“The real challenge is still ahead of us,” Stephanie Loose, Programme Manager in Afghanistan, told journalists in Geneva on Friday.

“We’re speaking about the reintegration of people who’ve lost their homes, who’ve lost their assets and also their hope.” 

Millions on the move

Afghanistan is currently facing an unprecedented returnee crisis. 

Since September 2023, some three million Afghans living in Pakistan and Iran were either deported or voluntarily repatriated, with over two million arriving so far this year.  For some, it’s not a return but a new start.

“Many of the returnees don’t have a place to go in Afghanistan because they’ve never actually lived in Afghanistan,” Ms. Loose said.

“Sixty per cent of those who are returning now are below 18, so they don’t have any social ties, they don’t have any networks, and there is a real risk for them taking negative coping mechanisms.”

Concern for women and girls

Returnees are coming to a country under Taliban rule and where roughly half the population – 22.9 million people – requires humanitarian assistance amid economic, human rights and climate-related crises. 

Ms. Loose noted that Taliban edicts preventing women and girls from attending secondary school, getting a job, or going outside without a male chaperone, present a serious challenge to returnees.

“They’re being pushed back into a country where there’s no education for girls beyond 12, where they don’t actually know where to go, and where there’s actually specifically for women and girls no social and no economic development opportunities,” she said. 

“We also have women-headed households who return to the country. So, you can just imagine actually what it means to them. They cannot actually leave their houses without being accompanied by a mahram, a male guardian, even if they want to go and see a doctor.”

Challenges to integration

She added that integration is likely to be further complicated by the high level of needs in Afghanistan, given the fragile political, economic and social situation, linked to more than four decades of conflict.

Afghanistan is also among the top 10 countries impacted by climate change, and droughts, floods and heatwaves have taken a toll on rural livelihoods. They also threaten people living in informal settlements in urban areas who account for up to 80 per cent of the population in these locations.

Given the scale of needs across Afghanistan, Ms. Loose stressed that rebuilding lives goes beyond emergency aid.

“People need access to basic services, to water, to sanitation.  And overall, they do need livelihood opportunities…to lead their lives in dignity and to support their families,” she said.

International appeal

Reintegrating large numbers of displaced people will require huge efforts from the international community and the Afghan authorities, she said. 

“It is a humanitarian crisis for individuals, but demands systemic, locally grounded approaches, and strong investment in basic services, infrastructures, housing solutions and livelihood opportunities,” she said.

Ms. Loose urged the international community not to forget about Afghanistan and its people, especially women and girls, and to ensure adequate funding is made available so that they can live in dignity. 

“For over 150 days, not a single truck from UNRWA has been permitted to deliver food, medicine or other essentials into Gaza,” the agency said on Friday. “This denial of access is costing lives every single day.”

Nearly 100 children dead from malnutrition

According to Gaza’s Ministry of Health, cited by the UN, at least 61,158 Palestinians have been killed and more than 151,000 injured since October, amid relentless Israeli bombardment and ground operations.

UNRWA said nearly 350 of its own staff are among the dead since Israel’s military operation in Gaza began following the 7 October 2023 Hamas-led terror attacks.

Many civilians have been killed while sheltering in schools or tents, or while queuing for food.

Food insecurity is now acute. UN data show 193 people — including 96 children — have died from malnutrition since the start of August, with July seeing the highest monthly rate of acute malnutrition recorded in children under five.

Soaring prices

Wheat flour prices have soared by up to 15,000 per cent compared to pre-war levels. “Sustained, large-scale deliveries are the only way to stabilise food supplies and prices,” UNRWA stressed.

Health services are close to collapse. More than half of essential medical supplies are already out of stock, and hospitals have been forced to ration fuel for generators. UNRWA teams have nevertheless managed over 1.5 million health consultations since March, but “without resupply, our ability to save lives is dwindling,” the agency warned.

Vast scale of displacement

Displacement is on a vast scale: 1.9 million people — around 90 per cent of Gaza’s population — have been forced from their homes, many repeatedly. Nearly 100,000 are crammed into over 60 UNRWA-run shelters.

In the northern Israeli-occupied West Bank, around 30,000 people from Nur Shams, Tulkarm and Jenin refugee camps remain unable to return home due to Israel’s “Iron Wall” military operation, ongoing since January.

The agency urged immediate, unhindered humanitarian access. “We need the world to act — to open the crossings, to stop the suffering, and to uphold the most basic principles of humanity,” it said.

The UN Security Council is due to meet in New York in emergency session on Sunday morning local time to discuss the Israeli cabinet’s endorsement of a military takeover of Gaza City which is home to around one million Palestinians.

Meanwhile, UN agencies confirmed the deaths of three Palestinians from Guillain-Barré Syndrome (GBS), a rare auto-immune disease that can cause sudden muscle weakness and even paralysis.

Before war erupted in Gaza in October 2023, only a handful of cases surfaced every year.

Mass casualties now the norm

“Hospitals are overwhelmed by mass casualty incidents, with an average of eight incidents per day,” said the UN aid coordination agency, OCHA, citing health partners.

In an update on the dire health crisis in Gaza, OCHA noted that specialised rehabilitation facilities were also overstretched handling complex trauma injuries and cases of Guillain-Barré.

To date, three deaths out of around 64 cases of GBS have been confirmed by the health authorities in Gaza. Two of the deceased were children.

According to the UN World Health Organization (WHO), 30 per cent of GBS patients require intensive care but there is no available stock of the primary medication needed to treat it, intravenous immunoglobulin.

