A devastating magnitude 6.0 earthquake in eastern Afghanistan on August 31 killed more than 2,200 people and injured some 3,600, according to the Taliban authorities.

Nearly half a million were affected by the earthquake in the worst-hit Kunar and Nangarhar provinces, with relief and rescue efforts continuing even after three weeks of the tragedy.

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However, as the local government and aid agencies attempt to provide support to victims in a country largely dependent on international humanitarian support, women remain visibly absent from these efforts.

In 2022, the Taliban government banned women from working in NGOs operating in the country. A year later, it also forbade Afghan women from working with the United Nations and other international NGOs.

While several NGOs were able to negotiate terms allowing some of their female staff to continue working if accompanied by their “mahrams” (male guardians), there are significantly fewer women working as aid workers in Afghanistan today than was the case before the Taliban returned to power, observers say.

The Taliban ban, some of them say, has made it harder for aid agencies operating in Afghanistan to reach women who need support during a disaster, like the recent earthquake. According to the UN, more than half of those killed or injured in the earthquake were women and girls.

Several women in the earthquake-affected areas, however, said male rescue workers did help them, and the Taliban insists it is doing all it can to ensure that all victims receive assistance — irrespective of their gender.

Women overlooked? Mixed stories

On September 7, the World Health Organization (WHO) urged the Taliban authorities to lift their restrictions on female aid workers in Afghanistan in the aftermath of the disaster.

“A very big issue now is the increasing paucity of female staff in these places,” said Mukta Sharma, a representative of the WHO in capital Kabul, at the time. She said nearly 90 percent of the earthquake-affected region’s medical staff were men, and the remaining 10 percent were women who mainly worked as midwives and nurses, and therefore were not trained to tackle severe injuries.

A few female volunteer healthcare workers, who were able to reach the sites affected by the earthquake, corroborated the challenges faced in rescuing women.

Fatema, a volunteer who shared only her first name, told Al Jazeera after returning from Kunar on Friday that the unwillingness of many male volunteers to touch women because of Afghanistan’s strict social code meant that “many women still remain missing due to the neglect”.

“Cultural restrictions can make it harder for women to access support and services, as we have seen with the Afghan women returnees from Iran and Pakistan,” Susan Ferguson, the UN Women’s special representative in Afghanistan, told Al Jazeera in an email interview, referring to thousands of Afghan refugees and migrants expelled by the two countries in recent months.

“In the 2023 Herat earthquake, nearly six out of 10 of those who lost their lives were women, and nearly two-thirds of those injured were women,” Ferguson added. In October 2023, three consecutive earthquakes – all more than magnitude 6 – left large parts of Herat province in ruins, with nearly 1,400 people killed, thousands injured, and several villages flattened.

But many women Al Jazeera spoke to said, after the recent earthquake, they were in fact rescued by male aid workers.

Gulalai, a resident of Aurak Dandila village in Kunar’s Nurgal district, lost all six children and was badly wounded. Her brother-in-law carried her to safety. “I was screaming in pain and waiting to be rescued,” she said.

They were able to signal to a rescue helicopter flying past the area. “It couldn’t land at the location where we were, and they had to carry us to where the helicopter could land. The rescue team came. They cleaned my wounds, patched my injuries, and evacuated me,” said Gulalai, who gave only her first name.

Taliban officials also told Al Jazeera they were committed to ensuring that women are properly treated by male health workers if necessary.

Najibullah Haqqani, Kunar’s provincial director for the Ministry of Information and Culture, said the Afghan military and volunteers “evacuated and cared for everyone”.

“On the second day, UNICEF set up a medical clinic in [Kunar’s] Nurgal district, and they had female doctors as well. We took as many injured people as the clinic could handle there, and they were treating everyone, male and female. In any emergency situation, there is no gender-based discrimination; any doctor available will treat any patients coming in. The priority is saving lives,” he said.

Unhygienic conditions

Still, say female volunteers and leaders of global nonprofits, women and girls who survived the earthquake continue to struggle as they battle injuries and difficult conditions in relief camps.

According to a UN-led assessment on September 16, more than 7,700 families displaced by the earthquake were still sheltering in open spaces in two main locations in Nurgal district.

There are no gendered toilets — a problem for men and women. But for women, social barriers mean that sharing toilet spaces with men is particularly challenging.

“They often wait until late at night or early in the morning to use the toilets in the camps,” said Ruhila Mateen, a spokeswoman for Aseel, an Afghan organisation facilitating emergency aid, adding that the organisation was focusing on building more toilets for women in the area.

“Women survivors have also reported experiencing fever, diarrhoea, bellyaches, kidney and stomach pain due to unhygienic conditions [in the camps],” Mateen added.

Shortage of female medical staff

A shortage of female personnel has also affected the emergency and healthcare services that women could have received.

While women are still allowed to work in Afghanistan’s medical sector, many female medical professionals have left the country since the Taliban’s takeover. Some of those who have stayed back say the group’s policies have made it harder for them to work because of restrictions on their movements. Women in many parts of Afghanistan are forbidden from travelling by themselves, requiring a mahram to move around publicly.

The Taliban’s ban on women’s higher education has also stopped many of them from continuing their medical education. Since the ban, there have been no new female medical graduates in Afghanistan.

Pregnant women are particularly vulnerable in the aftermath of calamities like the recent earthquake, said Pashtana Durrani, founder of Learn Afghanistan, an NGO that trains midwives and nurses, defying the Taliban’s ban on women’s education.

“Women who are pregnant are not able to seek medical attention at all,” she told Al Jazeera. The conservative nature of Afghan society means women are either uncomfortable or not allowed to interact with male doctors on issues of maternal and reproductive health.

Durrani’s team of five female medical workers went to three districts in Nangarhar with medical equipment, including ultrasound machines, after the earthquake. While they were able to treat some pregnant women, there remains an urgent need to reach more than 11,600 pregnant women affected by the quake, the UNFPA said in a report earlier this month.

Afghanistan has one of the highest maternal mortality rates in the South Asian region. As of 2023, the country recorded 521 maternal deaths per 100,000 live births, many times the regional average of 120, according to the World Bank.

Some openness

Ferguson of UN Women said female humanitarians were vital to overcoming gender barriers in times of crisis, like the aftermath of earthquakes. “Without them, too many women and girls will miss out on life-saving assistance,” she said. “It is essential that women are delivering assistance to women and girls.”

Mateen of Aseel NGO said life-saving assistance for women needed to be accompanied by the necessary professionals and infrastructure to administer it.

“Sending medicines without doctors to deliver them or sending hygiene kits for women without providing access to toilets is not of much use,” she said.

Durrani of Learn Afghanistan, however, said there was growing acceptance of aid workers working with women.

“Yes, these are conservative communities, but at the same time, they have been very open to receiving help and support,” she said. “A lot of local people have reached out to us and have supported us and helped us a lot. So I think all of that counts.”

(Additional reporting by Sorin Furcoi from Kunar and Nangarhar provinces, Afghanistan)