Sage Journals: Discover world-class research

Abstract

Afghan refugee women in the United States are facing mental health challenges due to COVID-19 and the 2021 Taliban takeover. Given the key role of formal support in refugees’ mental health, in this study we examined the effectiveness, barriers, and facilitators of formal support from governmental and nongovernmental organizations (NGOs) by interviewing 34 Afghan refugee women and 18 refugee service providers in California. Results indicated sufficient formal support was received by women in areas like food/grocery assistance, COVID-related programs, financial aid, and referral services. However, gaps were identified in areas like support for empowerment (e.g., literacy support), support for social integration (e.g., community centers), stress mitigation and coping support (e.g., domestic violence programs), informational support (e.g., informational workshops) and instrumental support (e.g., occupational skills training). Although barriers like inefficient policies, cultural and language barriers, patriarchal norms, and limited funding negatively impact the effectiveness of formal support to women, facilitators such as increased political attention, contributions of religious communities, and strengthened NGO relationships with local providers could enhance these services. We concluded that while Afghan women's immediate needs were relatively addressed, long-term, culturally competent approaches are required for their integration and well-being, suggesting NGOs focus on cultural competence, communication, capacity building, sustainability, and collaboration.

Keywords

formal social support nongovernmental organizations Afghan refugee women COVID-19 pandemic 2021 Taliban takeover

The number of forcibly displaced people worldwide reached a record high in mid-2024, with over 122 million people forced to leave their homes. Of these, 46 million are officially recognized as refugees or asylum seekers.¹ Millions of these refugees come from Middle Eastern countries like Syria, Afghanistan, and Iraq, where prolonged conflicts and political instability–often linked to U.S. military interventions–have forced many to flee their homes.² Afghan refugees represent one of the largest refugee populations, with over six million globally, many fleeing decades of conflict, systemic persecution, and poverty. Following two decades of U.S. military intervention in Afghanistan, which began in 2001 after the 9/11 attacks with the goal of combating terrorism and stabilizing the region but ultimately led to greater sociopolitical instability, the United States has become a major resettlement destination for Afghan refugees, now hosting nearly 300,000 individuals.³ Over the past two decades, thousands of Afghan allies, such as translators and contractors, were granted Special Immigrant Visas (SIVs) for their support of U.S. operations. The sudden withdrawal of U.S. forces in 2021 and the rapid Taliban takeover prompted a large-scale evacuation, leading to the resettlement of over 76,000 Afghans in the United States under Operation Allies Welcome.⁴

Refugee women, making up nearly half of the global refugee population, face significant challenges during displacement. They are highly vulnerable to gender-based violence, including harassment, trafficking, and domestic abuse. Limited access to health care, economic dependency, and caregiving responsibilities restrict their opportunities for education and work. Additionally, separation from family and cultural and language barriers contribute to social isolation, further hindering their integration into host communities.⁵ In addition to these challenges, Afghan refugee women in the United States have faced deep-rooted gender inequalities and systemic oppression in their home country. Many have endured decades of violence, limited access to education and work, and cultural pressures to maintain traditional roles, which often conflict with norms in their host countries like the United States. Afghan refugee women bear a significant caregiving burden, with little support or resources due to patriarchal culture in Afghanistan, which further limits their ability to work or pursue education.⁶ The trauma of the Taliban takeover in 2021, family separation, and loss of safety have further intensified their vulnerabilities. These challenges place Afghan refugee women at a heightened risk of developing mental health disorders, including PTSD, anxiety, and depression.

The challenges of Afghan women cannot be fully understood without acknowledging the larger historical and geopolitical forces that have shaped their trajectories. Afghanistan has experienced decades of external intervention and internal conflict, with U.S. foreign policy playing a critical role. The Taliban, who ruled Afghanistan from the mid-1990’s until 2001 and resumed control in 2021, were initially empowered in part by U.S. geopolitical strategies during the Cold War, particularly in the context of the Soviet–Afghan war.⁷ In the aftermath of the 2001 U.S.-led invasion, the American presence in Afghanistan–intended to dismantle terrorist networks and promote democratic governance–resulted in prolonged occupation, sociopolitical instability, and civilian displacement.⁸ The sudden U.S. military withdrawal in August 2021 contributed to the rapid collapse of Afghan national institutions and the return of Taliban rule, triggering a mass exodus, especially among women and minority groups who feared persecution.⁹ As of 2024, Afghanistan ranks among the largest sources of refugees globally largely due to decades of warfare, economic instability, and regime changes.¹⁰ U.S. policies have thus played a dual role–first as a contributor to the destabilization of Afghan civil society and subsequently as a provider of humanitarian aid and refugee resettlement.¹¹ This duality is essential to understanding the complexity of U.S. and nongovernmental organization (NGO) support to Afghan refugees within a humanitarian framework.

Social support as a resource provided by individuals’ environments that helps them cope with stressful conditions and day-to-day problems could help Afghan refugee women by alleviating their anxiety, reducing PTSD symptoms, and enhancing their recovery after trauma.¹² Social support for refugees can come in various forms–emotional, informational, and instrumental–from both formal sources like government and NGOs, and informal sources like family and friends.¹³ Due to prolonged disruptions in social networks, refugees often lack informal social support, making formal support from government and NGOs key for their well-being. Formal support can provide crucial resources like counseling, health care, and community programs for Afghan refugee women. These services, typically delivered through partnerships between federal and state agencies and NGOs in the United States, could help ease the compounded trauma of displacement, family separation, and systemic oppression while addressing the void left by disrupted informal support networks.¹⁴ However, Afghan women's ability to benefit from the formal support provided by the U.S. government and NGOs has been met with challenges from multiple sides.

