In aid-starved Afghanistan, relief workers fight a forgotten hunger crisis

When Khalid Riaz turns off a dusty, single-lane road into a village in Guzara district, half an hour south of the bustling heart of Herat city in western Afghanistan, he is immediately greeted by a group of children.

Some barefoot and sucking their thumbs, the children surround the car as Riaz begins unloading bags of flour and rice from the trunk of a blue sedan. With the help of a fellow volunteer from a nonprofit group called Aseel, Riaz carries the bags over uneven ground, walking carefully through a maze-like jumble of homes built of sand-colored mud.

Looking down at his papers to check if he’s arrived at the correct house, Riaz lowers the food packages onto the fuchsia carpet of a local couple’s living room. That day’s delivery – an emergency donation of everyday necessities like grains and cooking oil – will hopefully be enough for the couple and their three young children to survive for the next few months.

Khalid Riaz, 25, a volunteer with the nonprofit organization Aseel, delivers emergency food packages to families in Markhor-e-Sufla village, Herat, Afghanistan, October 26, 2024.Reuters

Riaz sits down to greet the couple. But before he can speak, a dozen women and children begin crowding the doorway. The mother tries to wave them away but they refuse to leave.

“Please let me register. I have nine children,” says one of the women, waving a handful of loose papers in Riaz’s face. The air is stifling as more women arrive, all talking over each other as they plead for help.

“I’m sorry, we only have two deliveries today,” mumbles Riaz, the 25-year-old volunteer, shrinking into the corner of the room.

Through Aseel, a U.S. nonprofit started by an Afghan entrepreneur, individuals can donate around $100 for a single food package to be sent to a family in Afghanistan. But there are always far more people requiring aid than individuals donating.

“I don’t want to promise something to anyone,” Riaz says. “I can’t lie to them.”

With Afghanistan’s economy reeling and millions of people going hungry, nonprofit groups like Aseel are trying to fill a growing humanitarian void, providing aid to destitute families.

Reuters traveled around Herat city and surrounding villages in October, accompanying non-government volunteers delivering food and visiting nutrition clinics run by aid organizations like World Vision.

Everywhere, there was a sense of desperation: Mothers begging aid workers for food. Young children working physically exhausting jobs on the street to feed their families. And doctors treating malnourished children and worrying what winter will bring in remote areas where people burn cardboard boxes to keep warm.

An Afghan boy stands next to houses damaged by an earthquake in 2023, in Guzara district, Herat, Afghanistan, October 19, 2024.Reuters

Afghanistan poses special difficulties: It has been shut out of development aid, because not a single foreign state officially recognizes the Taliban administration. Its treatment of women is impeding its path to recognition, Western diplomats say. Afghanistan’s leaders have said they respect women's rights in accordance with their interpretation of Islamic law.

These NGOs are part of a sprawling global network geared to detect and fight hunger and famine. Reuters is examining how this system is faring at a time when food crises have put hundreds of millions of people at risk of disease and death in places like Sudan, Gaza, Ethiopia and Afghanistan.

More than a third of Afghans are enduring dangerous levels of food deprivation. The world’s leading hunger monitor, the Integrated Food Security Phase Classification (IPC), said in a May report that while it saw “marginal improvements” in the food situation, an estimated 14.2 million people were experiencing high levels of acute food insecurity.

Mud houses stand on a hillside in Rabat-e-Sangi district, Herat, Afghanistan, October 22, 2024.Reuters

NGOs are required to comply with the law, said Abdul Rahman Habib, spokesperson for the economy ministry, responding to questions on Taliban rules about women who work in these organizations. But “there are no obstacles to the humanitarian aid activities of NGOs.” Aid, he added, shouldn’t be used as “a tool to achieve political objectives.”

'Real need'

For two decades, Afghanistan was mired in a war that ended abruptly in August 2021 when the United States made its chaotic withdrawal. Today, the country is isolated by sanctions that affect the banking system and other measures. Economic output plunged 27% between 2020 and 2023.

