© (AP Photo/Ebrahim Noroozi) A Taliban fighter stands guard as two women enter the government passport office, in Kabul, Afghanistan, Wednesday, April 27, 2022. .Afghanistan’s Taliban leadership has ordered all Afghan women to wear the all-covering burqa in public. The decree Saturday, May 7, evoked similar restrictions on women during the Taliban’s previous hard-line rule between 1996 and 2001. (AP Photo/Ebrahim Noroozi)

A report published on Tuesday has revealed signs of a “severe deterioration” in the conditions for women and children’s health care in Afghanistan, more than a year after the country fell to the Taliban.

[ READ: The Daunting Transition From Afghanistan to America ]

The findings shared by researchers from Johns Hopkins University, culled from interviews conducted between February and April 2022 with 89 Afghan practicing health professionals and 42 other health professionals who work in a facility operated by a nongovernmental organization, paint a concerning picture of the hardships being faced by providers day-to-day. Nearly 44% of those interviewed described their working conditions as “worse” or “much worse” and more than half reported that they had not been paid regularly since August of last year.

“Without a commitment for longer-term funding of the health system – not just stop-gap measures – we have every reason to expect that health will decline for women and children, that death in childbirth will increase for women and that services generally will be less available until the economy improves,” says Leonard Rubenstein, a report co-author and professor of the practice at the Johns Hopkins Bloomberg School of Public Health with global expertise in violence against health care.

The authors clarify that the report’s findings could not be verified because the researchers were not able to “safely confirm” information provided by the respondents “regarding conditions and practices at the facilities and communities where they work.” They also note that the fear related to the Taliban regime’s large and extensive intelligence network might have impacted how those surveyed answered the interview questions – even in an anonymous format.

Even so, results from the more than 100 interviews indicate a perceived increase in maternal, infant and child mortality in Afghanistan. Specifically, more than a third of respondents said that infant and child mortality had “increased a little” to “increased a lot,” according to the report.

“That’s all preventable,” adds Rubenstein, who is also a human rights lawyer and author of “Perilous Medicine: The Struggle to Protect Health Care from the Violence of War.”

At the root of many of these problems are what Rubenstein describes as the Taliban’s “draconian” rules for women in Afghanistan. More than 4 in 5 of the female health workers surveyed reported safety issues such as being stopped and harassed by the Taliban because they were not being accompanied by a required male chaperone known as a “mahram.”

“It sounds like there’s just been a real chilling effect since the Taliban came into power,” says Nicolette Waldman, a researcher with Amnesty International’s Crisis Response Program. “We didn’t find a certain causal link of the Taliban saying ‘no, you can’t access health care.’ It was more, kind of, death by a million cuts.”

Waldman is referencing an Amnesty International report released in July, which laid out how the Taliban has “decimated the rights of women and girls” since they took control. One interviewee described the experience as being sentenced to “death in slow motion.” A group of independent rights experts with the United Nations similarly said in August that there has been a “virtual erasure of women and girls from society” in Afghanistan.

“There’s so many issues that are interlinked,” Waldman adds. The rules around mahrams, she notes, affect a woman’s ability to work or to access health care. And when women can’t work, they can’t get money to then get an education.

“It’s just this kind of spider web of restrictions,” she says.

Among the several possible solutions to address the crisis women and children are facing in Afghanistan include, she says, simply changing the nature of those restrictions – such as allowing women to travel on their own. But even that might be a tall order with the Taliban in charge. Rubenstein notes, however, that their policies are not “cast in stone” and, thus, pressure is essential.

“The Taliban is not a monolithic organization, and we know there are differences of views on women’s rights issues among the Taliban,” he says. “So, I think what has to happen is pressure has to be kept up so the international standing of the Taliban becomes an issue because of the kind of relentless criticism in their treatment of women.”

There are some signs for optimism. One of the recommendations from the Johns Hopkins University authors is for international donors – including the U.S. – to expedite the development of a “longer-term health and health financing plan” for Afghanistan, and Rubenstein says that a related planning process is already underway within the U.N. He adds that there has also been some progress on restoring central bank functions in the country.

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Additionally, a study published in The Lancet in late September found that while access to primary health care for women and children “remains a major concern” in Afghanistan, there are signs that women are increasingly accessing “some services” when compared to 2021. Waldman herself finds hope in the “incredibly brave” women doctors who have continued to work.

“I think there’s just so much untapped potential right now,” she says. “There are women who could work in this system. There are women who could be going out to help and get medical care for themselves or for their family members. And they’re just being cut off at every chance. So I think it’s something where, as you’re looking at solutions … just a few changes could make a huge difference.”

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