From the refugees’ perspective, Afghan women in the United States encounter significant obstacles in accessing mental health-focused formal support due to cultural, structural, and systemic barriers. The stigma around mental health within Afghan communities often discourages women from seeking care, while language barriers and a lack of culturally competent services further hinder access.¹⁵ From the government and NGOs’ perspective, many providers and resettlement agencies are not adequately trained to address the unique sociocultural traits and trauma experienced by Afghan refugee women, which can result in mistrust and limited engagement with available services.¹⁶ Fragmented coordination among support systems and insufficient funding exacerbate these challenges, leaving many Afghan women without the care they need.¹⁷ Moreover, the limited budget of the Office of Refugee Resettlement (ORR) and political influences, especially during the Trump administration, have further strained these services.¹⁸

Policy changes like prioritizing gender-sensitive and culturally tailored approaches to mental health care have been suggested by previous studies to address these issues. One suggestion was to offer comprehensive training for providers on reflective listening, cultural sensitivity, and the refugee experience to build trust and improve patient outcomes. Establishing community-based support networks and enhancing collaboration between resettlement organizations can help bridge gaps in service delivery.¹⁹ Additionally, increasing funding for mental health programs and implementing policy reforms to improve the accessibility and affordability of culturally appropriate services were found critical. To enhance Afghan refugee women's access to formal support and promote culturally competent policies and training, it is essential to understand available resources, the barriers and facilitators influencing access, and the impact of support on their mental health.

Therefore, in this study, we explored how formal support provided by the U.S. government and NGOs to Afghan refugee women addressed the intensified challenges faced by them during the COVID-19 pandemic and the 2021 Taliban takeover. By analyzing interviews with Afghan refugee women and their service providers, we explored two research questions: a) What resources have been provided to Afghan refugee women by the U.S. government (USG) and NGOs during COVID-19 and the Taliban takeover? and b) What social, cultural, and policy barriers and facilitators affected the effectiveness of USG and NGO services to Afghan refugee women?

Methods

We collected data from U.S. Afghan refugee women and their service providers through a qualitative approach. The University of South Carolina's institutional review board reviewed this study plan under 45 CFR 46.104(d)(2) and 45 CFR 46.111(a)(7) and determined it to be exempt from human research subject regulations (Pro00121005; 5/16/2022). Informed consent was obtained from all participants included in the study. Participants’ confidentiality was protected using arbitrary identification numbers, and interview recordings were erased after the study.

Participants and Recruitment

Participants were recruited from California, where more than 40% of Afghan immigrants live and over 20 private organizations offer refugee resettlement services.²⁰ Participants, including Afghan refugee women and refugee service providers, were recruited using purposive and snowball sampling. In purposive sampling, participants were recruited based on diverse demographics from the first author's network and supporting service organizations. In the next stage, participants were recruited through snowball sampling by asking existing participants if they knew others interested in the research.

Afghan Refugee Women

We recruited Afghan refugee women, both newly resettled during the pandemic and those who have been in the United States for some time. Eligible Afghan refugee women were those residing in the United States legally, aged 18 to 80, speaking Dari, English, or Pashto, having family in Afghanistan, and willing to participate in a one-hour online or in-person interview.

Refugee Service Providers

Eligible service providers were over age 18 with at least one year of experience in U.S. refugee services and six months of experience with Afghan refugee women. Providers were recruited from agencies providing essential services to Afghan refugee women, including emergency assistance, resettlement support, housing assistance, health care access, employment services, education programs, and mental health counseling to help them rebuild their lives and integrate into their new communities. The principle of information power was followed to ensure a sample size that provides comprehensive and valuable insights.²¹ Data saturation was reached by interviewing 34 Afghan refugee women and 18 service providers.

Demographics

The participants’ demographics in this study are shown in Tables 1 and 2.

Table 1.
Demographics of Afghan Refugee Women (n = 34).

Age Number Percent

18–35 21 61.8

36–50 8 23.4

51–65 4 11.8

> 65 1 3

Occupation

Unemployed 26 76.5

Employed 8 23.5

Marital status

Married 22 64.7

Single 4 11.8

Divorced/Widow 8 23.5

No. of Children

0 6 17.6

1–2 12 35.3

3–4 14 41.2

>4 2 5.9

English proficiency

None 20 58.8

Low 8 23.5

Satisfactory 6 17.7

Education

Elementary and less 8 23.5

Diploma 15 44.1

Associate/Bachelor 10 29.4

Master and above 1 3

Time of Arrival

Before 1/2020 18 53

After 1/2020 16 47

Immigration Status

Special Immigrant Visa 16 47.1

Citizen 2 5.9

Refugee 8 23.5

Asylum 6 17.6

Parole 2 5.9

Table 2.
Demographics of Refugee Service Providers (n = 18).

Age Number Percent

18–35 4 22.2

36–50 10 55.6

51–65 4 22.2

> 65 0 0

Occupation

Caseworker 8 44.4

Counselor/Therapist 4 22.2

Coordinator/Manager 6 33.4

Gender

Male 4 22.2

Female 14 77.8

Education

Diploma 0 0

Bachelor 8 44.4

Master 7 38.9

MD/PhD 3 16.7

The demographics of Afghan refugee women in this study reflect the broader Afghan refugee community in the United States. Our participants’ median age of 35.7 years aligns with the 33-year median for U.S. Afghan immigrants.²⁰ However, their employment rate of 23.5 percent is lower than the 48.7 percent of Californian Afghan refugees, possibly due to gender employment disparities among Afghans.²² Most participants (64.7%) were married with 1 to 4 children, like the average Afghan refugee household in the United States, with 4.7 members.²² English proficiency was 41.2 percent among our participants, aligning with the 40.8 percent rate among Afghan refugees.²² Our participants showed slightly higher education attainment (32.4%) compared to the broader population (25.8%; 22). Notably, 47 percent of our participants arrived after the 2021 Taliban takeover, indicating recent migration patterns.²³

Data Collection

Data collection, conducted from August 2022 to July 2023, involved online and in-person semi-structured interviews with researcher-developed and demographic questions. The first author conducted interviews in Dari, Pashto, or English, based on participants’ preferences, with verbal consent obtained beforehand. Interviews were audio-recorded, transcribed verbatim, and translated into English by the first author. Each Afghan refugee woman received a $50 gift card for participating in the interview.

Data Analysis

Data analysis was conducted as early as the first interview using Braun and Clarke's thematic framework to identify themes, coding, and theme development.²⁴ Guided by grounded theory-driven thematic analysis, we critically reviewed interview transcripts to determine the right coding and the formation of themes.²⁵ Using MAXQDA (version 12, VERBI GmbH, Germany), key themes related to the research questions emerged through systematic coding (i.e., initial coding, pattern recognition, theme development, review, and refinement) and were structured into a thematic map. Regular transcript and summary table reviews ensured both across-case and within-case perspectives.²⁶ To minimize bias, input from multiple Afghan informants was included in finalizing the thematic map. The first author, a public health PhD candidate fluent in Farsi/Dari with experience serving Afghan refugee women, used rigorous methods like reflection, openness to different views, and peer consultations to minimize bias.

