Facts and Figures

Afghanistan is a landlocked country located in Central Asia. Iran is situated to the west, Pakistan to the south and east and the northern border is shared with Turkmenistan, Uzbekistan and Tajikistan and also China at the end of the Wakhan Corridor.

Afghanistan stretches over more than 652,000 square kilometres and is mostly covered by mountains in the north and desert plains in the south west. The land is high above sea level and the climate is very dry with cold winters and hot summers.

The capital of Afghanistan, Kabul, is located on the southern foothills of the Hindu Kush, which is the second highest mountain range in the world.

People

Afghanistan's population is estimated at 23.2 million people at a growth of 2.5% per annum. Around 75% of the population live in rural areas and follow a traditional way of life, with many groups still leading a nomadic lifestyle. The population is predominantly younger with more than 45% of people aged 15 years or younger and only 2% aged 65 years or older.

Afghanistan is located at the crossroads of central, south and west Asia and has been part of a significant trade route throughout history.  As a result, the population is a varied mix of ethnicities.  The main ethnic groups are Pashtun, Tajik, Hazara, Uzbek, Aimaks, Turkmen and Baloch and the main religion is Islam, mostly Sunni Muslim and Shi’a Muslim.

Politics and History

For more than 100 years Afghanistan has suffered numerous political coups, several civil wars and intrusive foreign influence. 

Afghanistan was united as a nation in 1747 by a Pashtun chief who took control of the region and proclaimed himself Shah (King). By the late nineteenth century, the kingdom was under pressure from the British who were expanding their influence beyond India. In 1919, Afghanistan declared independence from Britain with backing from the Soviet Union.

In the early 1950s, the government began to modernise Afghanistan and by 1964 had introduced provisions to establish the country as a constitutional monarchy. These provisions were never fully implemented and in 1973, the Prime Minister Mohammed Daoud staged a coup, abolished the monarchy and declared the country a republic, with himself as President.

In 1978 Daoud was overthrown by The People’s Democratic Party of Afghanistan, a Marxist party backed by the Soviet Union. After several more coups by different Afghani factions, the Soviet Union invaded Afghanistan in 1979 and installed a new government. 

The country was then plunged into a decade of civil war between the Soviet backed government and the Mujaheddin (holy warriors) resistance fighters, who had backing from the United States, Saudi Arabia and Pakistan. More than one million people died during the war. 

The Soviet Union withdrew in 1989, but civil violence continued until the late 1990s when the Taliban, a faction of the Mujaheddin, took control of the country. The Taliban forced an extreme interpretation of Islam on the Afghan people that severely restricted civil rights, particularly for women. By 2000, the United Nations had imposed sanctions on Afghanistan in response to the Taliban’s relationship with Al-Qaeda, an organisation that is believed to train militants for terrorist activities.

Following the notorious terrorist attacks in the United States on 11 September 2001, the Taliban came under extreme international pressure, particularly from the US, to surrender Osama Bin Laden, the leader of al-Qaeda. 

In October 2001 the US began an aerial bombing campaign in Afghanistan. Afghani resistance fighters of the Northern Alliance also stepped up their campaign to defeat the Taliban. By December 2001, the Taliban had been overthrown and an interim government was installed.

A new constitution was endorsed in January 2004 which established a presidential system of government and guaranteed equal rights for women and minority groups. The first general election for the President was held in October 2004. General elections for the Lower House of Parliament and the Provincial Councils were held in September 2005.

Today, Afghanistan is still plagued by violent attacks from some remaining Taliban supporters, as well as rising crime and a surge of warlord-like fighting by armed groups. Thousands of civilians have been targeted or killed in the crossfire. The US and allied nations maintain a strong military presence in the region, however, these forces have also been criticised for the deaths of civilians in counter terrorist activities.

The United Nations and other development bodies are investing heavily in rebuilding the war-torn nation, however progress is being severely limited by the continuing violence, extreme poverty, political instability and the limited capacity of the existing public infrastructure.

More than 3.5 million Afghani refugees have now returned to their homeland after having fled to Iran and Pakistan to avoid the violence and civil restrictions of the past two decades. A similar number of refugees remain in Pakistan. 

Economy

Afghanistan is one the poorest countries in the world as a result of the decades of war wreaking havoc within the country's economy and infrastructure.

Agriculture is the main economic activity (60% of GDP) - mostly grains, rice, fruits and nuts  - however, output has halved over the past few years due to the effects of war and severe drought. The country's main industries include textiles, soap, furniture, shoes, fertiliser and carpets. Afghanistan also has excellent deposits of mineral resources that remain under utilised because of the instability.

The illegal cultivation and trade of opium has created a large black economy and the government is under increasing international pressure to eradicate opium plantations.

Post 2001 efforts to reconstruct the country has resulted in some economic growth and rebuilding of limited infrastructure. However, extreme poverty and the threat of terrorist activity continue to hamper progress.