Billions of dollars in foreign aid for development and security were also cut after the U.S. left. That money had formed the backbone of Afghanistan’s government finances. United Nations humanitarian funding is declining, too: As of December, only 45% of the Afghanistan plan drawn up by the U.N. and aid organizations for 2024 had been funded, leaving a $1.7 billion shortfall.

Riaz was born only a few years before the U.S. invaded Afghanistan in 2001. For most of his young life, venturing outside his hometown in Herat, one of Afghanistan’s largest cities, was unthinkably dangerous. He remembers his family worrying every time his late father, an engineer, traveled to remote regions of Afghanistan to build water treatment projects during the war.

Water containers belonging to Afghan families sit outside their mud houses in Markhor-e-Sufla village, Herat, Afghanistan October 26, 2024.Reuters

The end of the war in 2021 has made it safer for Afghans like Riaz to travel around their own country. But many of his old professors and classmates have left, pursuing education and job opportunities abroad.

“It’s a fact that no one wants to abandon their home country,” Riaz says. For those who emigrate, “it’s a choice between bad and worse” – staying in Afghanistan with all its problems or abandoning home and family.

Riaz, who studied urban planning at Herat University, dreams of pursuing a master’s degree and eventually creating a nonprofit focused on improving Afghanistan’s polluted environment. To further his education and find people who can help him with his venture, he says he may need to leave, too.

Before the Taliban returned, Riaz had taught himself how to play classical guitar and the piano using YouTube videos. Now, there are restrictions on playing music in public.

On days he’s not volunteering for Aseel, Riaz tutors students online from home. He recently discovered German philosophers.

“Now’s the time to read Nietzsche!” he laughs, explaining that the philosopher helped him find his own meaning in what sometimes feels like an increasingly meaningless world.

Male guardians

Policies imposed by the Taliban regarding women have made it more challenging for nonprofits to operate, diplomats and humanitarian officials say.

Besides barring girls from attending school beyond sixth grade and requiring women to cover their faces, the Taliban prohibits women from traveling without a male guardian. It also issued orders to NGOs and the U.N. to stop their Afghan female staff from working. The government has made some exceptions, like in the healthcare sector.

Afghanistan’s donor base isn’t expanding, and the “restrictive policies towards women and girls,” along with competing crises around the world, have contributed to a “decrease in funding,” according to Indrika Ratwatte, the U.N.’s deputy special representative for Afghanistan and humanitarian coordinator for the mission there.

The U.S. Agency for International Development says it has provided more than $2 billion in humanitarian and basic needs assistance to Afghanistan since 2021. The humanitarian crisis in Afghanistan was "a direct result of the Taliban’s draconian edicts and policies – which we condemn,” a spokesperson for the agency said.

The economy ministry’s Habib said Afghan women are involved in commercial and service-related activities “in accordance with the applicable regulations,” including health, education and banking.

On Aseel’s second delivery of the day, Riaz hangs back while Madina, a 19-year-old female volunteer, approaches a one-room house on the edge of another village outside of Herat. Madina, who prefers to go by her first name for privacy reasons, is joined by her 15-year-old brother Mohammad, who accompanies her as her “mahram,” or male guardian.

Madina, 19, a volunteer from a nonprofit group called Aseel, her brother Mohammad, 15, delivers food packages to an Afghan family as Khalid Riaz, 25, a volunteer from Aseel, looks on, in Guzara district, Herat, Afghanistan, October 19, 2024.Reuters

Inside the home, an exhausted mother sits on tattered carpets next to her two crying children. Flies buzz around the room and settle on empty bowls of food on the ground. The mother, a 21-year-old, lost her husband in the days following the earthquake last October when a destroyed wall collapsed on top of him. Madina fills out a form, then hands the mother an emergency food package.

Later, after she returns to a taxi idling outside the home, Madina explains that she can empathize with many of the young women and mothers she encounters because her family is also struggling.

“Like the families we distributed aid to today, we also compromise,” she says, sitting in the backseat of the taxi, squeezed in next to her younger brother. Her family can afford a few staples like rice and beans; meat is too expensive.

Young breadwinners

Back in Herat city, the taxi carrying Madina and her brother speeds down a busy market road. Shops filled with meat and other produce line the street. Despite the appearance of abundance, four wholesalers in Herat’s main market say sales are down significantly since the fall of the previous Afghan government.