Results

The United States supports refugees’ transition with financial aid, health care, employment, and community services, often via NGOs. Interviews showed Afghan refugee women received mixed support during COVID-19 and the Taliban takeover (i.e., some services met needs and others fell short).

Effective Support Services

Food/Grocery Support

Afghan refugee women received food support via food stamps and grocery deliveries from NGOs, which also provided food, clothing, kitchen tools, and gift cards for emergencies. Afghan refugee woman #21 stated, “When we were staying at the hotel, they gave us food stamp cards to buy bread and food . . . . Their support was great.” Another woman (#4) shared, “When we came to the U.S., we had no support or income. They gave us everything we needed like food cards, grocery items, and clothes. I was very stressed because of sudden exit from Afghanistan. However, when I saw the unconditional help here, I felt safe and relieved.”

COVID-Related Programs

During the pandemic, NGOs offered COVID-related programs for Afghan refugee women, including contact tracing, isolation guidance, medical resources, vaccination access, food, health workshops, and monitoring services. Provider #11 said, “We organized contract tracing groups, offered isolation guidance, and linked Afghan women to medical care. Moreover, we provided them with preventive health workshops.”

Financial Support

Refugee women received financial support through Refugee Cash Assistance, Medicare, interest-free car loans for Muslims, food stamps, utility bill payments, and rent assistance. Much of this financial support was made available through federal programs such as Refugee Cash Assistance, administered by ORR in collaboration with local NGOs. In interviews, they expressed gratitude for the government's aid. Refugee woman #31 shared, “We received the government's financial support right after we arrived here. The unemployment compensation during the pandemic helped us a lot . . . . Without this money, I had no idea how to live. It has significantly eased my stress.”

Referral Services

Referral services by NGOs provided Afghan women with rental assistance, donations, mental health support, and language learning, easing Afghan women's access to partner organizations and improving their well-being. Provider #14 said, “We connected them with other organizations or partners for rental assistance, donations, and mental health services.” Woman #15 shared, “When we had any issues, we called them, and they told us where to go. I had depression and they referred me to a counselor that made my depression much better.”

Support Services with Gaps

The interviews identified five main support areas requiring enhancement, including support for empowerment, support for community building, coping support, informational support, and instrumental support.

Support for Empowerment

Literacy

Afghan women expressed the need for support on financial literacy, as many women noted unfamiliarity with fundamental financial tools like credit cards. Refugee woman #14 said, “I do not know what these credit cards and stuff are. Most women do not know what they are.” NGOs provided financial education and banking information, but their support was insufficient. Service providers emphasized the importance of education in promoting practical understanding, employment, and financial independence for Afghan women. Provider #4 said, “We need to teach economics to Afghan women so that they can have economic perspectives and get to improve their status.”

Interviews revealed a need for health literacy programs to teach Afghan refugee women self-care practices, medical attention, and therapeutic communication. Provider #1 shared, “The thing which is so important in working with Afghans is to teach them what therapy is. For example, many of them are unaware of the therapeutic benefits of simply talking. We need to teach them.”

Educational/English Support

Interviewees emphasized the need for educational and English language support for Afghan women's integration. NGOs provided tailored English courses, crucial for communication, understanding documents, job seeking, and accessing emergency services, yet participants called for long-term programs balancing learning with daily tasks. Provider #8 stated, “The English skills of Afghan women are low. While we provided them with two English programs, I believe they were inadequate. I did not observe any significant changes. It may be because their engagement in these programs was not high. Many of them had issues with online classes or were busy with their children.”

Getting a Driver's License

Interviews emphasized driver's licenses as key to Afghan women's mobility, finances, social life, and stress relief, with some programs providing female-led instruction. Provider #11 shared, “Another thing is driving so that these women can at least take their children to different places and help solve some of the problems of the family. They need to drive, so they have more job opportunities and can be involved in social activities.”

Job and Technological Skills Development Programs

Some NGOs offered workshops in jewelry making, sewing, and cooking, but many Afghan women lacked job skills. Programs could offer certifications and support, turning talents into viable careers. Provider #11 said, “We had classes for Afghan women on how to apply for a job. However, due to the pandemic restrictions on in-person classes, we could not hold classes to teach them some real skills so that they could earn money with them.” Refugee woman #19 said, “NGOs should help women to get a job to do at home. They need to support them by getting them a sewing machine so that they could work at home.” Developing these programs often requires coordinated planning and funding from both government agencies and nonprofit organizations. The quarantine underscored the need for NGOs to enhance refugee women's technological skills for better access to health care and jobs. Provider #12 said, “I know many Afghan refugee women who were pregnant but missed their appointments or calls with the doctor since they even did not know the basics of technology.” Refugee woman #3 said, “We had a few classes on skills like making a call or logging into the computer. But I never learned how to work with Zoom or connect to online classes for my kids.”

Support for Community Building

Community Centers/Social Gathering Spaces

Interviewees stressed the need for community centers, group counseling, and social activities to help Afghan refugee women connect, share, and reduce isolation, especially during crises. Afghan woman #12 said, “There should be a place where we could meet other people and have a chat. We could learn about others’ problems and tell them about our problems.” Provider #3 expressed, “During the pandemic, there was a virtual mechanism that we used where people were seeing each other, talking with each other, tracking each other, and eating with each other.”

Family Sponsor Programs

Providers noted a lack of programs offering volunteer support from community members or families to guide refugees through their transition. Provider #11 shared, “I think having some kind of sponsor or like a community member is going to help the newcomer families. They would have someone that they can call and ask for guidance.”

Coping Support

Domestic/Sexual Violence Programs

Interviews revealed widespread domestic and sexual violence among Afghan refugee women post-2021, worsened by cultural stigma and fear of shaming. Provider #2 said, “There are a lot of cases of domestic violence in the military camp they took Afghans to.” NGOs tried to address this issue with counseling in military camps, discreet support groups, and safe, coded communication for virtual meetings.

Anti-Suicide Programs

Rising suicides among Afghan refugee women post-2021 underscore the urgent need for mental health support and crisis intervention. Refugee woman #21 said, “Many have [committed] suicide. They might have been depressed. There was a woman who jumped off the camp rooftop when I was there.”

