHO) notes that decades of conflict have left an estimated 800,000 Afghans (2.7 per cent of the population) with a range of severe disabilities. The overall number of people with disabilities is likely to be much higher especially when considering psychological and mental health issues. Owing to decades of war, one in two adults in Afghanistan is suffering from some form of psychological distress.
Food Insecurity and Malnutrition
Afghanistan is facing a severe food insecurity crisis with 16.9 million people, or 42 per cent of the population, in crisis-level or emergency-level food insecurity (IPC 3+), a more than five-fold increase since 2015. This includes the world's second highest IPC 4 population, with 5.5 million people in emergency food insecurity. The updated IPC analysis published in November 2020 shows the food security situation deteriorated during COVID-19 due to a confluence of factors, including: reduced daily wage opportunities and small trader income, conflict leading to displacement and loss of livelihood, and higher than usual prices for key commodities. Food insecurity and livelihoods in urban areas deteriorated severely, with 40 per cent of households reporting a poor food consumption score in 2020, compared to 16 per cent in 2019. The percentage of urban households using emergency coping strategies increased from 11.7 per cent in 2019 to 30 per cent in 2020.
Twenty-seven of the country’s 34 provinces are now within the emergency threshold for acute malnutrition. Nearly one in two children under age 5 (3.1 million out of 7 million) and one in four pregnant and lactating women will face acute malnutrition and require life-saving treatment in 2021.
Disaster Impacts
A total of 104,470 people were affected by natural disasters, including flooding, heavy snowfall, landslides and avalanches in 2020. Natural disasters regularly affect various parts of the country, with those in the capital, the south-east, and east bearing the brunt in 2020. Flooding in Parwan was especially severe. While fewer people were affected by the floods than the previous year, they faced increased risk of contracting COVID-19 due to inadequate WASH systems and facilities in displacement sites, where people were often unable to comply with physical distancing and other preventative measures.
All provinces were affected by the impact of natural disasters in 2020. Afghanistan is prone to earthquakes, flooding, drought, landslides, and avalanches. Over three decades of conflict, coupled with environmental degradation and insufficient investment in disaster risk reduction strategies, have contributed to increasing people’s vulnerability and ability to cope with sudden shocks from natural disasters.
Internal Displacement and Returns
In 2020, 404,000 people fled their homes due to conflict. A total of 32 out of 34 provinces recorded some level of forced displacement. Displacement Tracking Matrix (DTM) data estimates that 4.9 million people have been displaced since 2012 and have not returned to their homes. Many are renting or squatting in insecure housing, including in informal settlements on private land on the fringes of major cities. 2020 was also a record year for returns, with 865,900 undocumented returnees crossing the border from Iran and Pakistan. Since 2012, four million people have returned to Afghanistan.
Along with the immediate impact of displacement on the financial and social wellbeing of households, displacement leaves people further exposed to explosive hazards that contaminate large parts of the country. Each month, approximately 97 civilians are killed or injured by mines, including IEDs and explosive remnants of war (ERW).
COVID-19 and Other Disease Outbreaks
As of 25 March 2021, 56,226 people across Afghanistan’s 34 provinces were confirmed to have had COVID-19, according to Ministry of Public Health data. Some 49,802 people recovered, and 2,467 people died – at least 91 of them health-care workers. The actual figures are likely to be significantly higher, as only 335,965people, out of a population of 40.4 million, were tested. The comparatively low testing levels can be attributed to limited public health resources and testing capacity, but also to reluctance to get tested for fear of being stigmatized. As of March 2021, Afghanistan had a test-positivity-rate – positive tests as a percentage of total tests – of 17 per cent, suggesting overall under-testing of potential cases. A sero-positivity study by John Hopkins University and WHO suggested that by June 2020, COVID-19 had infected more than 30 per cent of the population nationally (50 per cent of Kabul residents) and that the numbers were likely to grow.
Measures initially implemented to slow the spread of the virus, including lockdowns, border closures, and suspension of formal and informal livelihood activities, led to a sharp contraction of the economy, crippling household debt, lower remittances and higher food prices, and exacerbated rising food insecurity. The economic and social conditions created by the COVID-19 pandemic exacerbated protection risks for vulnerable families, many of whom had already depleted limited financial, mental, and social coping capacities due to prolonged conflict or recurrent natural disasters. COVID-19 resulted in an estimated 5.5–7.4 per cent contraction in the economy in 2020, a significant spike in food prices and reduced income for 59 per cent of households.
Tuberculosis remained rampant, with some 72,000 cases, 3 per cent more than in 2019. Some 9 per cent of children under age 5 have Acute Watery Diarrhoea (AWD), while there were 183 cases of Crimean-Congo Haemorrhagic Fever (CCHF) in the first 10 months of 2020, with some 15 deaths. Afghanistan is one of only two countries where polio remains endemic, along with Pakistan. In the first 11 months of 2020, there were 255 confirmed cases of polio in the country. Winter presented an added challenge to those living in inadequate shelters and remote areas, increasing the risk of morbidity and mortality from respiratory infections, the most prevalent causes of mortality among children under age 5.
Operating Environment, Access Challenges and Attacks on Aid
In 2020, humanitarians faced 1,095 access constraints – more than double the incidents reported in 2019. These incidents included interference in the implementation of humanitarian activities, levy requests, military operations and kinetic activity, movement restrictions, physical environmental factors and lack of infrastructure, violence or threats against humanitarian personnel, assets or facilities, and landmines. There were 155 attacks against schools between July 2019 and July 2020, while 165 incidents against health facilities or personnel were recorded in the first 11 months of 2020.
Afghanistan remains among the five most dangerous countries in which to be an aid worker. The Humanitarian Access Group (HAG) reported that 22 aid workers were killed, 53 injured and 110 abducted in 2020. The COVID-19 pandemic is adding to pre-existing risks for aid workers as PPE shortfalls continue to endanger frontline responders, while the general population grows increasingly complacent about protective measures, including mask wearing.