Workers unload goods from a cart at a wholesale store in Herat, Afghanistan October 22, 2024.Reuters

A survey conducted by a nonprofit initiative called REACH found that more than three-quarters of Afghan families are in debt. Farmers have been hit hard by climate shocks like droughts and floods. That has hurt their ability to cultivate crops – leaving less money in their pockets. To stock up on food supplies before winter, they now must buy more on credit.

Many of these families have fled rural provinces to cities like Herat, where even middle-class Afghans have been pushed into precarity.

Nowhere is this more obvious than on the city’s streets, where large numbers of young children can be seen doing an array of menial jobs. Many are the primary breadwinners in their families.

An Afghan girl carrying her sister poses for a picture in Markhor-e-Sufla village, Herat, Afghanistan October 26, 2024.Reuters

As Madina’s taxi drives deeper into the city, more and more young boys can be seen outside, pushing carts laden with fruit, polishing shoes, or baking bread. Many have been forced to leave school to support their families. Most look several years younger than Madina’s brother.

Off the busy main road, in a quiet alley, over 20 girls sit behind neat rows of desks facing a whiteboard. The girls are all elementary school age and wear matching white hijabs as they learn Dari phrases in a small classroom. A family charity called Khana e Meher, which translates to “House of Kindness,” runs the school for young girls and boys. The charity’s founder, Abdul Qadir Salehi, is a longtime social worker from Herat.

Hosna Salehi, whose family runs a charity called the House of Kindness, writes on a white board as she teaches children inside a classroom in Herat, Afghanistan, October 27, 2024.Reuters

His wife, Najiba, identifies working children from families requiring assistance, and their daughter helps teach classes. The goal of the charity, Salehi says, is to encourage the children’s families to let them study instead of work. Once they finish their studies, Salehi refers the boys to apprenticeships for skilled work like carpentry that can guarantee stability and more income in the future.

“Our role is like that of a father and mother for these children because their families don’t have anything to support them,” he says.

The children at the school fall into two categories: Those who are neglected by their parents and those who have lost a father or mother. Some of the children are still working: The girls make money cleaning houses or shelling nuts, while the boys work grinding jobs like making mud bricks for construction sites.

An Afghan villager employed on a project run by nonprofit organization World Vision digs a canal near a riverbed in Khwaja Shahab village, Herat, Afghanistan, October 20, 2024.Reuters

Even before the Taliban took power, Afghanistan had a large population of working children. But aid workers like Salehi say the number has jumped since 2021. A 2023 Save the Children survey of six Afghan provinces, which didn’t include Herat, found that more than a third of children had been pushed into work to help their families.

Inspectors from the Ministry of Labor and Social Affairs are monitoring child labor and “advise employers to refrain from hiring children for arduous work,” said ministry spokesperson Samiullah Ibrahimi. Repeat offenders are “referred to judicial authorities.”

While there are more children in need of help, donations to Salehi’s charity have fallen. Middle-class Afghan families can no longer afford to be generous, he says. Women and men who used to live comfortably off jobs at international nonprofits and had other employment or income can no longer provide support. Before 2021, Salehi’s school enrolled 90 children. Now, with donations down, he can support 60.

Afghan children play outside a mud house in Markhor-e-Sufla village, Herat, Afghanistan, October 26, 2024.Reuters

Najiba, dressed in all black with a surgical mask hiding her face, listens to her husband while a young boy lingers next to her skirt. The boy, named Omar, was shining shoes and collecting trash on the street when Najiba noticed him walking with a limp.

“This little one, his father was killed, and he’s the oldest in the family,” Najiba says, squeezing the boy’s shoulder. At 11, Omar is his family’s only son and the sole breadwinner for his mother and two sisters.

Like many others, Omar’s family moved to Herat from a province in northern Afghanistan two years ago.

Omar would take home 40 or 50 Afghanis (about 60 to 70 U.S. cents) after working a full day on the streets, barely enough to buy a few pieces of bread for his family. When Najiba offered to enroll him in the school program, Omar was elated but explained he couldn’t attend because of his responsibilities.

