Medical Research Center, Kateb University, Kabul, Afghanistan.
Afghanistan National Charity Organization for Special Diseases, Kabul, Afghanistan.
Front Public Health. 2022 Jul 14;10:905481. doi: 10.3389/fpubh.2022.905481. eCollection 2022.
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.
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.
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 ( < 0.001). With respect to physical health concerns 36% of Females report extreme concern compared to 16% of Males ( < 0.001). Finally on the mental health concerns, 54% of Females report extreme concern compared to 22% of Males ( < 0.001).
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.
美国武装部队于 2021 年 8 月 30 日完成从阿富汗撤军，结束了在阿富汗长达 20 年的战争。从宣布到撤军以及随后的权力交接，这一时间线如此之快，对阿富汗人民产生了深远的影响，尤其是在健康和医疗保健领域。
2021 年 9 月 15 日，我们在社交媒体（Twitter、Facebook 和 WhatsApp 群组）上发布了一项匿名在线横断面调查，以收集来自阿富汗的受访者数据。问题集中在 COVID-19 症状、担忧和个人护理方面，重点关注与美国（US）从阿富汗撤军相关的变化。该表格由 17 个问题组成，包括多项选择、单项选择和数字选项。所有问题都是可选的，包括人口统计数据。
我们的调查从波斯语版本中获得了 1074 份回复，从普什图语版本中获得了 572 份回复，总计 1646 份回复。在调查提交时，有 1286 名（80%）受访者在阿富汗。关于美国从阿富汗撤军，26%（412 名）受访者非常关注，12%（181 名）受访者表示中度关注。大多数受访者表示，由于美国撤军，他们对心理健康感到担忧。27%（418 名）报告极度关注，12%（186 名）报告中度关注，15%（229 名）报告略有关注。不同性别对美国撤军的关注程度（对美国撤军的总体情况，以及对身心健康的关注）存在显著差异。与 22%的男性受访者相比，49%的女性受访者对美国撤军表示极度关注（<0.001）。在对身体健康的担忧方面，36%的女性受访者表示极度担忧，而男性受访者为 16%（<0.001）。最后，在心理健康方面，54%的女性受访者表示极度担忧，而男性受访者为 22%（<0.001）。
本研究结果可能存在内部有效性和/或外部有效性的问题。然而，考虑到这项调查的设计并非旨在无懈可击，而是为那些无法发声的人发声，并向公众通报由于美国坚决从其领土上撤军而在全球范围内出现的困难，我们接受这些可能性。我们的发现表明，在美国从该地区撤军后，阿富汗人在健康方面发生了显著变化和公共卫生方面的担忧。这些担忧在性别和族裔群体之间存在差异。我们的研究结果可能是解决阿富汗人在美军存在二十年之后出现的健康问题的第一步。这些结果应结合调查研究设计的局限性来理解。未来针对阿富汗短期和长期健康和社会问题的研究和政策，应考虑美国撤军的影响。
