Improving Neurosurgical Care in Afghanistan: Milestones, Challenges, and the Road Ahead.

Abstract

Neurosurgical services remain critically underdeveloped in Afghanistan, where decades of conflict, political instability, sanctions, donor contraction, and workforce migration have compounded the baseline challenges faced by many low- and middle-income countries. Afghanistan has an estimated 124 neurosurgeons, approximately 0.3 neurosurgeons per 100,000 people, concentrated primarily in urban hospitals despite a largely rural population. This historical report and contextual analysis describes recent Afghan-led and internationally supported efforts to strengthen neurosurgical capacity through a structured change-management approach. Major milestones include a national capacity assessment, installation of stable internet and power support at nine hospitals; procurement and distribution of cranial, spinal, and drill sets to public hospitals; short- and long-term training pathways for neurosurgeons and nurses; smart-glasses-enabled telemedicine and intraoperative mentoring; reactivation of the Afghan Neurosurgical Society; national neurosurgical conferences; and diaspora-supported fundraising. Persistent challenges include geographic barriers to care, out-of-pocket costs, limited neurosurgical epidemiologic data, border closures, customs and sanctions-related logistical barriers, restricted travel and visa access, unstable internet connectivity, and gender-related constraints on medical education and professional mobility. The Afghan experience highlights both the fragility and possibility of neurosurgical capacity-building in conflict-affected settings. Locally led partnerships, diaspora engagement, practical infrastructure investments, remote mentorship, and flexible logistics can create meaningful progress even when conventional global health pathways are disrupted.