From the Torkham border crossing to the suburbs of Tehran and informal settlements of Kabul, forcibly displaced Afghans and returnees are navigating compounding crises – facing poverty, infectious diseases, climate risks, natural hazards and disasters, all while contending with health systems that struggle to respond.

As of December 2024, the UN Refugee Agency reported that approximately 8.9 million Afghans are residing in the Islamic Republic of Iran and Pakistan. Since September 2023, over 3 million have returned to Afghanistan, as a result of by restrictive policies, changing public sentiment, and growing social and economic pressures in host countries. These factors are accelerating returns – often into communities already under significant strain.  

Behind these numbers are countless stories of severe pressure placed on already fragile health systems, as well as critical gaps in healthcare access, disease surveillance and preparedness. These gaps affect not only forcibly displaced populations but also host communities and risk undermining regional health security.  

A case in point: In 2024, Iran conducted active case finding for tuberculosis (TB) among 98,000 individuals from Iranian host communities living in close contact with Afghan migrants in densely populated migrant neighbourhoods across nine pilot sites. Among those screened, 56 Iranians were diagnosed with TB, a detection rate of 56 per 100,000, over four times higher than the national average.

Barriers such as language, poverty, insecure legal status and social exclusion often prevent access to essential services. These barriers delay diagnosis and treatment of preventable diseases such as TB and HIV and limit access to mental healthcare.

Mobility further disrupts care. As people move across borders or within countries, treatment is often interrupted. Weak referral systems and fragmented health services increase the risk of infectious disease transmission. Establishing point of care screening and testing and strengthening cross-border collaboration are critical to ensure early detection, coordinated care, effective follow-up and treatment continuity.

Climate change adds another layer of complexity. Rising temperatures, droughts, sand and dust storms, and flash floods are displacing communities and fuelling the spread of diseases, including malaria and dengue, and respiratory diseases such as including TB. These evolving threats demand adaptive systems capable of managing both emerging infectious diseases and climate-induced health shocks.  

For displaced Afghans and returnees, the convergence of environmental and health challenges further deepens vulnerability, exacerbating strain on overstretched health systems and host communities.

To improve health access among displaced populations, UNDP is advancing digital innovations that put people and communities at the centre. Through the Multicountry TB Asia programme supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNDP partnered with national TB control programmes, the International Organization for Migration and the UN Refugee Agency to strengthen case detection and continuity of treatment across Afghanistan, Iran and Pakistan.  

A new cross-border TB application, designed to function even in low-connectivity settings, enables health workers to track patients, manage referrals and share data. With multi-language support and country-specific features, it helps ensure no patient is lost to follow-up simply because they cross a border. It also guides community healthcare workers in conducting comprehensive screening of mobile populations.