Afghan Diaspora in Pakistan: Healthcare and Education Policy Recommendations

Politically charged philosophical debates concentrate more frequently than ever on the rights of displaced persons. They are ‘moving people’ in both senses of that term: on the move or migrating as well as stirring various emotions in host countries. My study presents evidence about the reception of one group of moving people, Afghan refugees in Pakistan. Afghans have crossed the border into Pakistan in appreciable numbers since the late 1970s, making Pakistan one of the top refugee-hosting countries in the world, both registered and unregistered. As of March 18, 2020, the UNHCR places the number of registered refugees with Proof of Registration (PoR) cards in Pakistan at 1.42 million. This is a rough estimate, and the number of unregistered refugees is unknown, but the total is likely closer to 8 million. My larger study looks at the differences between refugee outcomes for those living in rural versus urban areas. Around 68% of the total registered Afghan refugees live in urban and rural areas of Pakistan, and 32% percent live in the country’s refugee villages as of December 2018 (HRCP [pdf]). Refugees living in different geographic environments have unique needs that must be met with unique solutions.

Two policy areas that must receive immediate attention from the Pakistani government are health services and educational opportunities, which are closely correlated. Greater access to education yields better health outcomes, and the impact of improved community health can create opportunities for those who may not typically attend or teach in schools. Major issues for Afghan refugees’ access to healthcare services include women’s health and maternal care, mental health and psychological trauma, and inclusion in national health plans for issues such as public health crises. In terms of education policy, systemic barriers to obtain schooling, poor quality of instruction, gendered expectations, and inaccessibility for rural students all contribute to a lack of education for Afghan refugees. What follows is an excerpt from my study—the policy recommendations I made based on my observations on these policy issues and implementations in Pakistan. Once refugees’ basic needs are met, the hope is that their political status can be improved.

Healthcare Services

Objectives:

A. Recognition in national healthcare programs

1. Allow refugees to use PoR cards as a valid form of identification for use in hospitals.
2. In refugee villages, create a streamlined program to have Afghan women register their pregnancies and register their children with the National Database & Registration Authority (NADRA) upon birth.

B. Accessibility for rural refugees

1. Adopt a mobile-hospital system for use in rural areas and refugee villages. These mobile hospitals can travel within a wide radius of rural villages.
   1. Services may include immunizations, screenings, oral health services, laboratory services, or counseling for chronic disease management.
   2. Implement proper hygiene practices in these mobile clinics and other refugee clinics. Additionally, create a system of accountability to lower cases of HIV/AIDs due to poor cleanliness.
   3. For domestic violence prevention, mandate healthcare professionals operating clinics to ask women in privacy about domestic and gender-based violence and equip her with resources to help.
2. Create a bus or van system from rural areas to local hospitals to ensure access to quality care. Some Afghan workers already have driving skills, so this can offer new job opportunities.
3. Place reproductive health specialists in every refugee village.
4. Provide post-abortion counseling in every abortion clinic for refugees.
5. Mandate that every new arrival, particularly children, see a psychologist at the refugee village they enter to inspect trauma-related mental illness.

C. Community Building

1. Partner with UNHCR and other refugee organizations to provide midwife training for Afghan women, which many Afghan women already do informally. This could be a source of livelihood for women and provide maternal care to rural women who are unable to travel to a hospital.
2. Build women’s community centers in semi-rural areas equipped with broadband internet access to empower women to seek out information regarding their health.

D. Changes in Pakistani national policy

1. Urban areas are subject to intense smog, contributing to the incidence of respiratory illness amongst Afghan refugees. Refugees should have access to free face coverings.
   1. Urban governments must pressure Pakistan’s national government to sign onto more international environment treaties.
2. Increase criminal punishment for domestic violence, sexual assault, and rape.
3. COVID-19: International refugee organizations and the Pakistan national government must work in concert to fully fund vaccinations in refugee villages.

Educational Services

Objectives:

A. Policy changes

1. Amend the Right to Free and Compulsory Education Act 2012 [pdf] so that it does not require families to provide proof of age by birth certificate.
2. Include Afghan refugee education as a special section in national education reform programs and planning.
3. Include Afghan adult refugee education as a special subsection in national education reform programs and planning to increase the adult literacy rate.

B. Financial Assistance

1. Afghan refugee education is still funded by emergency funds. This is not appropriate as many Afghan families have been in Pakistan for generations.
2. International organizations need to finance Afghan refugee education in the following areas: free tuition at private schools, transportation to school, and financial subsidies to families sending a child to school who would otherwise be working to encourage long-term human capabilities investment. This is especially important in urban areas because children are more likely not to attend school because of work.
3. Use international oversight to monitor how emergency foreign aid is being spent by the Pakistani government to ensure it is used for the most pressing concerns facing schools such as classroom space, furniture, and toilets.

C. Rural education accessibility

1. Expand curriculum and training for home-based learning.
2. Expand broadband WiFi access across rural areas.
3. Create bus systems to serve as transportation options for students far from the school.

D. Closing the gender gap

1. Train Afghan women to be teachers to create employment opportunities and allow more Afghan girls to attend school.
2. Offer more part-time school options that will be accessible for girls if they are expected to stay home to do household work.

E. Curriculum changes

1. Review curriculum for sensitivity towards minority issues.
2. Mandate check-ins for children at different stages of schooling. If a student is considering dropping out, equip school officials with information on alternative vocational options.
3. Expand vocational training programs in refugee villages and other refugee-populated areas.

Afghan refugees are one of the most vulnerable populations in the world today. The diaspora has migrated across the globe, with one of the largest communities settling in Pakistan. Through careful analysis of existing policies and trends for this group, my study has offered several policy suggestions for the Pakistani government to improve their healthcare and educational opportunities. Moving people deserve to feel secure regardless of their statelessness, and it is the responsibility of hosting countries to see the humanity in each new arrival. As the state of countries in conflict is everchanging, its migrants’ basic needs remain the same. Through these recommendations, I hope to further action and ensure that these needs are met with urgency.