Afghanistan: migrant health guide
Advice and guidance on the health needs of migrant patients from Afghanistan for healthcare practitioners.
Main messages
If the patient is new to the UK:
- explain to them how the NHS works and their entitlements to healthcare
- discuss how this compares to the healthcare system they’ve been used to
- follow guidance on how to comprehensively assess new migrant patients
- ensure that they are up to date with the UK immunisation schedule
- ask about any travel plans the patient may have to visit friends and relatives in their country of origin
Screen all new migrants, including children, for tuberculosis (TB).
Consider screening for hepatitis B, particularly among those who have recently arrived. Afghanistan has an intermediate prevalence.
Be alert for signs and symptoms of polio, and ensure vaccination as required. Polio is endemic in Afghanistan.
There is a risk of malaria in some areas of Afghanistan.
There is a high risk of typhoid infection in Afghanistan.
Consider nutritional and metabolic concerns.
Infectious diseases
Immunisation
Ensure that all patients, especially children, are up to date with the UK immunisation schedule. See the current childhood immunisation schedules.
Tuberculosis
The incidence of tuberculosis (TB) in Afghanistan is high (40 to 499 cases per 100,000), so:
- screen all new entrants (including children) for TB according to the NICE guideline on tuberculosis
- refer to TB services promptly if screening is positive
- maintain long-term vigilance for symptoms of TB even if initial screening is negative
- be aware that TB is a notifiable disease
Sexually transmitted infections and HIV
Take a sexual history and:
- screen for sexually transmitted infections (STIs) and HIV according to risk as specified in the UK national standards and guidelines
- test all sexually active patients under the age of 25 for chlamydia - see NICE guidance on management of chlamydia
Afghanistan has a low rate of HIV (less than or equal to 1%), so offer and recommend an HIV test if the patient:
- falls into a high risk group
- is newly registering in a high prevalence area
Hepatitis B
Afghanistan has an intermediate prevalence of hepatitis B, so:
- consider screening for hepatitis B, particularly those who have recently arrived
- offer screening for hepatitis B to all pregnant women during each pregnancy
- immunise appropriately babies born to mothers who are hepatitis B positive, and follow up accordingly
- be aware that the UK has a universal infant immunisation programme for hepatitis B and a selective immunisation programme for higher risk groups
Hepatitis C
The prevalence of hepatitis C is higher than the UK, so consider screening for hepatitis C if other risk factors apply.
Polio
Polio is endemic in Afghanistan, so:
- be alert for signs and symptoms of polio in anyone arriving from Afghanistan, and investigate as appropriate
- ensure all new entrants are brought up to date with the UK immunisation schedule, including polio vaccine as required
- See the National Travel Health Network and Centre for advice about polio vaccine requirements if patients are planning to travel back to Afghanistan, as specific recommendations are in place for long-term visitors (over 4 weeks) to Afghanistan
Malaria
There is a risk of malaria in some areas of Afghanistan, due to Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax), so:
- test any unwell patient who has travelled to and from affected areas of Afghanistan in the last year
- remember that malaria can be rapidly fatal
Typhoid
There is a high risk of typhoid infection in Afghanistan, so:
- ensure that travellers to Afghanistan are offered typhoid immunisation and advice on prevention of enteric fever
- remember enteric fever in the differential diagnosis of illness in patients with a recent history of travel to or from Afghanistan
Helminths
There is a risk of helminth infections in Afghanistan, including soil transmitted helminthiasis.
Travel plans and advice
Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin. People who travel to visit friends and relatives should visit the Foreign and Commonwealth Office for overseas travel advice and National Travel Health Network and Centre for country-specific travel advice prior to leaving the UK.
Nutritional and metabolic concerns
Anaemia
There is a moderate risk of anaemia in adults (estimated prevalence in non-pregnant women is 20 to 40%) and a high risk in pre-school children (estimated prevalence is greater than 40%) in Afghanistan, so:
- consider the possibility of anaemia in recently arrived migrants, particularly women and pre-school children
- test as clinically indicated
Vitamin D
Consider the possibility of vitamin D deficiency in people who may be at risk due to:
- darker skin
- those who are not often outdoors
- those who cover up most of their skin when outdoors
Vitamin A
There is a high risk of vitamin A deficiency in Afghanistan.
Women’s health
Reproductive health indicators
| Reproductive health indicator | UK | Afghanistan |
|---|---|---|
| Children per woman (lifetime average) | 1.7 | 4.3 |
| Use of contraception (by woman of reproductive age or partner) | 71.7% | 18.2% |
No data is available on:
- mammography screening rates
- cervical cancer screening rates
Find out more about women’s health.
Country profile
Health indicators and healthcare
The World Health Organization Global Health Observatory has a summary of health indicators and healthcare in Afghanistan.
Culture, politics and history
BBC News and The World Factbook provide background information on the culture, politics and history of Afghanistan.
Languages
| Language | Population (%) |
|---|---|
| Afghan Persian or Dari (official) | 78 |
| Pashto (official) | 50 |
| Uzbek | 10 |
| English | 5 |
| Turkmen | 2 |
| Urdu | 2 |
| Pashayi | 1 |
| Nuristani | 1 |
| Arabic | 1 |
| Balochi | 1 |
| Other | <1 |
Notes: Dari functions as the lingua franca. Percentages do not sum to 100% as there is much bilingualism.
Source: The World Factbook.
Find out about language interpreting and translation
Religions
| Religion | Population (%) |
|---|---|
| Sunni Muslim | 84.7 to 89.7 |
| Shia Muslim | 10 to 15 |
| Other | 0.3 |
Source: The World Factbook.
Migration to the UK
There were over 85,600 people from Afghanistan living in England and Wales at the time of the 2021 Census - see international migration, England and Wales.
Afghan relocation and resettlement schemes
Guidance on individual health assessments for Afghan refugees was developed to support people working with Afghan refugees who have arrived in the UK since summer 2021.
Afghan Resettlement Programme: operational data factsheet contains the latest operational data on the programme.
Updates to this page
Last updated 4 December 2023 + show all updates
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Updated migration to the UK statistics in line with Census 2021 data and removed the document titled ‘Afghan relocation and resettlement schemes: advice for primary care’.
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Added link to Afghan Resettlement Programme: Operational Data Factsheet, a new Home Office publication
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Link to guidance on individual health assessments for Afghan refugees added under 'Afghan relocation and resettlement schemes: advice for primary care'.
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Updated 'Afghan relocation and resettlement schemes' PDF with new section on hepatitis C.
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New primary care guidance for Afghan relocations and resettlement schemes.
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Updated prevalence of communicable diseases and reproductive health indicators. Updated estimates for language and religion.
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Updated advice for hep B, malaria, and anaemia screening, based on current prevalence in Afghanistan.
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First published.