– Sarah Hawkes, co-director of the Global Health 50/50 research group

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In May, Sediqa’s husband fell ill with symptoms of Covid-19 in a small village in Herat province, Afghanistan, and was taken to a hospital in Herat City for treatment. When he came home 10 days later, Sediqa was taking care of him.

Within a week she got sick too.

“I had the same symptoms, and day by day it got worse,” said Sediqa, whose last name was omitted for fear of repercussions. “I felt so weak that I didn’t feel like eating or drinking.”

But when she asked to go to a hospital, her husband refused. “He said ‘no way.’ He told me to sunbathe and drink more tea. “

Sharifa, who lives in Kabul, faced a similar situation. Her husband tested positive for the coronavirus and when she took care of him she eventually got sick too. But her husband stopped her from taking a test or seeing a doctor.

“My husband said that I wasn’t even sick and that I just wanted his attention,” Sharifa said. “He even laughed at me.”

In Afghanistan, the number of women who allegedly tested positive for the virus or died from Covid-19 is far below the number of men. According to the independent research group Global Health 50/50, men make up 53 percent of confirmed cases and 58 percent of deaths. However, the country tracker from the same organization shows that 70 percent of cases and 74 percent of deaths in Afghanistan are due to men – a particularly large discrepancy that experts say is most likely due to gender inequalities that exclude women like Sediqa and Sharifa from health care have system and the public.

“There is a legitimate concern that women do not have access to services,” said Sarah Hawkes, professor of global public health at University College London and co-director of the Global Health 50/50 research group.

However, the data from Afghanistan has one important caveat: it does not contain any information about the country’s testing rates, Professor Hawkes said. Anecdotally, tests are reported to be neither common nor widespread, even though they are free. This means that the numbers do not fully capture whether the discrepancy in infection and death rates is due to women not being tested or, in fact, not being infected.

Nor is Afghanistan the only country with a remarkably wide gap between infection and death rates for men and women. For example, in Singapore and Qatar, men account for around 90 percent of confirmed Covid-19 cases, Professor Hawkes said, in part due to severe outbreaks among male migrants who work in low-paid jobs and live in tight quarters (neither of those countries) has data disaggregated for deaths).

Some experts have also pointed to biological differences between men and women as the main reason for the gender gap in global death rates.

But with Afghanistan, “it’s very likely that women just won’t get into the system,” said Professor Hawkes.

Decades of conflict and widespread poverty have made it difficult for men and women to access Afghanistan’s fragile health infrastructure, according to a recent report by Médecins Sans Frontières, the group also known as Doctors Without Borders. However, women and children are more likely to be excluded from this system or receive inferior care because of patriarchal traditions that are still deep and widespread in Afghanistan.

Afghan women face barriers both in their own households and in the health facilities themselves, said Suraya Dalil, who served as Afghan health minister from 2010 to 2014 and now leads special public health programs at the World Health Organization.

“Women need someone to accompany them to go to the hospital, so these decisions are often made by the men in a household, whether it’s the husband or the father or the son,” said Ms. Dalil.

And when women get to health care facilities – a dangerous task in itself given the country’s vast mountainous landscapes – they are expected to only deal with female doctors, added Ms. Dalil. Given the small number of women doctors, especially in rural areas, this becomes an almost impossible hurdle.

Currently, the country has just over 2,000 female health professionals caring for more than 18 million women in the country, according to official government figures. And many of these workers are concentrated in the urban centers of Afghanistan, according to the World Health Organization.

Since Sediqa’s husband insisted that she should not be examined by male doctors, her brother had to call a doctor to see a doctor. She was prescribed some paracetamol and after 27 days she felt a little better.

In Sharifa’s case, there was simply no question of seeing a doctor. Sharifa is now 50 years old and has not seen a male doctor since she married 35 years ago when she was 15.

“If my husband gets sick, I’ll do what I can,” she said. “I’ll take him to the doctor, I’ll talk to his male doctors. But if I get sick, I can’t see a male doctor. I delivered my two boys at home. “

If a woman actually see a doctor and the situation reaches a point where she is hospitalized, another female relative is expected to stay with her in the hospital, Ms. Dalil said, causing another wrinkle in a complex situation.

Add to this the cost of health care, which is unaffordable for many Afghans, and a volatile environment where health facilities are often bombed or attacked by insurgents and the chances of a woman actually receiving adequate care are decreasing, Ms Dalil explained .

The Afghan government claims it has tried over the years to remove some of these obstacles. “The ministry is working hard to provide services to patients,” said Masooma Jafari, deputy spokeswoman for the health ministry. “We have doctors and we try to allocate separate areas and beds for patients.”

But the government didn’t provide Details on how the gender gap in coronavirus testing and treatment should be closed.

Another explanation for the different rates of infection and death among women in Afghanistan could be the fact that the country’s workforce was dominated by men even before the pandemic broke out.

A new study, published in May by the Center for Economic Policy Research, tracked Global Health 50/50 data using labor force participation rates across OECD countries and found a positive correlation between female labor force participation and the Covid-19 death rate for women.

“The percentage of female deaths from Covid-19 is higher in countries where women make up a larger proportion of full-time employees,” writes Renée Adams, study author and professor of finance at Oxford University, focusing on gender inequality . “Work can be associated with a higher incidence of pre-existing illnesses and higher exposure to the coronavirus.”

In Portugal, for example, women made up almost 50 percent of the workforce in 2018 and accounted for 50 percent of deaths from Covid-19 in April. In Mexico, women made up about 38 percent of the workforce in 2018 and 35 percent of Covid-19 deaths in April.

In Afghanistan, women make up around 30 percent of the workforce, removing many of them from situations where they might even be exposed to the virus.

However, this statement does not take into account cases such as Sediqa and Sharifa’s, which were most likely infected because their husbands carried the virus home.

All of this shows how much the balance of Afghan women depends when the government conducts peace negotiations with the Taliban. This process only involves a handful of female delegates representing the government side.

So far, the Taliban have been unsure whether they would support women’s rights to education and entry into the workforce, and many women feared that a peace deal could push them back into the shadows.

“As of 2002, there has been some significant investment in women’s empowerment,” said Ms. Dalil. She recalled that during her time at the Ministry of Health, the government made a conscious effort to use more midwives in hard-to-reach communities and in tough vaccination campaigns.

But now that the pandemic further emphasizes a delicate system and expands the schism between those in need of care and those in need of care, she added, “I am concerned about the progress made.”

Asad Timory contributed to the coverage of Herat.

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