Afghanistan has faced recurrent measles outbreaks for more than two decades, with uneven routine immunisation allowing the disease to return even after large vaccination campaigns. Drawing on interviews conducted in 2025 and 2026 with doctors, health workers and parents, AAN’s Jelena Bjelica, Rama Mirzada and Rohullah Sorush hear about the latest major outbreak in 2024-25, the overcrowded wards, multiple cases in families and deaths among young children. While measles cases fell sharply in many areas in 2026 after a major vaccination campaign in November 2025, our interviews suggest Afghanistan remains at risk of renewed outbreaks unless routine two-dose vaccination coverage improves.
One of the tens of thousands of children who contracted measles during the 2022 outbreak being treated in hospital in Kabul. Photo: Sayed Khodaiberdi Sadat/Anadolu Agency, via AFP, 18 April 2022
“You might not believe me, but it took a long time for us to appreciate the danger of measles to children until we experienced it. We’d been unaware of its dangers and the deaths it caused.”
– Muqem, 29-year-old father of three children in Faizabad, Badakhshan
All three of Muqem’s children contracted measles in May 2025. He described one of his daughters becoming so ill she could not open her eyes. The experience shook him so deeply that it changed how the family thinks. They had not previously understood how dangerous the disease could be. More awareness, he said, including through mosques, was needed to encourage families to vaccinate their children.
Fortunately, all of Muqem’s children survived, but in the same year, 550 people did die of measles. Following the re-establishment of the Islamic Emirate in 2021, there had been a two-year gap in mass national vaccination campaigns (between 2023 and 2025) and in that gap, the country experienced its worst outbreak on record. Suspected measles cases rose to 60,000 in 2024 (WHO) and surged in 2025, with more than 97,000 suspected cases by mid-December (WHO). Only after a nationwide vaccination campaign that reached more than 16.7 million children in late 2025 did measles cases decline – falling to almost 19,000 in the year to the end of August. However, Afghanistan still faces the risk of measles outbreaks because access to health services in the country remains patchy and not enough children have the regular two-dose vaccination – also called ‘routine vaccination’. This is when parents take their infants for regular check-ups and vaccination in designated local health facilities.
Measles outbreaks are not a new problem: Afghanistan has experienced recurrent measles epidemics in the period under review, ie since 2001, reflecting longstanding problems with routine childhood immunisation, which, in turn, are driven by poor access to health services, poverty, illiteracy, prejudice, malnutrition and the health system’s poor ability to respond.
This report draws on 12 interviews conducted in 2025 and 2026 with doctors, health workers and parents about the spread of measles, access to vaccination and the pressure outbreaks have placed on families and health facilities. Taken together, the interviews offer a snapshot of the outbreak at two different moments – 2025, when the measles outbreak put intense pressure on hospitals and households and 2026, when cases had fallen substantially in several provinces, but measles transmission rates remained high and problems with routine immunisation remained.
The report opens with the experiences of the major outbreak in 2025, with interviews conducted in July of that year Badakhshan, Farah and Helmand, with hospital doctors and two parents whose children had contracted measles. This is followed by a look at how the situation was a year later after a major vaccination campaign, based on interviews conducted in August and September 2026 with doctors and health workers in Badakhshan, Farah, Helmand, Faryab, Ghor, Maidan Wardak and Ghazni provinces, including reinterviews with the doctors in Badakhshan and Farah. The report closes with an overview of recurring measles outbreaks in Afghanistan since 2001.
The report shows that routine immunisation is not enough, often because parents lack information or general knowledge about vaccination or because health service coverage is inadequate or difficult to access, with the system especially struggling since the 2025 aid cuts. It also shows how vulnerable Afghanistan is to outbreaks unless there is substantial development support for its health sector, and how unprepared the Emirate government has been to deal with a major health crisis, presumably because the health sector has never been a budgetary or policy priority.
