Barriers to Health among IDPs in Kabul, Afghanistan: a qualitative study

Background: Forced displacement is a significant problem for regions experiencing prolonged humanitarian crises due to armed conflict. Afghanistan, having experienced over four decades of conflict, has an estimated 1.2 million internally displaced persons (IDPs), a majority of which are concentrated in urban centers. IDPs have limited resources and face challenges accessing health services through traditional channels, leading to a disproportionate burden of morbidity and mortality. Health care facilities created for and existing within IDP camps also face numerous challenges. We aim to understand the structural factors that negatively impact health and the specific barriers to healthcare access for IDPs using qualitative methods. Methods: A brief qualitative study was done to assess the barriers to health faced by IDPs and to understand the experience of providers caring for IDPs. We conducted open-ended interviews using a semi-structured interview guide across three IDP camps in Kabul, Afghanistan between May and June 2017. Participants were interviewed in focus groups, interviewing a total of 37 IDP ag 18 and older. In addition, two former health care providers were interviewed. We used grounded theory to code interviews using a priori and emergent coding, from which several themes and sub-themes emerged. Two independent readers coded the data and discrepancies were resolved by consensus. Results: Human security, water access, limited livelihood and employment, poor housing infrastructure and environmental factors significantly impacted IDP health. Closure of clinics within the camps caused substantial limitations to healthcare service access. Accessing existing health care infrastructure was limited by cost, distance, discrimination, and limited access to medication and vaccinations, particularly for children. Key informant interviews identified healthcare funding and vaccination delivery to be priority problems. Across all focus groups and key informant interviews, there appeared to be a solid and trusted patient-provider relationship. Conclusion Structural factors that negatively impact health coupled with new barriers to healthcare access for IDPs in Kabul are a source of serious concern. Our study identified structural factors that exacerbate poor health and new challenges to healthcare access resulting from the discontinuation of in-camp health services. Further research should be done on the barriers and facilitators of transition from emergency humanitarian response to long-term care for IDPs, as well as on the ability of local health systems to absorb vulnerable populations after humanitarian crises