Afghan Health Related Concerns Following the US Withdrawal: Results of a Survey Given via Social Media.

Background: The United States Armed Forces completed their withdrawal from Afghanistan on August 30th, 2021, ending 20 years of war in Afghanistan. This rapid timeline from announcement to withdrawal and subsequent power transfer had profound consequences on the Afghan people, particularly in the domains of health and healthcare. Methods: On 15 September 2021, we posted an anonymous online cross-sectional survey on social media (Twitter, Facebook, and WhatsApp groups) to collect data about respondents from Afghanistan. Questions focused on COVID-19 symptoms, concerns, and individual care with a focus on changes related to the United States (US) withdrawal from Afghanistan. The form was composed of 17 questions which included multiple choice, single choice, and numeric options. All questions were optional including demographic data. Results: Our survey yielded 1,074 responses from the Farsi version and 572 responses from the Pashto version for a total of 1,646 responses. 1,286 (80%) of respondents were in Afghanistan at the time of survey submission. Concerning the US withdrawal from Afghanistan, 26% (412) respondents were extremely concerned and 12% (181) were moderately concerned. A majority of respondents report concerns regarding mental health due to the US withdrawal. 27% (418) report extreme concern, 12% (186) report moderate concern, and 15% (229) report a little concern. There is a significant difference in the proportions of concern (for US withdrawal generally, as well as physical and mental health) across gender. 49% of Female respondents report extreme concern regarding the US withdrawal compared to 22% of Male respondents (P < 0.001). With respect to physical health concerns 36% of Females report extreme concern compared to 16% of Males (P < 0.001). Finally on the mental health concerns, 54% of Females report extreme concern compared to 22% of Males (P < 0.001). Conclusion: The results from this survey are susceptible to the possibility of internal validity and/or external validity. However, we are accepting of those possibilities considering this survey wasn't designed to be bulletproof, but rather serve as a voice for those who can't be heard and to inform the public of the hardships occurring across the globe due to a steadfast retraction of the US footprint from their soil. Our findings indicate salient changes and public health concerns among Afghans following the US withdrawal from the region. These concerns varied across gender and ethnic groups. Our findings may serve as the first step in addressing the health concerns of Afghans following two decades of US military presence. The results should be understood through the limitations associated with a survey study design. Future research and policy aimed at tackling short and long-term health and social concerns in Afghanistan should consider the role of US withdrawal.

War Experience, Daily Stressors and Mental Health Among the Inter-taliban Generation Young Adults in Northern Afghanistan: A Cross-Sectional School-Based Study.

Objectives: The specific objectives of the study are to examine the mental health (depression and anxiety) of the first generation of post-Taliban government and compare these measures with its preceding generation, and to assess war experience of the first generation of post-Taliban government. We also wanted to assess the daily stressors and their contribution to the mental health, and to assess mental health as a result of war experiences and daily stressors with respect to demographic measures such as sex, marital status, age, mother's age, birth order, and ethnicities. Methods: In a cross-sectional design, 621 high school students, were randomly selected to participate in the study to assess war experience, daily stressors, and mental health among the first generation of young adults under post-Taliban government. Results: The participants had 17.37 ± 0.9 mean years of ages, 94.8% of them were unmarried. Poor mental health was significantly associated with higher exposure to war, but not with the age of participants (P = 0.08). There was no association between war experiences and the age and ethnicity of our participants (p = 0.9, p = 0.7). Age differences were negligible for daily stressors too (P = 0.07). Daily stressors scores were higher for female than male students (P = 0.02). The majority of young adults surveyed, declared themselves in agreement with statements such as the security situation in Afghanistan makes me frustrated (56%), air pollution as a concern (41%), and not having anyone to talk about what is in their heart (28.8%). Gender differences were highly significant for mental health, as appraised by both The Hopkins Symptoms Checklist (HSCL) -depression and HSCL-anxiety. Girls presented higher rates of depression, anxiety, and daily stressors than boys, and boys presented higher rates of war experiences than girls. Conclusion: War experience, daily stressors, and mental health were irrelevant with age, ethnicity and marital status. Factor such as being the first-born child of the family, higher reported war experiences, and daily stressors all negatively impact mental health. Alongside war and its direct effects, the existing socio-cultural context must be considered as a potential factor mediating the mental health of girls in Afghanistan.