The 2025 measles outbreak: why vaccine matters
Muqem, the 29-year-old father of three in Faizabad whose story opened this report, described how in 2025, his two-and-a-half-year-old daughter became so seriously ill she had to be taken to the doctor every day. He was a little uncertain about his daughter’s vaccination status: “I asked her mother and she said she had taken her to the hospital for her vaccinations, but wasn’t sure if the measles vaccine was given.” Two nephews who lived with the family also contracted measles and became very sick: Muqem believed they had not been vaccinated. One, a three-year-old, developed such a high fever and severe rash that, as Muqem described it, his skin began to peel.
In total, eight children in our extended family, including my nephews, nieces and my own children, got measles, one after another. It started when one child got sick. After she recovered, another child got infected. The children who were in the most severe condition were those who had not been vaccinated.
The experience left him convinced that vaccination mattered, not least because of the nine children in his extended family, the only child that did not contract measles was the one the family was certain had been fully vaccinated, ie had received two doses.
At the other end of the country, in Farah, another parent, Razia, described how her eight-month-old daughter contracted measles before receiving her first vaccination. The child became critically ill, she said. Her whole body turned red and she appeared lifeless and was unable to drink milk.
Her body had no strength – it was like a dead body. Only her heart was beating, which was the only way we could tell she was still alive. She was admitted to hospital for eight days. It was a truly horrible situation. I pray to God that no mother ever experiences this.
For Razia, with five children, the experience also became an argument for vaccination. She said her older children had previously had measles, but experienced the illness far more mildly – which she attributed to them having been vaccinated (with at least one dose) or having contracted the disease at a later age. Children under five are particularly vulnerable if they have not received both recommended vaccine doses to measles because protection from maternal antibodies fades during infancy. Also, once infected, young children are more likely to develop serious complications, particularly if they are malnourished or have weakened immune systems. Razia’s baby was not yet of age for vaccination: “I hope and pray that no child will ever contract measles before receiving the vaccine.”
During those eight days in hospital, Razia said the number of children admitted with measles rose from around 15 to around 50. This scenario was echoed in our interviews with doctors in Badakhshan, Farah and Helmand in 2025, who described how the severe measles outbreak h placed considerable pressure on hospitals and families. Doctors in all three provinces reported substantially higher caseloads than in previous years. According to the WHO’s infectious diseases monitoring report from 2025, the highest cumulative incidence of suspected measles cases per 10,000 population was reported in Helmand (69.4) and Badakhshan (49.9).
In Badakhshan, Dr Mushtaq at Faizabad Hospital said they were admitting 50 to 60 measles patients a day in mid-2025, compared with no more than six a day in 2024. Although admissions had fallen to between 12 and 18 a day by the time of the interview (in July 2025), he estimated that as many as 2,500 measles patients had been hospitalised over the previous five months. “At the peak of the outbreak, we were admitting up to 80 patients a day,” he said. The children’s ward has only 30 beds, he said, but could be caring for as many as 180 children, forcing staff to put several patients in one bed and use corridors. “We even had to use the kitchen as a temporary ward,” said Dr Muttaq. There had been between eight and twelve deaths a month, most of them, children under two.
Dr Gulli described a similar situation at Boost Hospital in Helmand: they were seeing around 200 to 300 measles patients a week at the time of the interview (July 2025) and earlier in the year had recorded as many as 120 patients a day. He said around 15 to 20 children were admitted every 24 hours, principally those with complications or underlying health problems. “In some instances,” Dr Gulli said, “I was treating ten or so members of a single family infected with measles.” Although less than one per cent of the measles patients died, he said that still meant they had as many as four deaths every week at the hospital.
Farah’s hospital was also struggling with overcrowding. At peak periods in 2025, paediatrician Dr Farid Hakimi said they were admitting as many as 20 measles patients a day. He said the hospital lacked a dedicated quarantine section with enough nurses and also that several sick children sometimes had to share a single bed, making effective isolation difficult. “At times,” he said “we had 25 inpatients with only one nurse, working a 24-hour shift, and one doctor attending to 120 patients.” He described an unbearable situation.
