Short distance, long journey: the struggle for healthcare in rural Daikundi
In Gulsom’s village, a small clinic provides basic health services, but its limited resources often fail to meet the most critical needs. “When the clinic can’t help, we have no choice but to take our sick family members to Nili [the provincial capital],” explains Gulsom, a 42-year-old mother of seven children.
Reaching Nili, however, is an immense challenge. Though Gulsom’s village is relatively close, the unpaved, mountainous roads make the journey treacherous. Winter conditions worsen the difficulties, shrouding the mountain passes with dangerous ice. “The transportation costs are beyond what most of us can afford,” Gulsom says. “If we’re lucky, we can borrow money to pay for transportation and treatment. Otherwise, we have no choice but to watch our loved ones suffer. In the worst of winter, people often die before they can reach help.”
Like most families in the village, Gulsom relies on agriculture for income. However, frequent droughts and climate shocks have left their harvests barren, pushing the families closer to despair. Her husband, despite living with a disability that limits his ability to work, tirelessly cultivates their small plot of land, growing wheat to sustain their family. Yet, the increasingly harsh conditions make survival a constant struggle.
The health crisis in Gulsom’s community doesn’t stop at access to medical facilities. The village, home to 85 families, has only two hand-dug wells for water. These wells are uncovered and contaminated, contributing to frequent cases of diarrhea, kidney disease, and other preventable illnesses. “We rely on this water because we have no alternative,” Gulsom says. “Fetching water is the responsibility of women and children, even in winter. The snow makes the journey dangerous, and many slip and get hurt—but what choice do we have?”
This situation reflects a broader crisis; in Afghanistan, 14.3 million people will need humanitarian support to access healthcare services in 2025, due to major deficiencies in the reach of public health facilities. Additionally, 21 million people across the country will require water, sanitation, and hygiene (WASH) support, underscoring the severe water scarcity and sanitation issues facing rural communities like Gulsom’s.
Recognising these dire challenges, the Driving Action for Wellbeing to Avert Mortality (DAWAM) consortium is working to improve healthcare access in Daikundi’s most vulnerable communities. Through DAWAM, new health centres and water networks are being planned, with Action Against Hunger (ACF/AAH) as the strategic partner in this province. These initiatives aim to provide essential health and nutrition services as well as access to water, ensuring families like Gulsom’s no longer have to endure life-threatening delays for care.
Gulsom is also a participant in DAWAM’s hygiene promotion sessions, conducted by the Nai Qalah Association, a local Afghan organisation. “Before these sessions, we didn’t know much about cleanliness,” Gulsom reflects. “Now, we’ve learned how to protect ourselves and our children from diseases by practicing proper hygiene.”
When asked to prioritise her community’s needs, Gulsom’s response is heartfelt and clear, “First, we want job opportunities for women. Second, having a water tap close to our homes is every child’s and woman’s dream. And third, we need a well-functioning health facility in our village, so our children and women no longer have to suffer from lack of access to care.”
Gulsom’s story is not just about her family’s struggles - it’s a reflection of the health and water shortage challenges faced by rural communities in Daikundi. It’s also a call to action for access to clean water, healthcare, and sustainable livelihoods that could transform lives in rural Daikundi. Addressing these challenges requires integrated, multisector support across the humanitarian, development and peace nexus, to help communities like Gulsom’s move from mere survival to adaptation and thriving.