Mentorship Programs

Interviewees stressed the need for mentorship programs to support Afghan refugee women in coping, stress management, and cultural adaptation. Provider #16 said, “We should have programs on how to lower women's stress, how they could deal with their problems here, and how to get to understand the difference between living in Europe, Asia, and America.”

Informational Support

Informational Workshops

NGOs offered workshops on COVID-19, stress, parenting, and skills training, yet many newcomers remained unaware of services and struggled with basic tasks. A newcomer refugee (#15) shared, “We had to apply for the housing programs and other governmental services on different websites. However, we did not know how to do it.”

Informing Women About Their Rights

The interviews revealed a poor knowledge about refugee rights and legal challenges, including specific cultural and legal information upon arrival. Provider #8 said, “The women who participate in these programs do not know enough about their rights. Some women, for example, think they should do nothing when their husbands harass them because there is no one to defend them. They should be taught about their rights.”

Instrumental Support

Housing Support

Housing support was vital in preventing homelessness for Afghan refugee women, but system navigation remained challenging, highlighting the need for better aid. Provider #4 said, “We provided Afghan refugees with temporary housing and rental assistance, yet some families faced denial because of the program's limitations.”

Childcare Support/Parental Programs

Interviews suggested the need for tailored childcare and parenting programs to educate mothers on child nutrition, adaptability to local diets, parenting within American norms, and managing children's screen time, especially during the pandemic. Provider #18 said, “They need to know how to take care of their children, how to buy different ingredients and food, or how to feed their children. They need guidance on raising children in this new society.” NGO support often includes virtual parenting groups, child behavior workshops, and information resources.

Benefits Application Support

Maximizing access to benefits is crucial for refugees to secure loans, housing, and family reunification. While some women accessed COVID-19 loans, many faced frustrations and obstacles in getting responses or aid. Refugee provider #24 shared, “I filled out forms for housing and disability a couple of times. But I received no response, and they told me to fill them out again.”

Family Reunion Services

Interviewees stressed the need for clear guidance on family reunification, highlighting NGOs’ vital role in providing reliable information and support for family reunification. Provider #16 said, “We were all on our computers receiving requests from Afghans who wanted us to bring their families to the U.S.”

Challenges and Barriers to Support

Inefficient policies have been a significant barrier to NGOs and government support for Afghan women in the United States. Providers highlighted inadequate long-term support and integration planning, criticizing rapid refugee admissions that strained resources and left gaps in aid. Provider #12 said, “I think the policies that politicians have made are full of drawbacks. They open the borders when they do not have any plans for this population.”

Ineffective moderation of cooperation between government, civil society, and refugees by NGOs hindered effective support for refugees. Despite tracking integration efforts, NGOs struggled to ensure programs were inclusive and equitable. Refugee woman #4 said, “I appreciate the NGO's efforts, but at times, it feels like some of their programs are not designed with all of us in mind. Sometimes, there is a gap between what they offer and what we truly need.”

The limited duration of programs has hindered support for Afghan refugee women, with many finding short-term housing, food, and social support insufficient for stability and self-sufficiency. Interviewees stressed the need for extended support, especially for trauma survivors and single mothers, to aid their transition. Refugee woman #12 said, “It is too short and not long enough to let us stand on our own feet. They provide us with housing support for only six months.”

Delays in services have been another barrier to NGO/government support. Long waits for essentials, cumbersome EBT card processes, and delayed government aid have caused dissatisfaction and anxiety among refugees. Provider #2 said, “We were held up for hours only for applying for an EBT card. Both we and our clients were caught long on this case.”

Limited awareness of support programs has been a barrier, leading to missed opportunities and unresolved challenges, highlighting the need for better communication and outreach to inform Afghan refugee women about available resources.

COVID-19 restrictions and increased workloads strained NGOs and government agencies, reducing service quality and accessibility. The shift to online services and limited in-person support delayed aid, health care, and communication, worsening access for Afghan refugee women. Provider #4 stated, “Everything was online in NGOs, and our lines were mostly busy. The clients referred to us so often while we guided them to another office.”

Unfamiliarity with virtual programs and tech illiteracy have presented another barrier to support during the pandemic. Virtual programs were convenient but lacked in-person interaction, reducing support quality and hindering refugee engagement. Refugee woman #18 said, “If we were in a classroom together, maybe we could joke around and know each other more, but on Zoom, it was pretty hard to do that.” Provider #15 shared, “I tried to work on coping strategies with my clients through some apps, but I found it is very hard for them to work with phones and apps.”

Language barriers and poor communication hindered Afghan refugee women from accessing NGO support, especially during the pandemic. Language barriers, shyness, and lack of communication channels frustrated refugee women seeking services. Refugee woman #21 said, “In the pandemic, talking on the phone with those who had called us for an appointment, county or any organization, took up a great deal of time from us. This caused us to get disappointed and think that it would not work.”

Patriarchal norms restricted Afghan refugee women's mobility, education, and work, with husbands controlling their access to NGO support. Provider #8 shared, “Despite that they are living in the U.S., their husbands overthink about them and do not let them work.”

Religious beliefs hindered NGO support due to varied cultural practices. NGOs need to understand and accommodate these differences to provide culturally competent services. Provider #9 shared, “We had a recent event for Afghan refugees. Some were in favor of music while some were against playing music.”

Low-quality NGO services undermined support for Afghan women, as some prioritized funding over aid delivery, leading to negligence and minimal assistance. This fueled mistrust and dissatisfaction among Afghan women, highlighting the need for greater accountability and quality control. Refugee woman #12 said, “While an organization received a lot of donations in the name of Afghan people, it did not give us anything.”

Program mismatches with participants’ demographics negatively affected NGO support for Afghan women, as many services focused on married mothers, leaving single women and others underserved. Cultural, educational, and childcare incompatibilities further limited accessibility. Refugee woman #12 shared, “Many of these programs are not inclusive for all Afghan women. They often consider an Afghan woman who is married caring for multiple children at home.”

The gap between refugee expectations and NGO services, driven by short support durations, high U.S. living costs, and comparisons to Europe, led to disappointment and feelings of being underserved or exploited among Afghan women. Refugee woman #27 shared, “Sometimes a program does not fulfill our expectations. It may be due to unreasonable expectations of us or a lack of good work from the NGO's staff.” Refugee woman #32 shared, “Many of us came to the U.S. as our men helped U.S. soldiers in Afghanistan. We hoped to find opportunities to rebuild our lives here. However, the services and help we received here was far from our imagination. My sister is in Germany. Her family receives much better support compared to us.”

