Health care for Afghan refugees and migrants in Pakistan

For more than a decade, Pakistan has been engaged in a process of documentation and registration of Afghan migrants and refugees in the country. Registered refugees have since 2006-2007 received renewable Proof of Registration (PoR) cards which entitle them to certain rights and assistance from the state, while since 2017 there are also holders of citizen cards Afghan (ACC). There are currently approximately 1.4 million PoR cardholders and 840,000 ACC cardholders. In addition, there are various estimates – ranging from 400,000 to one million – of unregistered and undocumented Afghans.

Registration was considered important to ensure better and more effective data-based policies. However, there does not appear to be an overarching or clear government health policy for refugees that incorporates the different categories of PoR and ACC holders, or unregistered refugees. Access to national health care programs and private facilities is available to registered refugees, and is also not legally out of reach for unregistered refugees.

UNHCR was the main supporting agency for the provision of health care. Until 2014, it worked with the Pakistani government to operationalize Basic Health Units (BHUs) in refugee villages, where approximately 40% of registered refugees reside. In addition to unregistered refugees, this approach left out sixty percent of registered refugees – who also relied on public or private health care providers outside refugee villages for many of their needs. It was also noted that UNHCR’s health programming budget was mainly used for payment of salaries and operating costs of implementing partners, with only eighteen percent spent on supplies, medicines and vaccines. .

As a result, even as BHUs in refugee villages were credited with success in maternal and child health and other prevention programs, a new five-year approach was designed in 2014. The goal was to minimize mortality and morbidity and improve the quality of life of refugees. of life. To achieve this, the BHU model was phased out and it was decided to improve the quality of community health care enjoyed by registered and unregistered Afghans as well as Pakistani citizens, and initiatives such as female medical visits, higher vaccination coverage. , and community health workers providing maternal and child health care have been promoted. For complicated illnesses, public hospitals could be visited. This new strategy also focused more on maternal and child health, including prenatal and postnatal care and safe deliveries, and sought to increase immunization.

Broadly, this strategy aimed to empower and empower refugee households to manage their own health needs through community-based health programs rather than relying on UNHCR. It also aimed to provide access to alternative health care providers and to develop links between refugee health systems in refugee villages and those in Pakistan. After all, informal collaborations already existed between the two systems, as refugees used public health facilities while locals also used UNHCR services. This was part of a plan to improve access and quality of health care in host communities. In 2020, UNHCR noted that refugees’ access to national health services in Pakistan, as also reflected in the first months of the COVID-19 response, was comparable to that of Pakistani nationals. Registered refugees were also included in the national vaccination programme.

Currently, PoR and ACC holders have access to healthcare services equal to Pakistani nationals, although this is not based on any specific policy or legislation. In fact, most Afghan refugees can access health services when needed. But free health care is linked to registration status. Registered refugees are also included in government health programs such as vaccination campaigns, tuberculosis control and HIV prevention and treatment. But the quality of health care for refugees remains a concern. And the situation is likely to be worse for undocumented refugees, who have also been known to borrow PoR cards or ACCs to access healthcare.

There are several concerns regarding health care for Afghans that Pakistan, UNHCR and implementing partners should be aware of when designing new policies. For example, some common occupations among Afghan refugees are more disproportionately affected by certain illnesses, such as a large number of carpet weavers who suffer from hepatitis, asthma and sight problems. There are also mental health issues among Afghans that often go unaddressed. During the COVID-19 pandemic, only PoR cardholders had access to specific types of support from UNHCR, and even their registration for vaccinations came quite late.

Finally, Pakistan must also develop better plans for Afghan citizens who intend to visit to access medical care. In 2018, Pakistan issued a total of 61,731 medical visas to Afghan citizens – out of around 500,000 visas in total. They can apply for medical visas, but there are many delays. It is estimated that around 100,000 Afghans seek treatment in Pakistan every year. Although the visa itself is free, the process is long and arduous and, depending on the disease, medical treatment in cities like Peshawar is not cheap. It has been suggested that Pakistan is the preferred destination for medical treatment for Afghan citizens due to cultural and linguistic comfort, but considering the hurdles in the visa process, Pakistan has been replaced by India since 2016 as as the most visited country for Afghans. Medical tourism. That was largely since Pakistan tightened its visa policy, leading to a drastic drop in the number of Afghans seeking medical care, dropping the number to just 50 a month.

According to the General Directorate of Immigration and Passports website, Afghan holders can also obtain a medical or treatment visa if they surrender their PoR cards and apply through the appropriate channel. Additionally, Afghan citizens can obtain a three-month visa upon arrival at the Torkham border in case of serious illness or injury, and pregnant women can also be allowed with an attendant. If Afghan citizens apply for a visa from the Pakistani mission in their country, they can obtain a six-month treatment visa for complicated or long-term illnesses such as cancer, heart disease, liver disease and kidney disease. , etc., as well as an attendant.

While in Pakistan, they can apply for an extension of this visa with the recommendation of the concerned doctors and hospitals. Obtaining a visa officially, however, comes with many obstacles. Decades of experience have led to a strategy of developing community programs and investing in public health care systems that benefit registered and unregistered Afghans as well as Pakistanis. But there must be continuous efforts to improve the quality of health care, and also focus on policies that improve the situation of medical visits in Pakistan. This can go a long way in strengthening the ties between the two countries.

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