In every family, around two or three children had measles. They were treated at home because their financial situation was not good enough to admit their children to private hospitals and the capacity of the public hospital wasn’t enough to admit all patients. It was such a horrible situation. People were affected both mentally and financially. For instance, three children from the same family had contracted measles, but they had no money to hospitalise them in a private hospital. So, the family bought medicine for one child and shared it with the other two as well.
The doctors we interviewed repeatedly stressed that malnutrition, poverty and other illnesses made measles more dangerous. Dr Gulli said around eight out of every 20 children admitted with measles were malnourished. It is among the principal complications associated with deaths, along with pneumonia and dehydration. Families’ economic circumstances are also an underlying factor in a child’s prospects of recovery, with some families lacking the resources to seek treatment promptly or provide sick children with adequate food.
What the parents we interviewed instinctively felt, the doctors confirmed: gaps in vaccination emerged as the most consistent explanation for the scale of the outbreak. Doctors said many of the children they treated had no record of measles vaccination, particularly those coming from remote areas. In Helmand. In Farah, Dr Hakimi also said that most of the children he treated had not been vaccinated and described greater reluctance towards vaccination in villages and districts than in the provincial capital. In Badakhshan, access to remote areas is the main problem: while mobile vaccination teams can operate in many villages and districts, Dr Mushtaq said that places such as Wakhan, Pamir and parts of Darwaz were difficult to reach.
The doctors we interviewed also raised concerns raised about how vaccines were transported, stored or administered, particularly in remote areas. Measles vaccines must be kept within a functioning cold chain, generally at between 2°C and 8°C and protected from heat and light. The doctors suspected possible breaks in the cold chain and inadequate vaccinator training. In Badakhshan, for example, Mushtaq said he believed delayed delivery, cold-chain problems and administration errors may have contributed to vaccination failures in 2024 and 2025. The Helmand doctor raised similar concerns, while saying storage and handling at Boost Hospital itself were properly monitored. There is no doubt that Afghanistan’s vaccine cold chain faces persistent logistical challenges, including unreliable electricity, shortages of refrigeration equipment and the difficulties of transporting vaccines to remote areas. UNICEF and its partners have invested substantially in solar-powered refrigerators, generators and other cold-chain infrastructure. In 2024, they installed 318 solar direct-drive refrigerators in health facilities across all 34 provinces, alongside cold rooms, freezers, vaccine carriers and generators (UNICEF). There is also no evidence that might verify that it was a cold-chain failure that caused the recent measles outbreak.
What the 2025 outbreak did clearly show was that gaps in mass national immunisation campaigns in environments such as Afghanistan, where multiple children can become infected in succession in large households, are dangerous. The images of overcrowded wards, shortages of staff and large numbers of seriously ill children last year displayed how serious a measles outbreak can be. At the same time, the interviews suggest that attitudes towards vaccination were not uniformly hostile. Many parents saw vaccination as beneficial, while some who had experienced severe measles firsthand became strong advocates for immunising children. The central challenge emerging from these accounts was therefore not vaccine hesitancy, but ensuring that children, particularly those in remote and poor communities, were actually reached by effective mobile immunisation campaigns, if routine vaccination is not available, before outbreaks occurred.
The situation in 2026: a decline in cases, but not an ending
Interviews with doctors and health workers in selected provinces conducted in 2026 showed that measles cases have fallen in many parts of Afghanistan since the 2024-25 outbreak, although the picture remains uneven. In some provinces, like Helmand, as we will see, there has been little improvement.
In Farah province, we reinterviewed Dr Hakimi. He said the number of measles cases had fallen significantly:
The number of cases hasn’t yet dropped to zero. However, the number of patients admitted has gone down compared to 2025. … to three per day on average and on some days, we have only one. These are only patients with severe conditions, not those whose condition is normal and who can be sent home.
