A Fortress of Despair: The Plight of Women in Afghanistan’s Mental Health System

By: BBC

A Fortress of Despair: The Plight of Women in Afghanistan’s Mental Health System

High on a hill in Kabul stands a place known to locals as Qala, or "the fortress." It is the largest of a few facilities dedicated to women with mental illnesses in Afghanistan, and a recent visit by the BBC revealed a facility struggling to contain a growing crisis. Within its walls, 104 women are confined—many not because they need institutional care, but because a society governed by strict patriarchal traditions has left them with nowhere else to go.

The Confinement of Abandonment

Mariam, a woman in her mid-20s, has lived in Qala for nine years. Her story is one of domestic abuse and familial abandonment that led to homelessness. Despite her radiant smile and willingness to contribute by cleaning, she is trapped. "I don't expect to return to my father and mother," she says, having been kicked out for defying strict cultural norms. With no possibility of living independently and a family that won't take her back, Mariam is effectively an inmate of the system, ready for freedom but without a path to it.

A Fortress of Despair: The Plight of Women in Afghanistan’s Mental Health System

Her story echoes that of Habiba, a 28-year-old whose husband forced her out after remarrying. Abandoned by her husband and with a widowed mother unable to support her, she, too, is ready to be released but has nowhere to go. She has lost contact with her three sons and desperately longs to be reunited with them. The deeply-rooted regulations of the Taliban, which require women to have a male guardian for nearly every aspect of life, ensure that for women like Mariam and Habiba, leaving Qala is a social and legal impossibility.

A System Overwhelmed by a Crisis

The stories of Mariam and Habiba are a common refrain at the center. As psychotherapist Saleema Halib notes, some patients have been completely abandoned by their families for decades, "living and dying here." Years of conflict have taken a toll on the mental health of many Afghans, particularly women, and the issue remains poorly understood and highly stigmatized.

A Fortress of Despair: The Plight of Women in Afghanistan’s Mental Health System

The problem extends far beyond the fortress walls. The facility has seen a several-fold increase in patients over the last four years and now has a waiting list. Dr Abdul Wali Utmanzai, a senior psychiatrist, sees up to 50 outpatients a day, most of them young women with family issues. He points to severe economic pressure and the absence of male relatives as key drivers of the mental health crisis. Despite the Taliban government's claim to be committed to health services, its restrictions on women’s movement make it incredibly difficult for many to even seek help. The UN reports that 68% of women surveyed in 2024 described their mental health as "bad" or "very bad," directly linking the crisis to the government's crackdowns on women’s rights.

The Desperate Plight of the Youngest

The lack of space at Qala has created a harrowing dilemma for families. Zainab, a 16-year-old girl, was confined to her home for a year—her ankles shackled to prevent her from running away—before a bed was finally found for her at the center. Her struggles, which began at age eight, worsened dramatically after she was thrown against a wall by a bomb blast at her school. Her repeated attempts to flee were a source of "dishonor" for her family, and her father argued that confinement was the only option for both her and the family's reputation.

For Zainab, Qala is a place of refuge from chains and a father who sees her as a source of shame. But for women like Mariam and Habiba, it is a prison from a society that has no place for them. The core issue remains: a mental health crisis is ravaging Afghanistan, but for its women, the greatest threat is not just the illness itself, but the lack of a strong societal support system that would allow them to heal and live with dignity.