“It brings me hope”: The impact of universal health coverage for Afghan refugees in Iran

MASHHAD, The Islamic Republic of Iran – ”My mother is in dire need of eye surgery, but the cost of treatment is beyond our means,” said Zahra*, a refugee from Afghanistan. “Both my sister and I work hard to support our family, but we barely manage to meet our basic needs.”

For several decades, millions of people have been forced to flee their homes in Afghanistan due to the country’s political and economic instability, repeated outbreaks of conflict, and – following the Taliban’s ascension to power in 2021 – drastic restrictions on the rights of women and girls. Zahra is one of them; she left Afghanistan in 1979 for the Islamic Republic of Iran, which for more than four decades has hosted one of the largest refugee populations in the world.

Refugees everywhere – and especially women and girls – struggle with particular health challenges. In the Islamic Republic of Iran, Afghan women refugees have higher rates of complications during pregnancy, with many finding it difficult to access any kind of reproductive health care. 

For the last ten years, an Iranian universal health insurance programme has been expanded to enable refugees to also access health care, for free or at a reduced cost – yet many women and girls are still not managing to do so. 

“Every day, we meet many people who are struggling financially and unable to afford necessary treatments,” Fatemeh*, a community health worker in Golestan province, told UNFPA, the United Nations reproductive health agency. “They have to prioritize their basic needs over their health.” 

Offering support through health coverage 

Since 2015, an agreement between UNHCR, the United Nations High Commissioner for Refugees, and Iran’s Ministry of the Interior and the Ministry of Health and Medical Education, has allowed registered refugees to access the national health insurance scheme, which covers more than 1,000 public hospitals and a number of private facilities. 

This not only helps people to more consistently take care of their own and their family’s well-being, but supports efforts toward inclusion, registration and reducing harmful coping mechanisms, for example forfeiting health care due to financial constraints. 

In recent months, UNFPA has begun providing cash vouchers to help cover the costs of health insurance premiums for vulnerable Afghan women, such as female heads of households, pregnant women and refugees with chronic illnesses.

For Zahra’s mother, the vouchers are a tool to bridge the gap between basic eye care and the specialized surgery she needs. “Having medical insurance [is] a lifeline for my mother, rescuing her from the threat of total blindness,” Zahra told UNFPA.

The vouchers are also intended to encourage more women to visit health providers for prenatal and antenatal care. 

“In just one week, I'm expecting to give birth,” another woman, Raziyeh*, told UNFPA. “This assistance is providing me with much-needed support during a critical time.” 

Hope and peace 

The programme has so far disbursed nearly 3,500 cash vouchers to Afghan women refugees in the Islamic Republic of Iran. 

Although displacement can drive uncertainty, the ability to seek and receive health care, even while in transit or temporary accommodation, can be a significant source of comfort. “It brings me hope and a sense of peace of mind, knowing that I have some help to navigate the challenges I'm facing,” Raziyeh said. 

“When we gave out the cash cards for health insurance, the recipients’ smiles brought us great relief,” added Fatemah. “It was rewarding to know that we could provide them with the support they needed and potentially make a positive impact on their lives.” 

* Names changed for privacy and protection

This is part of a series of stories illustrating progress made since the 1994 International Conference on Population and Development, which committed to ensure gender equality and the right to sexual and reproductive health for all. Find out more.