Malnourished children

The U.N.’s World Food Program, a major food aid distributor that plays a vital role in Afghanistan, says a lack of funding means it will reach just over six million hungry people this winter with emergency food aid – less than half of those who need it.

Among children, malnutrition is on the rise. An estimated 2.9 million Afghan children will suffer acute malnutrition in 2024, according to the Humanitarian Response Plan for this year. Another 570,000 children are expected to become malnourished next year, according to Harald Mannhardt, the WFP’s deputy country director for Afghanistan.

An Afghan girl poses for a photo at Markhor-e-Sufla village, Herat, Afghanistan, October 26, 2024.Reuters

Doctors at remote clinics run by international nonprofits are among the first to catch the most desperate cases.

Just a few minutes outside of Herat city, crowded markets and leafy boulevards give way to vast skies and sand-colored dwellings that look as though they’re carved into the arid landscape. Goats and sheep roam over desert terrain that resembles the rocky surface of Mars.

About two hours drive along the wide asphalt road that connects Herat to the Turkmenistan border is a health clinic called Yaka Dokan. It’s run by World Vision, a nonprofit active in Afghanistan for over two decades. The clinic, housed in several adjoining white shipping containers, serves 16 villages with a combined population of 5,400 people. It sees up to 150 patients a day, mostly children.

People walk outside Yaka Dokan health clinic run by the nonprofit organization World Vision in Yaka Dokan village, Herat, Afghanistan, October 23, 2024.Reuters

One weekday in October, more than an hour before the Yaka Dokan clinic is scheduled to open, a dozen women in billowing black burqas wait outside the gates. They huddle against the white wall circling the clinic, trying to shield their children from the bitter wind. By the time World Vision doctors drive up to the clinic in their minivan, more than 20 women and a dozen of their male guardians are assembled outside.

A few minutes after the clinic opens, dozens of women with babies and toddlers are queued up outside the office of Gulnisa, a 28-year-old doctor who serves as a community nutrition promoter for World Vision. Gulnisa and the other doctors interviewed for this story asked that only their first names be used, in line with the media policies of their organizations.

Gulnisa, 28, a doctor who serves as a community nutrition promoter for nonprofit organization World Vision, works at the Yaka Dokan health clinic run by the organization, in Yaka Dokan village, Herat, Afghanistan, October 23, 2024.Reuters

Wearing a white coat and a tartan scarf to cover her hair, she begins pulling out worn notebooks. A mother cradles a nine-month-old baby while another child sits quietly beside her.

Gulnisa instructs the mother to roll up the baby’s sleeves so she can use a color-coded tape to measure the boy’s upper arm. The baby begins to wail loudly as the doctor helps the mother lay him on a small scale. A wooden measuring device is then used to check his height.

Once the boy is back in the mother’s arms, Gulnisa carefully touches his feet to see if there is any swelling visible on his limbs, an indicator of acute malnutrition. The doctor checks the measurements against a chart, which helps her determine whether the boy is malnourished.

Gulnisa, 28, a doctor who serves as a community nutrition promoter for nonprofit organization World Vision, measures the upper arm of Habib, a three-year-old boy, suffering from severe acute malnutrition, at Yaka Dokan health clinic run by the organization, in Yaka Dokan village, Herat, Afghanistan, October 23, 2024.Reuters

The baby is too small for his age and is on the cusp of moderate malnutrition, Gulnisa tells the mother.

“He cries day and night and doesn’t sleep,” the mother says as she tries to hold the wiggling child in her arms. They have traveled from a village several hours away.

“I give him goat’s milk,” the mother says in a tired voice.

“Why not breast milk?” Gulnisa asks. Informational posters about basic hygiene and the myriad benefits of breastfeeding cover the doctor’s walls.

“How can I? I have no milk at all,” the mother replies.

The doctor hands the mother a plastic bag with 15 sachets of therapeutic food supplements. Leaning over her desk, she demonstrates how to knead the small red and white sachet before cutting it open to squeeze out the supplement.

“Before giving him the food, you need to wash your hands with soap. Not only your own hands, but you must also wash your child's hands,” Gulnisa says, explaining in detail how to also try and feed the boy soft foods like porridge.

