A new report offers a sobering look at Afghanistan’s fragile healthcare system, revealing that essential emergency and surgical care remains inaccessible for many, particularly in rural and impoverished areas.

Published by the medical humanitarian group EMERGENCY in partnership with Italy’s Università del Piemonte Orientale, the report draws on the testimonies of more than 1,600 Afghan patients, caregivers, and healthcare workers across 11 provinces. It outlines the deep and persistent barriers facing a country long battered by war, underfunding, and a growing burden of disease.

“For this report, the research team spoke to patients, their families, and colleagues across our surgical hospitals and primary care clinics, as well as staff at government-run hospitals, in order to understand, first-hand from the Afghan people, exactly what barriers are preventing them from accessing the healthcare services that could save their lives,” said Rossella Miccio, president of EMERGENCY.

Although improved mobility following the end of major conflict has allowed more people to seek care, the system remains incapable of meeting urgent health needs, especially in cases involving trauma, obstetrics, and intensive care.

Among the most striking findings: fewer than 3 percent of respondents said they had access to a public ambulance. Nearly half reported traveling on foot — often from remote or mountainous areas — to reach a clinic or hospital. When they arrived, many encountered additional challenges: a lack of staff, intermittent electricity, or missing equipment.