Aid-drops are inadequate: WFP

In a related development, the UN World Food Programme (WFP) echoed repeated calls for aid to flood into Gaza, as opposed to the very limited amounts being allowed by the Israeli authorities.

“We can’t airdrop our way out of an unfolding famine. Not in Gaza,” insisted Cindy McCain, WFP Executive Director in a social media post late Wednesday.

The UN agency chief underscored that “500,000 people are starving today” and the only way to help them is to get food to them at scale and by land.

“We can’t afford to wait; Gaza is out of food and out of time,” Ms. McCain said.

WHO stocks destroyed

The destruction of WHO’s main medical warehouse in an attack on Deir Al-Balah late last month continues to impact lifesaving care.

In particular, the critical shortage of antibiotics has hampered treatment of meningitis, whose numbers are now in the hundreds – “the highest number recorded since the beginning of the escalation”, the OCHA update noted.

Isolation measures have been implemented, including the separation of the external department at Al Khair Hospital from the Nasser Medical Complex and the establishment of isolation tents at Al Aqsa Hospital to safely manage suspected cases.

Explosive weapons such as bombs and grenades have accounted for 83 per cent of medical consultations, said OCHA.

It cited partner NGO Médecins Sans Frontières (MSF) whose data covered more than 200,000 medical consultations in six MSF-supported health facilities in Gaza in 2024.

What is Guillain-Barré Syndrome?

Guillain-Barré Syndrome (GBS) is a neurological and autoimmune disease that affects the nervous system and causes progressive muscle paralysis. It is not contagious and is often triggered by a prior infection – viral or bacterial – that disrupts the immune system.

In most cases, patients can recover fully within a few weeks. But WHO stressed that even in the best healthcare settings, three to five per cent of patients die from complications of the disease, such as respiratory muscle paralysis, sepsis, pulmonary embolism, or cardiac arrest.

There have been several outbreaks of infectious diseases in Gaza since war erupted following Hamas-led terror attacks in Israel, including polio, cholera, hepatitis A and scabies.

UN Women – which champions gender empowerment and equality – alongside the international humanitarian agency CARE International and partners, issued the call in a report published on Thursday that also highlights the key challenges and needs of women aid workers assisting the returnees.

The Gender Alert comes amid a surge in returnees to Afghanistan, where the Taliban has ruled for four years, implementing numerous decrees that restrict women’s rights amid economic crisis, climate shocks and immense humanitarian needs.

Strangers in a strange land

Since September 2023, more than 2.4 million undocumented Afghan migrants have returned, or were forced to return, from Pakistan and Iran.

Women and girls account for a third of returnees from Iran so far this year, and about half of those coming from Pakistan.   

Many arrive in a country they have never lived in, with no home, income or access to education and healthcare.

A myriad of risks

Like all women and girls in Afghanistan, the returnees face increased risks of poverty, early marriage, violence, exploitation and unprecedented restrictions on their rights, movements and freedoms.  

“Vulnerable women and girls arriving with nothing into communities that are already stretched to breaking point puts them at even greater risk,” said Susan Ferguson, UN Women Special Representative in the country. 

We need a place to stay, a chance to learn and a way to earn.

“They are determined to rebuild with dignity, but we need more funding to provide the dedicated support they need and to ensure women humanitarian workers are there to reach them.” 

Housing, income and education

The report outlines urgent and long-term needs, such as safe and affordable shelter, livelihood support and girls’ education.  

As one participant in a focus group in Nangarhar province put it, “We need a place to stay, a chance to learn and a way to earn.”

Currently, only 10 per cent of women-headed households live in permanent shelter, nearly four in 10 fear eviction, and all girls are banned from attending secondary school.

Impact of aid cuts

Although women humanitarian workers at border points are critical to reaching female returnees, cuts in foreign aid and movement restrictions increasingly hamper their efforts.

For example, women humanitarians are required to be accompanied by a male guardian, or mahram, when travelling.  However, “funding cuts have sharply eroded staff mahram support in the provinces of Kandahar and Nangarhar, leaving provision inconsistent, delayed, or absent altogether,” the report said.

The funding cuts have severely weakened the capacity of humanitarian organizations to respond, and women humanitarian workers at border points report that they are overwhelmed by the sheer number of arrivals and being unable to meet even their basic needs. 

‘Distressed, disoriented and without hope’

“Witnessing the volume of arrivals and the hardship faced by women, children and families – many distressed, disoriented and without hope – has left a deep impact on all of us responding to this crisis,” said Graham Davison, CARE Afghanistan Director.

He underscored the urgent need for support to provide basic services, safe spaces and protection for women and girl returnees. 

The report noted that Afghanistan is already facing one of the world’s most dire humanitarian crises, driven by decades of conflict, poverty and natural disasters.

As this latest wave of returns threatens to push already fragile communities further into crisis, the partners urged the international community to act now to protect the rights of Afghan women and girls and to invest in the women humanitarians who support them.

Record number of returns

Separately, the International Organization for Migration (IOM) also called for international support as Afghanistan confronts “one of the largest return movements in recent history.”

Returnee numbers are on track to increase as one million more Afghans are expected to return from Pakistan following the Government’s decision not to extend their stay.

IOM operates four reception centres at major border crossings in Afghanistan, including Islam Qala and Milak with Iran, and Torkham and Spin Boldak with Pakistan. 

The UN agency is appealing for additional funding to scale up its response to address growing needs at the borders and in areas of return.