In Faryab province, another Dr Hakimi also reported a decline in measles cases: “The situation is good and under our control now. We have one to two cases a month.” In Badakhshan, Dr Mushtaq whom we had interviewed in 2025, said the situation was far better than that year, with only up to six measles patients admitted each week. He also said the patients’ cases were “not as complicated” as last year. However, he highlighted staff shortages and the remoteness of some areas in Badakhshan as the main problems in the province, problems that had not gone away. “We have vacancies, but we lack doctors and nurses, and if there are measles complications, we don’t have the doctors specialising in malnutrition and infectious diseases.” Also, he added, “Most of our doctors work in volunteer positions.”
Interviewees credited mass vaccination campaigns with much of the improvement. Safiullah Seddiqi, who supervises health services in Maidan Wardak and Ghazni, said measles cases fell after the ten-day vaccination campaign in late 2025 and that the children who continued to contract the disease were largely those who had not been vaccinated. In Ghor, the deputy head of the Emirate’s Expanded Programme on Immunisation, Dr Faroqi, described a similar cycle: a 2022 campaign was followed by very few cases in 2023, but outbreaks returned in 2024 and became very severe in 2025 after the two-year vaccination gap. “In 2025,” he said, “the cases increased to the level that the infectious ward of our hospital didn’t have the capacity to admit patients.”
Our interviewees in Farah, Ghor, Faryab, Badakhshan Maidan Wardak and Ghazni all agreed that access to vaccination remains highly uneven – and for a variety of reasons. In Faryab, one doctor described “white areas” that are beyond the reach of regular health services, although mobile vaccinators were increasingly being used to reach them. In Ghor, a doctor told AAN that even mobile teams could not reach remote districts, while transport costs, restrictions on women’s mobility and families’ workloads prevented many parents from bringing children to clinics for vaccination. In Farah, a doctor described a different cause: some parents avoided vaccinators and were reluctant to vaccinate their children, underscoring the ongoing importance of public awareness alongside physical access to services.
Helmand province stands out from the downward trend in cases. Dr Seraj, who works at Boost Hospital, said there had been little change from 2025 and that measles remained the most prominent disease in the hospital’s isolation ward. The ward has 34 beds, he said, and they are usually full. The peak this year had been in April, four months before the interview, when he said that 50 measles patients had been admitted, forcing the hospital to restrict admission to only complicated cases.
From my point of view, there’s not been much change compared to 2025. In our isolation ward, the number of measles patients is higher than for other diseases. It’s been two years since I started working here and I’ve reviewed the records of admitted patients. Based on these records, we still have many measles patients. Our beds are full most of the time.
The main reason for the high incidence of measles cases in Helmand is the same, however – missed immunisation.
Our interviews, supported by the monitoring data, suggest that the mass vaccination campaign in late 2025 was followed by a substantial reduction in measles nationwide, but that it has not eliminated the underlying conditions that allow outbreaks to recur. Routine immunisation in local clinics, hospitals or other health care establishments is still not common practice, particularly in remote communities, while poverty can prevent families from seeking timely care, and health facilities may struggle when cases surge. The situation in Helmand also shows that statistics showing a national decline can conceal significant local outbreaks. Afghanistan’s dependence on nationwide mass vaccination campaigns, rather than a routine two-dose immunisation, which requires a more comprehensive health infrastructure, suggests that there is still a long road ahead in eradicating measles.