Sources: Central Statistics Office of Afghanistan, DFAT, Government of the United Kingdom, SBS World Guide, United Nations Development Program, WHO.

Population: 28.5 million
Urban population: 22.6%
Life expectancy: 46.4 years
Literacy rate: 28.1%
Infant mortality rate: 165 per 1,000 births
Number of doctors: 19 per 100,000 people

The health and well-being of the Afghani people is in crisis. Life expectancy is just over 46 years, one in four children die before the age of five and only 40% of people have access to a safe water supply.

Afghanistan’s health system has largely been destroyed as a result of the past two decades of violence. In 2004, just one third of the population had access to primary health care services, which decreased to just one quarter of people living in rural areas. In that same year, only one in six births was attended by a trained health care professional and one in six babies died during or shortly after birth.

Food supplies have been scarce due to the low levels of agricultural output, international sanctions and extreme poverty. There is also a high prevalence of communicable diseases, including malaria, tuberculosis, cholera, congo-crimea haemorrhagic fever, measles, meningitis and pertussis.

International government and non-government assistance since 2001 has made some progress.  For example, in 2004 nearly seven million children were immunised against polio and no new cases of polio have since been reported. 

Management of the health sector has been divided between the government and non-government organisations. Secondary and tertiary level hospitals remain under the Afghan Ministry of Health while primary health care has largely been sub-contracted to NGOs.

Various NGOs have been contracted to provide a package of primary health services in specific geographic areas. These packages include maternal and newborn health, child health, nutrition, communicable diseases and supply of medications. 

Around 70% of districts within Afghanistan now have primary health care facilities which service around half of the total population. However, the out-sourcing of primary health care has raised concerns about efficiency, particularly in relation to the sub-contracting of services to a third party.

The major priorities identified for Afghanistan’s health sector, by the WHO, include:

• Restoring, upgrading and expanding health care facilities
• Improving the supply of medications
• Improving the efficiency of out-sourced contracts to provide primary health care services
• Building the capacity of the Ministry of Health to manage contracts
• Strengthening the health information services and collection of health data
• Training of health workers, particularly the increased numbers of female health workers
• Improving the capacity of the health sector to respond to natural disasters

Sources: Government of the United Kingdom, Human Deveopment Report 2006, UNDP, WHO.

Number of blind people: 200,000
National blindness prevalence: 1.5%-2%
Main causes of blindness: Cataract, trachoma, corneal opacity
Number of cataract operations performed annually: 8,000
Number of ophthalmologists: Unavailable
Reasons for low cataract surgical rates and backlog: Unavailable

Of the blindness affecting around 1.5%-2% of Afghanistan's population, trachoma is a major contributor. This is particularly the case in the north and west of the country where some regional eye centres report a prevalence rate between 1.35% and 1.54%. Around 10% of blindness is caused by corneal opacity.

Less then half of the cataract operations performed in Afghanistan are done with an intraocular lens implantation and while general services are free of charge, many patients need to purchase their own IOLs.

There are 79 ophthalmologists in Afghanistan, out of which 20 are IOL surgeons and three trained in community ophthalmology. Only ten of the ophthalmologists are accredited.

More than half of the country's ophthalmologists are located in the central provinces of the country, mainly in Kabul. The south western provinces are particularly underserved with only one ophthalmologist per 2.75 million population.

Around 80% of Afghanistan's population do not have access to eye care services.

Eye care personnel at mid level consists of 23 ophthalmic technicians (a further 24 are in training), 56 nurses, five pharmacists, six opticians and four technicians. The low number of ophthalmic nurses in particular, and mid level eye care in general, is a significant constraint for service delivery.

Two of the four training programs for ophthalmologists are based in Kabul, the other two in Mazar-e-Sharif and Herat. Ophthalmic technicians can be trained in Kabul only, while ophthalmic nurses receive training on the job and through courses in specialised clinics and hospitals.

Training of human resources to deliver low vision services is also scarce and inadequate. Training personnel in Kabul poses a significant problem as many do not want to work outside of Kabul, which is why most services are concentrated in this region.

In 2002 the Afghanistan Ministry of Health and the WHO collaborated to embrace the VISION 2020 initiative. As a result, a five year national plan for comprehensive eye care in Afghanistan was developed. The focus of the plan was to incorporate eye care into primary heath care systems and to develop secondary eye care centres at provincial and district levels.

A national committee has since been formed with representatives from the Ministry of Health, the International Assistance Mission (IAM) and other non-government and international development organisations.

In 2002 the office of WHO (Eastern Mediterranean Region) provided support for some Afghani eye doctors to undertake training at the Al Shifa Trust Hospital in Pakistan, as part of the regional office’s commitment to VISION 2020. 

Sources: International Assistance Mission, Ministry of Health of the Transitional Islamic Government of Afghanistan , WHO.