“You must also collect the packaging and bring it with you when you come back. Every 15 days, which is two weeks later, you should come here on a Wednesday,” she says. “What day should you come? How many days later?”

“After 15 days,” the mother repeats after her.

“You must give the food only to this child and no one else, understand? Who should you give the food to, Auntie?”

“This child,” the mother replies.

Gulnisa, 28, a doctor who serves as a community nutrition promoter for nonprofit organization World Vision, measures the height of a child to check if they are malnourished at Yaka Dokan health clinic run by the organization, in Yaka Dokan village, Herat, Afghanistan, October 23, 2024.Reuter

If doctors were to screen an average of about 50 patients in a day, they’d find 20, sometimes 25 cases of moderate malnutrition, says Nisar Ahmad, another doctor at the clinic.

An additional 10 patients or less would have severe malnutrition. Of those most severe cases, three or four of the children will have complications caused by a lowered immune system that need to be referred to a larger hospital.

“The situation is moving toward a crisis,” says Nisar Ahmad, 31.

Both doctors worry about what the winter will bring. Gulnisa spent last winter working in an even more remote clinic several hours northeast of Herat city. She says many families in far-lying villages there only had dry bread or potatoes to eat.

“In the villages where we work, things have gotten worse,” Gulnisa says.

Since the Taliban returned to power, the number of sites treating malnutrition has quadrupled, health ministry spokesperson Sharafat Zaman told Reuters. “We are fully prepared for this winter,” he said.

'We have nothing'

When doctors at rural clinics like Yaka Dokan find a child suffering from severe malnutrition with medical complications, they are referred to the Herat Regional Hospital, where medical charity Médecins Sans Frontières (Doctors Without Borders, or MSF) operates a pediatric emergency room, an intensive care unit and an inpatient therapeutic feeding center.

Inside, MSF doctors rush around the intensive care unit and adjoining feeding center, where dozens of babies and toddlers lie in cots next to concerned mothers and grandmothers.

Sediqa, an MSF doctor who works in the emergency room, says the number of patients with severe acute malnutrition and other complications is increasing daily. These children, most under two, have chronic conditions like congenital heart disease and neurological disorders, as well as severe issues like pneumonia, measles or sepsis.

Sediqa, an MSF doctor, examines a malnourished child as the child's mother sits beside them in the paediatric department of Herat Regional Hospital, supported by Medecins Sans Frontieres (MSF) also known as Doctors Without Borders in Herat, Afghanistan, October 28, 2024.Reuters

On a late October day, the hospital, which stands behind a brick and concrete gate in the center of the city, is a hub of activity. Women and children pace around the parking lot, walking past rows of tents set up by families who cannot afford to stay elsewhere while their child receives treatment.

Some of the children require surgery or other treatments that aren’t readily available in Afghanistan. Those with congenital heart defects in the MSF-supported pediatric department are usually put on a waitlist for surgery. In early November, 41 were awaiting cardiac operations.

“The capacity of treatment and surgery is low, so we have lots of patients who are dying while they are on the waitlist,” Sediqa, 26, says.

Afghan women and children wait for their turn to see a doctor at Yaka Dokan health clinic run by nonprofit organization World Vision, in Yaka Dokan village, Herat, Afghanistan, October 23, 2024.Reuters

She makes her rounds in one of the wards of the therapeutic feeding center, where four babies lie in their cots. She leans over one, a two-and-a-half-month-old called Haliza, who balls her fists and cries when the doctor carefully lifts her yellow lace dress to check her heartbeat. A tiny breathing tube sits under her nose.

The baby’s grandmother, who has traveled eight hours by bus from rural Farsi district to bring Haliza to the hospital, says the girl is suffering from pneumonia and convulsions. Gaunt and clad in a floor-length black abaya, the grandmother says it’s the second time the baby has been admitted to the ward for malnutrition.

Last time, Haliza spent 19 days here, she says.

Looking over at the hospital staff, the grandmother says her seven-year-old niece back in the family’s village is also malnourished.

“We took her to the doctor many times, but she still hasn’t recovered,” she says. “You must help," she says, with more urgency. “We have nothing.”