对于无法进行这些行程的妇女来说，替代方案更加危险。希拉说，在我们访问的十天前，一名20岁、大出血的孕妇向当地一家药房求助。柜台后面的人是一名男性，由于羞于描述自己身体的情况，她没有把全部实情告诉他。在没有进行适当检查的情况下，她被给予了用于治疗疟疾的药物。
For women unable to make those journeys, the alternatives are even more dangerous. Ten days before our visit, Shila says, a 20-year-old pregnant woman suffering severe bleeding sought help from a local pharmacy. The person behind the counter was a man and, ashamed to describe what was happening to her body, she did not tell him the full story. Without a proper examination, she was given medication intended to treat malaria.
她的病情恶化，在前往希拉诊所的途中分娩。她患上了严重的产后大出血，在抵达前死亡。只有她的婴儿幸存了下来。
Her condition deteriorated and she gave birth on the journey to Shila’s clinic. She suffered severe postpartum bleeding and died before reaching it. Only her baby survived.
“她太年轻了。她才20岁。在此后的三天里，我几乎吃不下饭。每当我回想起那件事，”她说。
“She was so young. She was just 20. For three days afterwards, I could barely eat. Every time I was remembering that thing,” she said.
这是一个极端案例，但希拉表示，潜在的问题正变得越来越普遍：“这种情况经常发生。她们去了药房，却拿到了错误的药物。”塔利班当局承认医疗保健监管不善的问题。12月，公共卫生部以缺乏合格员工等违规行为为由，关闭了查帕哈尔（Chaparhar）及邻近楠格哈尔（Nangarhar）三个地区的26个卫生中心。今年7月，楠格哈尔（包括查帕哈尔在内）的另外13家私营诊所以其他违规行为被关闭。
It was an extreme case, but Shila says the underlying problem is increasingly common: “This is happening a lot. They are going to pharmacies and they are getting the wrong medicine.”The Taliban authorities acknowledge problems with poorly regulated healthcare. In December, the Ministry of Public Health shut 26 health centres across Chaparhar and three neighbouring Nangarhar districts for breaches including a lack of qualified staff. This July, another 13 private clinics in Nangarhar, including in Chaparhar, were closed for separate violations.
甚至在2021年塔利班重新掌权之前，阿富汗的卫生系统就极其依赖国际援助，外国赠款为超过四分之三的公共开支提供资金。在长达二十年的西方干预期间，数十亿美元涌入该国，并推动医疗服务进入了甘达布卡罗蒂（Gandab Kharoti）等偏远社区。但现在这些资金几乎已经枯竭。
Afghanistan’s health system was extraordinarily dependent on international aid even before the Taliban returned to power in 2021, with foreign grants financing more than three quarters of public spending. Billions poured into the country during two decades of Western intervention and helped push healthcare into remote communities like Gandab Kharoti. But now that money has all but dried up.
它正受到来自两个方向的挤压。塔利班对妇女的严厉限制意味着西方政府理所不想使该政权合法化或为其提供资金。然而，国际资金的崩溃正在瓦解阿富汗妇女——这些已经承受了塔利班统治最沉重打击的人——所依赖的卫生服务。
It is being squeezed from two directions. The Taliban’s harsh restrictions on women mean Western governments understandably do not want to legitimise or bankroll the regime. Yet the collapse in international funding is unwinding the health services upon which Afghan women – already bearing the brunt of Taliban rule – depend.