Many Afghans evacuated to France as the Taliban took over their country more than six months ago are experiencing trauma and psychological distress, Human Rights Watch said today. While France has provided important support to evacuees, including many with professional ties to the country, there remains a significant gap in terms of urgent and adequate psychosocial support.
As Taliban forces took control of Afghanistan in August 2021, Afghans who had worked with foreign governments and militaries, and in Afghanistan's government, military, and security positions found themselves at heightened risk of persecution. Journalists and others who worked for foreign nongovernmental groups in various capacities, including promoting human rights and democracy, found themselves in the same position. Many fled the country at short notice, in some cases leaving behind family members.
"Afghans evacuated to France faced severely traumatic events and many continue to struggle with their mental health," said Jonas Bull, assistant disability rights researcher at Human Rights Watch. "As they navigate a new environment and language while managing feelings of isolation and trauma, France should provide everyone with quality mental health support."
With three million people fleeing Ukraine in the first three weeks following Russia's invasion, the situation of Afghans in France provides important lessons for receiving countries on how they can make mental health support a priority for asylum seekers.
The evacuees faced immense hurdles to reach the Kabul airport in Afghanistan, in many cases being threatened, harassed, and beaten at Taliban checkpoints. Women faced particular scrutiny from the Taliban. Some of those who made it through the checkpoints said they faced humiliating treatment. Some were separated from loved ones in the chaos of evacuations and had to leave them behind. Many Afghans had already experienced severe forms of trauma before these events, during Afghanistan's decades of war.
As Kabul fell to the Taliban, the French government opened "Operation Apagan" to evacuate more than 3,000 people to safety, including 2,630 Afghans, between August 15 and 26, 2021. Once they arrived in France, evacuees were resettled across France and entered the general asylum application system.
Human Rights Watch interviewed 28 people between November 2021 and January 2022, including 6 Afghan evacuees, as well as psychologists, doctors, humanitarian experts, representatives of nongovernmental organizations, staff of mental health centers, Afghan community leaders, interpreters, and French government officials. The interviews were conducted remotely via video and telephone as well as written exchanges with people in Paris, Lyon, Marseille, Montpellier, and Strasbourg.
Human Rights Watch found that the French government made important efforts to welcome, promptly accommodate, and support Afghan evacuees. Several representatives of nongovernmental and humanitarian organizations working to support asylum seekers consistently observed that the government prioritized asylum claims of Afghan evacuees who came to France after the Taliban takeover. One organization reported that the French asylum agency, Office français de protection des réfugiés et apatrides, organized extra appointments to swiftly evaluate asylum requests. Several evacuees interviewed received a positive response within weeks and were granted long-term stay.
France has expressed a commitment to prioritizing mental health, including by hosting the third Global Mental Health Summit in October 2021. Nonetheless, evacuees still faced significant hurdles in getting psychosocial support, Human Rights Watch found.
For many evacuees, the first days in France were filled with a mixture of relief and exhaustion. One psychologist, who was at Paris Charles de Gaulle Airport when evacuees arrived, told Human Rights Watch that people were still in shock, preoccupied with thoughts of physical survival. As time passed, they began grappling with anxiety, depression, insomnia, nightmares, and sometimes severe psychological distress, including post-traumatic stress.
One man told Human Rights Watch: "I'm in bed [in France] but my mind is in Afghanistan." One woman said: "I love my country; I love my people. But I have a hole in my heart, I can't do anything from here. I was in shock mode, and now I am still in shock mode. I keep forgetting things, I even forget my name." Another woman said: "I was unable to sleep, so they [French volunteers] introduced me to this [psychosocial services] center. First, I wasn't able to say anything, I was just crying. After one month, I came with a smile."
With evacuees scattered across the country, some were able to swiftly access mental health services, while others struggled to find the right support. Asylum seekers are not eligible for full health coverage for their first three months in France, a requirement that was often a major barrier to accessing mental health services. Evacuees sent to remote areas of France found it more difficult to find these services, and remote support by phone or video is rare.
Several psychologists interviewed said that specialized mental health centers in French cities were, in many cases, overwhelmed with the number of people seeking psychosocial support even before the evacuees arrived. One coordinator of a center in Paris told Human Rights Watch that some asylum seekers traveled long distances to get support.
While these centers usually work with a team of qualified and trauma-informed interpreters, some evacuees had counselling sessions with external, non-specialized psychologists and without an interpreter. Interpreters are also exposed to the trauma experienced by evacuees and worry about the well-being of family still in Afghanistan. Social workers working in shelters also experience vicarious trauma and are at risk of burnout.
The right to health, which includes mental health, is recognized in international and European human rights treaties, including the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of Persons with Disabilities (CRPD). France is a party to both treaties. In line with the provisions of these treaties and the principles of the CRPD, the provision of counseling and other mental health services should be equitably distributed throughout the country. France should make mental health support services available immediately to evacuees and other people seeking protection. Whenever a need for mental health support is voiced or identified, including in the asylum process, French authorities should direct people to psychosocial support services, ideally to dedicated centers with expertise in conflict-related trauma, qualified interpreters, and staff with relevant cultural competence and language skills. People seeking protection should be informed of the availability of support services and be able to choose the type of support most appropriate to their needs. They should have the right to withdraw from psychosocial support services at any point.
"People fleeing conflict shouldn't face the added burden of having to wait weeks to be eligible for mental health support and then finding there are no appropriate services in their area," Bull said. "Afghans in France still need more support, and as European countries begin to welcome refugees from the Russia-Ukraine war, lessons from the Afghanistan evacuation in France underline the importance of putting mental health high on the agenda."