Bureaucratic complexity and extensive documentation hinder Afghan women from accessing essential aid, especially those unfamiliar with English and technology. Provider #17 said, “All these programs are very complicated and based on many documents. Applying to these programs requires communication and technological skills often Afghan women do not have. They are even hard for well-educated Afghans.”

An overwhelming number of refugees during the pandemic and post-Taliban takeover exhausted NGOs personnel, hindering effective support and leading to delays and less effective assistance. Provider #16 shared, “The number of clients is too big for the personnel, and I could not take care of all these clients alone.”

Mental health stigma hindered Afghan refugee women from accessing NGO services, as cultural perceptions labeled seeking help as a sign of being “crazy,” fostering distrust. Provider #4 shared, “Some Afghans sometimes find it so hard to attend counseling sessions. These sessions kind of bring them a stigma.”

Western stress-management methods often do not align with Afghan refugees’ needs, making NGO health services less effective. Cultural differences mean approaches like yoga may seem irrelevant, as Afghan women often prioritize family support and community networks for coping. Provider #14 stated, “I mean the strategies you propose, like yoga and the like, would not work and seem ridiculous for Afghan refugee women and thus turn out to be useless.”

Limited funding and resources restricted NGOs from providing comprehensive support to Afghan refugee women, leading to service gaps in case management, housing, medical care, and legal assistance. Provider #13 said, “I think a lot of programs just did not start because there were not enough people or money to start them.”

The urgency to be independent by securing housing and employment forces Afghan women into hasty decisions, leaving little room for education or financial planning and increasing their vulnerability. Provider #5 said, “Pretty much they are told like: okay, you have space to live for one month. You have to find another place to live really fast and soon. Go find a place to live.”

The limited recognition of Afghan degrees in the United States hindered refugee women's access to employment and education services. Skilled professionals, like doctors and engineers, often had to requalify or start over, delaying work and affecting their identity and self-worth. Refugee woman #32 said, “I personally had earned a bachelor's in Afghanistan. However, they did not accept my degree. I started my education here from scratch and ended in college.”

Frequent scams targeting refugees have created considerable mistrust in government and NGO support systems, compromising the effectiveness of their assistance. Misunderstandings about the legitimacy of calls and threats, particularly regarding sensitive information like social security numbers, have led to this mistrust. Provider #7 shared, “These scams and calls made the refugees very concerned about giving their information to NGOs and support providers required for applications.”

Lack of support within the Afghan community also presented a barrier to effective NGO and government support for Afghan refugee women. Despite religious and cultural gatherings, there is a noted absence of mutual assistance in times of crisis, leading to isolation and increased difficulty in overcoming challenges among Afghan refugees. Refugee woman #23 said, “Afghans never support each other. Everyone just would rather take themselves out of crisis and care about themselves first.”

Facilitators of Support

Political attention following the 2021 Taliban takeover led to enhanced NGO and government support for Afghan refugee women, resulting in stronger aid for newcomers, including expanded assistance for families and improvements in essential services like food stamps. Refugee woman #31 shared, “After the Taliban takeover, their help and support grew a lot.”

Increased staffing and funding would strengthen NGO and government support for Afghan women, ensuring timely outreach, efficient responses, and comprehensive services like housing. Post-Taliban takeover, more case management and resources improved services, highlighting the impact of adequate funding on program expansion and efficiency. Provider #17 said, “Our NGO could have better services if we had enough workers or case managers so that they can reach out to the clients on time and respond to their questions.”

The contribution of religious communities in NGO programs facilitated their support for Afghan women. In collaboration with NGOs, these communities could provide Afghan refugees with food, rent, and necessities, along with cultural and spiritual support, fostering a sense of community and belonging. Provider #4 said, “Masjed Association could help clients with food, rent, and spiritual support.”

NGOs’ relationship with American employers, financial institutions, and landlords is a crucial facilitator for NGO support. By establishing these connections, NGOs can directly assist refugees in securing employment and housing, avoiding the challenges of navigating job and housing markets independently. Provider 2 said, “If NGOs build a strong relationship with big providers of jobs and housing when these refugees come, you do not have to send them to Indeed or The Guinness to find the job or housing.”

Utilizing peer support was a facilitator for NGO support, especially in addressing domestic violence. Training Dari/Pashto-speaking women as peer counselors in some NGOs bridged language and cultural gaps, ensuring victims receive understanding and effective assistance. Provider #11 shared, “We trained Dari/Pashto-speaking women to become peer counselors since the women who were exposed to domestic violence could not communicate properly with providers and centers which were assigned. This program was successful.”

Developing trust in the refugee-provider relationship enhances NGO support for Afghan women, encouraging them to share issues, including sensitive matters, and ensuring they receive needed guidance and support. Refugee #31 stated, “There are problems you cannot talk about with anyone. I only could talk about my sexual assault openly with my counselor in that NGO and ask for help.”

In-person services could significantly enhance the ability of providers to understand the unique needs of Afghan women. Face-to-face interactions allow for direct observation and interaction that can lead to better-targeted assistance, especially in areas like social networking and psychological support. Provider #6 said, “If somebody comes in person, we can easily support them, but through phone calls, it is impossible to find out what problems the person is struggling with.”

Discussion

This study examines the formal support system for Afghan refugee women in the United States, focusing on its effectiveness during COVID-19 and the 2021 Taliban takeover. Through interviews with refugees and service providers, we identified effective services, gaps, challenges, and factors influencing service success.

Refugee vs. Provider Perspectives on U.S. Support Systems

To assess U.S. support systems, it is crucial to consider both refugee and provider perspectives. Providers create programs, but refugees experience them firsthand and may face unseen challenges. Comparing their views helps improve services to meet the actual needs of refugees. Table 3 summarizes these perspectives.

Table 3.
Refugee vs. Provider Perspective on U.S. Support Systems.

Dimension of Support Refugee Perspective Provider Perspective

Food/Grocery Support Satisfied with food stamps, grocery deliveries, and emergency support. Recognized its importance in refugee stability and suggested considering culturally specific food aid.

COVID-19 Programs Benefited from contact tracing, vaccination access, and health workshops. Organized COVID-related programs but faced outreach challenges due to staffing shortages.