Setting the 2025 epidemic in historic context
Afghanistan has faced recurrent measles outbreaks for the last quarter of the century, largely because routine immunisation never achieved full coverage or consistent delivery, with many children, especially in rural and hard-to-reach areas, left unvaccinated. Following the years of conflict and international isolation, beginning in 2001-02, the Ministry of Public Health, WHO and UNICEF launched large vaccination campaigns (WHO). Around 11.5 million children aged six months to 12 years were immunised in 2002. Another five million children were immunised in 2003. Reported measles cases consequently fell sharply, from 8,762 in 2001 to 559 in 2004. However, the gains were difficult to sustain. Cases rose again to 836 in 2005 and 1,835 in 2006 as routine coverage remained inadequate and many children were left unprotected, especially in the south and southeast of the country (Relief Web).
In 2005, the Country Report on Afghanistan’s Millennium Development Goals (written by the United Nations Development Programme) said the measles vaccination campaign had been effective, at least in the cities:
The measles immunisation programme has been a success in Afghanistan, with 75% of children aged less than 12 months having being immunised. Owing to much higher immunisation coverage of children in urban as opposed to rural areas, infant and child mortality rates in the rural areas are around 25% higher.
However, routine immunisation alone never reached enough children, which meant Afghanistan has kept going through the same vicious cycle: a rise in cases followed by an immunisation campaign whether that targeted a specific province or was nationwide. That brought cases down, but without routine immunisation, they were bound to rise again. Afghanistan’s 2018 Health Survey concluded that the measles immunisation rate had fluctuated, without overall improvement between 2003 and 2018, with estimated measles vaccination coverage at about 64 per cent, and with only 51.4 per cent of children ever fully vaccinated (ie, with two jabs). This suggests that emergency campaigns repeatedly reduced outbreaks, but that routine immunisation was failing to reach enough children, enough times.
Reported measles cases per year, 2020-2025. Source: WHO Immunization Portal. Graph generated on 28 September 2026
After relatively lower transmissions in 2019 and 2020, suspected measles cases again began rising across Afghanistan after the Taliban takeover, from around 30,000 in 2021 (WHO) to more than 77,000 in 2022 (WHO), as explained in more detail in the following section.
Epidemics under the Emirate
The rise in cases is directly linked to the deterioration of the healthcare system and the economic crisis that struck the country following the abrupt change of government. Since the re-establishment of the Islamic Emirate in August 2021, funding for healthcare has plummeted and the number of health facilities and medical staff has shrunk (see this 2025 AAN report on rural women’s access to health). WHO’s 2025 Public Health Situation Analysis, using 2023 data, estimated there are only 10.3 doctors, nurses and midwives per 10,000 people. It described the workforce shortage and its distribution as critical. The sharp reduction in donor support in 2025, most significantly caused by the cut in US aid under President Trump’s Stop Aid order from January 2025, resulted in the closure of approximately 595 facilities since then, according to Médecins Sans Frontières (MSF), with 445 closed or suspended in 2025, plus more than 150 additional health centres during the first half of 2026 (MSF). At the same time, the Emirate’s spending priorities mean health gets only one to two per cent of the budget (compared to 40 to 50 per cent spent on security). The limited availability of health facilities across the country, coupled with staff shortages – particularly of specialist doctors and female health workers had the most severe impact on women, who are often tasked with taking care of children’s vaccination schedules. A series of prohibitions targeting women promulgated by the Emirate since 2021 has made independent travel difficult and in some areas, impossible, especially over long distances. In particular, a ban instituted in December 2021 on women and girls travelling “long distances” without a mahram (a close male relative) is often applied to any woman travelling independently, at all.
Number of suspected measles cases based on WHO data. Graph: AAN, 2026.
Number of measles-related deaths based on WHO data. Graph: AAN, 2026.
As the two graphs above show, 2022 was the first major peak since 2001 for measles in Afghanistan, with 77,210 suspected cases and 388 deaths. The response was extensive: several subnational campaigns reached around three million children, followed in November and December 2022 by the first nationwide measles campaign since August 2021. It vaccinated 5.36 million children aged 9 months to 5 years across all 34 provinces. This appears to have contributed to the much lower incidence seen in 2023: annual suspected cases fell by roughly two-thirds to just under 29,000. Nevertheless, WHO monitoring showed cases again beginning to increase towards the end of 2023.
