Major outbreak of disease escalates in camps as thousands return to Afghanistan from Pakistan

Thousands of Afghan refugees who crossed into Afghanistan from Pakistan in recent weeks are experiencing alarming levels of serious illnesses that are escalating quickly, including life-threatening and highly contagious acute diarrhoea.

Over 3,000 cases of acute respiratory infections and 1,200 cases of diarrhoea in children have been reported at Save the Children health facilities in the past month.

This is being driven by families having limited or no access to clean water for drinking and washing, and people being forced to defecate in the open due to a lack of toilets.

"The escalating cases of acute respiratory infections and diarrhoea present a major cause for concern"

Some 286,000 people have returned to Afghanistan from Pakistan since October 1, with 139,000 arriving in November alone, according to the UN, after Pakistan announced that all undocumented foreigners must leave the country voluntarily by November 1 or face deportation.

The vast majority – or 80% – of people returning to Afghanistan are women and children, with nearly one in four returnees children under five, and over 60% of returnees estimated to be children.

“The escalating cases of acute respiratory infections and diarrhoea present a major cause for concern. As the influx of people continues, the challenges associated with providing adequate water and hygiene facilities, particularly for families and girls, become even more pronounced," said Arshad Malik, Country Director for Save the Children in Afghanistan.

"The urgent need for comprehensive and sustainable solutions is paramount to address the potential health crisis and ensure the well-being of the arriving population," Arshad added.  

Pakistan is home to over four million Afghan migrants and refugees, about 1.7 million of whom are undocumented. Many came after the Taliban retook Afghanistan in 2021, and a large number have been present since the 1979 Soviet invasion.

Islamabad announced in October it would expel over a million undocumented refugees, mostly Afghans, amid a row with Kabul over charges that it harbours anti-Pakistan militants.

Pakistani police have been searching door to door in refugee settlements for those who have not left voluntarily, beginning with the port city of Karachi, where hundreds of thousands of Afghans live. Anyone remaining may be forcefully expelled. Over 370,000 Afghans have fled Pakistan since October 1.

This month the UN refugee agency urged Pakistan to halt the deportation during the harsh winter season, as police continued to search homes and expel Afghanis who had not already left.

"UNHCR is calling upon the government of Pakistan to halt these mass numbers of returns during this harsh season of winter because the cold in Afghanistan is really deadly and it can take lives," the agency's regional spokesman, Babar Baloch, told Reuters TV in an interview.

"We're talking about desperate women, children and men being on the move, leaving Pakistan in droves," he said.

The agency has said the Afghans' return should be voluntary and that Pakistan should identify vulnerable individuals who need international protection.

Authorities on the Afghan side of the border have been overwhelmed by the scale of the exodus as they attempt to process those returning — some of whom are setting foot in Afghanistan for the first time in their lives.

“These returning families arrive in Afghanistan with virtually nothing and face a grim reality – a stark contrast to the stability they desperately need," Arshad continued.

"Compounded by existing humanitarian crisis, the impending winter intensifies the urgency for immediate assistance. The nation cannot withstand a mass influx of people without collective support."