Financial Support Relied heavily on cash assistance, rent aid, and unemployment benefits for stability. Acknowledged short-term relief but emphasized the need for long-term solutions.

Referral Services Found referrals helpful in accessing mental health services and rental aid. Facilitated connections but noted barriers like stigma in seeking mental health support.

Literacy Struggled with credit card usage and lacked knowledge of medical self-care. Emphasized need for financial and health education to increase independence.

Educational/English Support Needed more long-term language support; online classes were ineffective. Provided language courses but struggled with low participation and engagement of refugees.

Getting a Driver's License Felt limited without a license, affecting mobility and employment opportunities. Stressed mobility as key for independence; advocated for more driving programs.

Job and Technological Skills Development Lacked job training and certifications; desired home-based work opportunities; tech illiteracy Offered some workshops but lacked resources for in-depth training or certification.

Community Centers and Social Gatherings Desired community spaces for connection, mental health, and reducing isolation. Created virtual programs but found them inadequate for meaningful connections.

Family Sponsor Programs Needed structured volunteer-led guidance for resettlement and integration. Identified a need for structured mentorship from community volunteers.

Domestic/Sexual Violence Programs Experienced some level of abuse but feared reporting incidents. Noted abuse cases; set up discreet support groups and virtual meetings.

Anti-Suicide Programs Worried about increasing suicide due to stress, isolation, and trauma. Recognized the high rate; emphasized the need for intervention and counseling services.

Mentorship Programs Needed mentorship to navigate cultural differences and stress management. Advocated for structured programs on stress management and cultural adaptation.

Informational Workshops Unaware of available resources and struggled with application processes. Held informational workshops but saw gaps in outreach and attendance.

Legal Rights Awareness Had limited knowledge of rights, especially regarding domestic abuse. Stressed importance of educating women on their rights to prevent exploitation.

Housing Support Struggled with securing long-term housing support and system navigation. Provided temporary housing but noted limited availability and long-term challenges.

Childcare/Parental Programs Needed guidance on childcare practices and adapting to American norms. Offered parenting workshops but found low participation due to busy schedules.

Benefits Application Support Frustrated with delays in receiving aid and navigating applications. Faced bureaucratic delays and complex application processes, frustrating applicants.

Family Reunification Overwhelmed by complex immigration policies and slow reunification processes. Worked on reunification but struggled with restrictive policies and legal hurdles.

How to Enhance U.S. Support Systems

Our findings show that U.S. refugee support has both strengths and gaps. Effective services like food aid during COVID-19 have met Afghan refugee women's basic needs and they reported little food insecurity. However, broader studies suggest that Afghan refugees may face food access challenges coming from unfamiliarity with local food, limited halal options, store access issues, financial struggles, and language barriers.^27,28 Suggestion: Enhancing food options, especially halal foods, fostering cooperation between community helpers and resettlement agencies, and maintaining public benefits access is crucial to improving food insecurity among Afghan refugees.^27,28

Our findings suggest that during the COVID-19 pandemic and the 2021 Taliban takeover, U.S. refugee support systems fell short of supporting Afghan women in terms of financial literacy. Financial literacy empowers Afghan refugee women to navigate the U.S. economy, overcome barriers, and achieve self-reliance through better money management and informed financial decisions.²⁹ It helps them avoid exploitation, build assets, and plan for a stable future, supporting their economic empowerment and integration.³⁰ Suggestion: NGOs can support Afghan refugee women by providing financial literacy programs on banking, credit, and budgeting, especially in their first year of resettlement. Culturally competent programs involving male family members can ease the transition and reduce stress.

According to our findings, Afghan refugee women need childcare support due to cultural norms and large families. During the pandemic and Taliban takeover, NGOs provided online parenting groups and daycare training, but language barriers and complex U.S. childcare systems made these programs inadequate.³¹ Suggestion: NGOs can help by educating refugee families on childcare, nutrition, and parenting norms while expanding childcare support in workshops and English classes.³² NGOs can also promote community-based care, policy changes, and family-friendly workplaces.³³

We found barriers like inefficient policies, short program durations, service delays, high refugee demand, and complex bureaucracy within the support system. Suggestion: Improving refugee support requires modernizing infrastructure, adaptable policies, and stronger community engagement.¹⁸ Diversifying funding resources and working with local groups can create stronger support systems, making refugee help more stable and effective.¹⁸ Additionally, simplifying administrative processes and advocating for long-term refugee policies can reduce service delays and enhance program efficiency.³⁴

According to our findings, stigma and cultural barriers limited Afghan women's use of NGO mental health services, a challenge also seen in other refugee studies.¹⁵ Stigma can cause fear, increase depression, and stop Afghan women from seeking needed mental health support.³⁵ Suggestion: NGOs can reduce stigma by raising awareness, building resilience, and offering support tailored to Afghan women's cultural norms.³⁵ NGOs can improve mental health access for Afghan women by expanding local mental health services, providing more interpreters, and promoting culturally competent care.

Patriarchal norms limit Afghan women's access to support services. For example, family restrictions and cultural beliefs often hinder their education.³⁶ For Afghan women, health care access, especially for mental and reproductive health, is limited by male escort requirements.¹⁵ Afghan women from patriarchal backgrounds often lack legal awareness and fear seeking help, especially for domestic violence. Also, NGOs may struggle to assist these women with legal aid without causing cultural conflict.³⁷ Gender inequality also limits Afghan women's job access, with their men often resisting job training programs for Afghan women.³⁸ Restrictive gender roles also limit Afghan women's exposure to the English language and American culture, hindering NGOs’ integration efforts. Suggestion: NGOs can support Afghan women by involving male family members in discussions on education, health care, and employment to reduce resistance. They should provide women-only spaces, discreet legal aid, home-based job training, and culturally adapted outreach to improve access. Training Afghan women as peer mentors and offering mobile or telehealth services can further enhance engagement while respecting cultural norms.