2024 saw another major resurgence, with 59,753 suspected cases and 289 deaths – more than double the number of suspected cases reported in 2023. Eighty per cent of suspected cases and more than 95 per cent of deaths were among children younger than five. The underlying vulnerability was considerable: Afghanistan’s 2022–23 Multiple Indicator Cluster Survey had found that only about 51% of children had received their first measles-containing vaccine dose and only 37% the necessary second dose. This is far below the level of 95 per cent, two-dose coverage (UNICEF) required to prevent outbreaks of a disease as infectious as measles.
As could be anticipated, the situation became still more serious in 2025. Cases rose steadily from the beginning of the year and reached a peak of 4,172 suspected cases every week in April. By 13 December, WHO had recorded 97,368 suspected measles cases and 552 associated deaths. This was the highest number of suspected cases recorded since 2001. In response, Afghanistan carried out a large two-phase national vaccination campaign in late 2025, reaching more than 16.7 million children aged six months to ten years across all provinces. By 29 August 2026, the national surveillance system had recorded 18,826 suspected cases and 78 deaths, compared with more than 97,000 cases already recorded by late June in 2025. Children under five still accounted for 14,367 cases, or 76 per cent of the 2026 total. Weekly cases have also been declining: between 23 and 29 August, only 292 suspected cases were reported, with no deaths and the Ministry of Public Health says the downward trend had been evident since June (MoPH).
However, there are still many children in Afghanistan who have not received at least one dose of measles vaccine. A recent REACH Initiative Whole of Afghanistan Assessment (WoAA) 2026 survey found that a fifth of respondents (21 per cent) had a child who had never received a measles injection at nine months or later and five per cent did not know if their child had received one.
Conclusion
Measles is one of the most contagious diseases in the world. The only way to really stop major outbreaks is to achieve ‘population immunity’, which requires the vast majority of the population to be vaccinated or to have previously had the disease (the UNICEF/WHO goal is 95%). Afghanistan’s vaccination practice cannot achieve this: large vaccination campaigns have repeatedly brought cases down, but weak routine, double-dose coverage caused by poor and uneven access to health services, malnutrition, periodic conflict and insecurity and the geographic isolation of many communities have allowed outbreaks to return. The fact that more than three-quarters of measles cases in 2026 were registered among children under five (both doses of measles vaccine should be administered before the age of 18 months; see footnote 5) (MoPH) clearly shows that the immunisation has not reached every child and the country remains vulnerable to renewed outbreaks.
The remedy is difficult. Rather than periodic vaccination campaigns, Afghanistan’s children, nationwide, need a two-dose routine immunisation. That it does need to be two-dose was the conclusion of a 2026 journal article, “Measles outbreak risk in Afghanistan: provincial immunity gaps and epidemic potential following immunisation system disruption,” in Vaccine, published by Elsevier. A single dose, the study found, would not give sufficiently high immunity, even if coverage were dramatically improved. The authors argue that controlling measles will therefore require a combination of sustained two-dose vaccination, large and well-targeted supplementary campaigns in vulnerable areas and the broader restoration of Afghanistan’s routine immunisation system, rather than relying on a single-dose vaccine alone.
However, in the current global political climate, Afghanistan has slipped down the international agenda and funding for basic services has become increasingly scarce. This leaves health providers, most of whom are NGO-run and donor-supported, struggling to sustain already depleted services, let alone expand preventive care or reach long-underserved communities. At the same time, a shift in Emirate policy that prioritised health and well-being is not on the horizon. Without sustained donor commitment or a change in national budget allocations, the cycle of avoidable illness, overstretched services and avoidable deaths among small children is set to continue.
Edited by Rachel Reid and Kate Clark
Revisions:
This article was last updated on 28 Sep 2026
