Communicable and Non-Communicable Disease Burden among Afghan Returnees from Pakistan: A Cross-Sectional Study
This cross-sectional study of 144 recently returned Afghan refugees at Omari Camp reveals a cumulative burden of communicable and non-communicable diseases across the migration continuum, underscoring the urgent need for integrated, phase-specific health interventions to address both chronic conditions and acute infectious risks.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For decades, the world has watched the movement of people fleeing conflict, often focusing on the immediate dangers of the journey or the struggle to find shelter. Yet, a quieter, more complex reality unfolds within the bodies of those who are forced to leave their homes and then return to them years later. When people are displaced for a long time, their health does not simply pause; it changes. They face a "dual burden," a term used by public health experts to describe the simultaneous weight of infectious diseases, which spread easily in crowded conditions, and chronic conditions like diabetes or heart disease, which develop slowly over time. This situation becomes even more difficult when the return is not a choice but a forced expulsion, cutting off access to the care people relied on for decades. Understanding how these health risks shift from the time before leaving, through the journey, and into the return is essential for building a system that can actually help these populations survive and rebuild.
A recent study conducted at the Omari Camp in eastern Afghanistan sought to map this shifting landscape of health among Afghan returnees from Pakistan. The researchers, working with a team of doctors and students, interviewed and examined 144 people who had recently been sent back to Afghanistan. They did not just look at who was sick; they looked at when the sickness started. By breaking the timeline into three distinct chapters—life before the return, the journey itself, and life after arriving back home—the study revealed how health challenges accumulate and evolve. The group they studied was largely made up of women, and most of the returns were not voluntary; about 85 percent of the people had been forced to leave Pakistan. Many of them had lived across the border for so long that their displacement spanned generations, with 39 percent having resided in Pakistan for more than 40 years.
Before the return, the health profile of these individuals was already heavy. Even while living in Pakistan, many carried the burden of chronic illnesses. The study found that conditions like tuberculosis, hepatitis B, and various respiratory infections were present, alongside non-infectious issues such as diabetes, high blood pressure, and mental health struggles. Vaccination records were patchy; a significant number of women and men reported never having received any vaccinations while in Pakistan. This lack of preventive care left them vulnerable to diseases that could have been avoided. At the same time, the stress of living as a refugee had taken a toll on their minds, with mental health disorders reported by a notable portion of the group, affecting men and women in nearly equal measure.
The journey back to Afghanistan proved to be a period of acute physical strain. As the returnees traveled, often under difficult and crowded conditions, many developed new, immediate symptoms. The most common complaints during this transit phase were fatigue, coughs, sore throats, and digestive issues like diarrhea. These were not the chronic conditions of long-term illness but rather the body's reaction to the harsh reality of the move: exposure to the elements, poor sanitation, and the exhaustion of travel. The data showed that while most people did not report severe symptoms during the trip, a significant minority fell ill, suggesting that the migration process itself acts as a trigger for acute health crises.
Once the returnees arrived in Afghanistan, the health picture did not simply reset; it adapted to a new set of challenges. The study found that the acute infections picked up during the journey, such as respiratory and diarrheal illnesses, persisted or appeared anew in the days following arrival. The environment played a major role here; the dust, heat, and overcrowding of temporary settlements in the camps contributed to these respiratory and digestive problems. However, the chronic conditions that had been present before the journey did not disappear. People with diabetes, high blood pressure, or chronic lung disease continued to manage these conditions, often without the consistent medication or care they had previously accessed. The study noted that large family sizes, common among the returnees, meant that resources were stretched thin, making it harder to manage these ongoing health needs.
The researchers concluded that the health of Afghan returnees is defined by a cumulative risk that builds up across the entire migration experience. It is not a single event but a continuous process where the lack of care before leaving, the physical trauma of the journey, and the harsh conditions of return all combine to create a complex health crisis. The study suggests that helping this population requires more than just treating a fever or a wound; it demands an integrated approach that addresses the immediate infectious risks while simultaneously managing long-term chronic diseases and mental health. Because so many of these returnees had lived in Pakistan for decades, often their entire lives, they return to a country that feels foreign to them, carrying health profiles shaped by a different place. The findings indicate that successful reintegration depends on health programs that recognize this dual burden and provide continuous, phase-specific support to help these individuals navigate a fragile recovery.
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