A major barrier for refugees is underfunding and poor long-term planning, limiting resettlement agencies’ ability to help. Funding hasn’t kept up with inflation, reducing resources for Afghan women's basic needs and support.³⁹ Unstable funding and local backlash led to staff cuts and resettlement site closures, especially during the pandemic.³⁹ Additionally, the system's inflexibility and poor information sharing hindered response to refugee influxes, leaving many without needed support.⁴⁰ Suggestion: NGOs can diversify their financial resources through grants and community donations. They can benefit from federal aid programs available to Afghan refugees after the Taliban's 2021 takeover to cover health-related activities, and livelihood initiatives like literacy and skill-building courses.⁴¹ Strengthening NGOs’ collaboration with local service providers and community/religious organizations and developing a network of service providers with real-time information-sharing can improve their response to refugee needs.⁴²

Reconciling Humanitarian Support with Historical Responsibility

While this study focused on the availability and effectiveness of formal support services for Afghan refugee women, it is vital to contextualize these services within the broader history of U.S. involvement in Afghanistan. The humanitarian assistance currently extended to Afghan women, although vital, exists within a paradox where the same geopolitical forces that have enabled resettlement and aid are also implicated in the destabilization that necessitated flight.⁴³ Framing U.S. support without acknowledging this history risks portraying the United States as a neutral or benevolent actor, overlooking its role in shaping the structural conditions of Afghan women's displacement.⁴⁴ This tension is particularly salient for Afghan women who, despite being offered refuge, must also navigate the psychological burden of leaving a homeland transformed by decades of military intervention. Moreover, many women have expressed feelings of betrayal or abandonment following the United States’ withdrawal, particularly those whose families had collaborated with U.S. military forces or NGOs.⁴⁵ Efforts to support Afghan refugee women should therefore be paired with policies and narratives that consider these contextual factors. Including restorative frameworks that recognize displacement because of global inequities–rather than simply a problem to be managed–can enhance U.S. refugee policy toward a more justice-oriented paradigm. Long-term solutions should thus encompass not only resettlement support but also international advocacy for women's rights in Afghanistan and efforts to create the conditions for safe voluntary return, which remains an aspiration for many refugees.⁴⁶

Shared Responsibility of State and NGOs

In the United States, NGOs often act as the primary interface between refugees and the support system, yet they operate under the guidance, funding, and policies set by federal and state agencies. The U.S. Department of State's Bureau of Population, Refugees, and Migration (PRM), along with the Office of Refugee Resettlement (ORR), plays a foundational role in coordinating services and distributing funds to local agencies and NGOs.⁴⁷ However, years of underfunding and shifting political priorities–particularly during the current administration–have weakened public infrastructure and limited the state's capacity to meet refugee needs.⁴⁸ This problem has forced NGOs to shoulder disproportionate burdens, often with insufficient resources, staff, or training.⁴⁹ However, this study underscores that effective formal support programs can only be achieved through a coordinated effort between the state and NGOs, ensuring not only emergency relief but also sustained support for long-term integration through services such as housing, employment, mental health care, and legal assistance.

Toward a Sustainable Future

Participants in this study–many of whom remain unemployed, lack financial literacy, or face housing insecurity–expressed ongoing concerns about achieving stability, autonomy, and dignity in the U.S. context. For many women, support services phase out within six to twelve months, leaving them vulnerable to economic hardship, social isolation, and psychological distress. A sustainable formal support model must address not only short-term resettlement needs but also long-term integration pathways. Afghan women require enduring access to housing, culturally tailored mental health services, job training, childcare, and legal support.⁵⁰ Programs designed with a trauma-informed and gender-sensitive lens are essential to help women move from survival to self-sufficiency. Without such support, refugee women are at risk of becoming “chronically displaced” in the host country, living in limbo with uncertain futures and restricted opportunities for advancement.⁵¹ At the same time, many Afghan women also hope for eventual safe return to their homeland. However, as of 2025, Afghanistan remains under Taliban control, and the regime continues to enforce severe restrictions on women's rights, including bans on education, employment, and freedom of movement.⁵² Given these conditions, return is not currently a viable or safe option. Until fundamental changes occur in Afghanistan, the United States bears ongoing responsibility to ensure Afghan women can lead meaningful, stable lives in their new communities. This dual aspiration–integrating successfully in the United States while holding on to hopes of eventual return–necessitates the policies to encompass long-term well-being including permanent residency pathways, educational credential recognition, culturally competent service delivery, and greater investment in affordable housing and job placement tailored to the unique needs of Afghan women.⁵³ Without these structural supports, Afghan women risk becoming trapped in a cycle of marginalization despite their physical relocation.

Limitations

This study's focus on Afghan refugee women in California could limit the generalizability of findings to those in other U.S. regions. However, demographic comparisons suggest the study sample represents the broader Afghan refugee community. Additionally, interview recordings may have introduced response bias, as participants might have adjusted their answers to please the interviewer, who was known for her prior role in refugee services. Future research should expand to include refugees from multiple states and employ neutral third-party interviewers to enhance objectivity and reduce potential biases.

Implications for Policy and Practice

Enhancing Cultural Competency

Based on our findings, NGO programs must be tailored to be culturally competent and inclusive, accommodating the diverse religious, cultural, and linguistic needs of Afghan women. This includes providing services in native languages, understanding cultural nuances, and involving religious and community leaders in the design and delivery of services.

Investing in Long-Term Integration and Mental Health Services

Support should extend beyond immediate relief and aim at long-term integration. This includes investing in education, job training, mental health services, and community-building activities that foster a sense of belonging and purpose. Mental health services need to be destigmatized, readily available, and made suitable for Afghan women, for example, by employing counselors who are fluent in Dari and Pashto.

Improving Communication and Information Dissemination

There is a pressing need to improve how information about services is communicated to Afghan refugee women. Ensuring that they are aware of and understand how to access services is crucial. This might involve community outreach programs, information sessions in native languages, and using technology to disseminate information effectively.

Building Capacity and Sustainability

Strengthening the capacity of NGOs requires increased investment in funding, staffing, and training by federal and state agencies. Effective coordination between NGOs and state is vital to ensure equitable resource distribution and the sustainable delivery of support programs. This includes ongoing education and professional development for service providers, with a focus on culturally competent care and the unique needs of refugee populations.

Fostering Collaborative Networks

Establishing and strengthening networks between NGOs, government agencies, community organizations, and the private sector can lead to more cohesive support systems. Collaboration can lead to shared resources, expertise, and more effective referral systems.

Conducting Comprehensive Needs Assessments

To develop effective solutions, it is essential to first assess Afghan refugee women's specific needs and priorities. Without a clear understanding of their challenges, policies and programs risk being misaligned with their actual circumstances. Future research should focus on identifying these needs through direct engagement with refugee women and service providers.

