The importance of sustained engagement for Afghanistan’s children

Johan Eldebo, Senior Adviser for Strategic Partnerships and Fragile Contexts at World Vision Nordics, shares personal reflections from a recent field visit to Afghanistan, highlighting why sustained engagement matters, especially for the country’s most vulnerable children.

It took almost four hours of scenic driving to arrive at the World Vision health clinic in Farah Road from the nearest town of Firuzkoh. Ascending one of the dramatic mountains, we pass an old Soviet fortification, recalling the many conflicts this country has seen over many years. 

Today the fortification is a wind shelter for us during a quick stop, as the temperature dropped close to freezing at an altitude of nearly 3000m. During the winter it can drop below -40 degrees. I was grateful for a good car, something most people that cross this mountain do not have.

It is pointed out to me repeatedly that the mountains and the fields are brown when they should be green. It has barely rained this year, and there was little rain during the previous few years either. This means few crops and inadequate harvests, which in turn contributes to a nutrition crisis in which more than half of children in some areas are malnourished. An estimated 22m people need assistance this year, but the ongoing drought is likely to make this much worse.

It also means families can’t keep livestock, leading to worsening livelihoods, with 15m people already needing food security and agriculture support. Negative coping mechanisms are becoming more common, with one in five children working instead of going to school.

Four hours later we arrive in Farah Road where the World Vision health facility serves 10,000 people who live in villages within a roughly 15km radius. The male and female medical staff provide vaccinations and healthcare for children, men and women in what used to be an old bazaar, now donated by the community to serve as their health clinic.

Children commonly suffer from waterborne diseases here in the summer and respiratory diseases in the winter, all treatable with the provision of basic medicine. Childhood vaccinations also prevent many common ailments. Young women receive psychosocial support, guidance and treatment during pregnancies. People with disabilities, such as children missing limbs due to explosions from old munitions, also seek treatment here.

World Vision has maintained this clinic with local staff and significant community support over the years, adapting the focus of the clinic to community needs through guidance of the local health committee. During my visit the community leaders expressed how important it was for them not to have to cross a mountain to access basic health care, especially in the winter. 

Alarmingly, this lifeline clinic is at risk of closing due to funding cuts in 2025. 450 health facilities have already closed this year, as humanitarian funding is pulled from the children who need it most. While the donor community struggles to articulate a clear strategy for how, and even if, to engage in Afghanistan, the fear of further funding cuts is real. 

Fortunately, research exists to inform the next steps of donor governments that see the importance of long-term solutions to entrenched challenges. The Swedish Ministry of Foreign Affairs supported a report in 2023 from New York University’s Center on International Cooperation and Chatham House, titled “Aid strategies in politically estranged contexts”. This report highlights the importance of staying engaged during times of estrangement and ambiguity, and to carefully assess what is feasible to do and how to maintain assistance for the most vulnerable together with local and international stakeholders. 

Once central recommendation is to reinforce collaboration across agencies, governments and multilateral institutions. It also notes the importance of supporting initiatives that are already in place and demonstrably working. World Vision’s clinics, with its integration of health, nutrition, water and hygiene, is a lifeline for communities, but more than that, it is also at the heart of a sustainable cycle of positive and enduring benefits.

Such interventions have nothing to do with complex debates around normalisation and legitimisation, however they do rely, as in any context, upon coordination with the authorities and goodwill from communities. 

As Sweden and other countries look at their strategies for Afghanistan and work through the European Union, decision-makers must remember the benefits of strategic engagement and the imperative of supporting the most vulnerable children in at-risk but resourceful communities such as Farah Road.