Prioritizing Community Integration Over New Programs

Given the high demand and limited funding in refugee support systems, the focus should be on integrating Afghan women into local communities rather than creating additional standalone programs. Strengthening existing community resources, fostering local support networks, and promoting social inclusion can provide sustainable solutions without overburdening the system.

Focusing on Basic Needs During Initial Resettlement

The early resettlement phase should prioritize immediate necessities, such as food, shelter, and health care, before directing resources toward long-term empowerment programs. Investing in employment training or education too soon may divert crucial resources from urgent survival needs. Future policies should ensure that foundational stability is established before introducing programs aimed at long-term self-sufficiency.

Conclusion

This study highlights the urgent need for comprehensive and culturally responsive support for Afghan refugee women in the United States. While immediate needs have been addressed, long-term integration remains a challenge. Sustainable solutions must go beyond short-term relief, equipping Afghan women with the skills, resources, and opportunities necessary for self-sufficiency. Addressing cultural barriers, reducing mental health stigma, and fostering stronger community engagement are crucial for their successful integration. Government policies, NGO programs, and community efforts must work together to create an environment where Afghan women can thrive rather than merely survive. To achieve this state, NGOs should conduct thorough needs assessments, shift from isolated programs to community-based integration efforts, and improve culturally sensitive mental health services. Clear communication strategies in native languages will also ensure greater awareness of available support. Government agencies must prioritize basic needs during resettlement, allocate more resources to existing services rather than creating new programs, and develop policies that promote employment and vocational training tailored to Afghan women. The community plays a vital role in fostering social inclusion through mentorship programs, cultural events, and partnerships with religious and local organizations. Future research should examine the long-term impact of existing support systems and explore evolving needs as sociopolitical landscapes shift. A coordinated, multi-sectoral approach involving NGOs, government agencies, and local communities is essential to ensuring Afghan refugee women achieve stability, integration, and long-term empowerment.

Age	Number	Percent
18–35	21	61.8
36–50	8	23.4
51–65	4	11.8
> 65	1	3
Occupation
Unemployed	26	76.5
Employed	8	23.5
Marital status
Married	22	64.7
Single	4	11.8
Divorced/Widow	8	23.5
No. of Children
0	6	17.6
1–2	12	35.3
3–4	14	41.2
>4	2	5.9
English proficiency
None	20	58.8
Low	8	23.5
Satisfactory	6	17.7
Education
Elementary and less	8	23.5
Diploma	15	44.1
Associate/Bachelor	10	29.4
Master and above	1	3
Time of Arrival
Before 1/2020	18	53
After 1/2020	16	47
Immigration Status
Special Immigrant Visa	16	47.1
Citizen	2	5.9
Refugee	8	23.5
Asylum	6	17.6
Parole	2	5.9

Age	Number	Percent
18–35	4	22.2
36–50	10	55.6
51–65	4	22.2
> 65	0	0
Occupation
Caseworker	8	44.4
Counselor/Therapist	4	22.2
Coordinator/Manager	6	33.4
Gender
Male	4	22.2
Female	14	77.8
Education
Diploma	0	0
Bachelor	8	44.4
Master	7	38.9
MD/PhD	3	16.7

Dimension of Support	Refugee Perspective	Provider Perspective
Food/Grocery Support	Satisfied with food stamps, grocery deliveries, and emergency support.	Recognized its importance in refugee stability and suggested considering culturally specific food aid.
COVID-19 Programs	Benefited from contact tracing, vaccination access, and health workshops.	Organized COVID-related programs but faced outreach challenges due to staffing shortages.
Financial Support	Relied heavily on cash assistance, rent aid, and unemployment benefits for stability.	Acknowledged short-term relief but emphasized the need for long-term solutions.
Referral Services	Found referrals helpful in accessing mental health services and rental aid.	Facilitated connections but noted barriers like stigma in seeking mental health support.
Literacy	Struggled with credit card usage and lacked knowledge of medical self-care.	Emphasized need for financial and health education to increase independence.
Educational/English Support	Needed more long-term language support; online classes were ineffective.	Provided language courses but struggled with low participation and engagement of refugees.
Getting a Driver's License	Felt limited without a license, affecting mobility and employment opportunities.	Stressed mobility as key for independence; advocated for more driving programs.
Job and Technological Skills Development	Lacked job training and certifications; desired home-based work opportunities; tech illiteracy	Offered some workshops but lacked resources for in-depth training or certification.
Community Centers and Social Gatherings	Desired community spaces for connection, mental health, and reducing isolation.	Created virtual programs but found them inadequate for meaningful connections.
Family Sponsor Programs	Needed structured volunteer-led guidance for resettlement and integration.	Identified a need for structured mentorship from community volunteers.
Domestic/Sexual Violence Programs	Experienced some level of abuse but feared reporting incidents.	Noted abuse cases; set up discreet support groups and virtual meetings.
Anti-Suicide Programs	Worried about increasing suicide due to stress, isolation, and trauma.	Recognized the high rate; emphasized the need for intervention and counseling services.
Mentorship Programs	Needed mentorship to navigate cultural differences and stress management.	Advocated for structured programs on stress management and cultural adaptation.
Informational Workshops	Unaware of available resources and struggled with application processes.	Held informational workshops but saw gaps in outreach and attendance.
Legal Rights Awareness	Had limited knowledge of rights, especially regarding domestic abuse.	Stressed importance of educating women on their rights to prevent exploitation.
Housing Support	Struggled with securing long-term housing support and system navigation.	Provided temporary housing but noted limited availability and long-term challenges.
Childcare/Parental Programs	Needed guidance on childcare practices and adapting to American norms.	Offered parenting workshops but found low participation due to busy schedules.
Benefits Application Support	Frustrated with delays in receiving aid and navigating applications.	Faced bureaucratic delays and complex application processes, frustrating applicants.
Family Reunification	Overwhelmed by complex immigration policies and slow reunification processes.	Worked on reunification but struggled with restrictive policies and legal hurdles.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics Approval Statement

The University of South Carolina's review board exempted the study from human research subject regulations. Respondents gave verbal consent before starting the interviews.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the University of South Carolina, Office of Research, SPARC Graduate Research Grant [115400-23-62684].

ORCID iDs

A. Aghaei

B. Roth

P. M. Koga

X. Li

S. Qiao

Author Biographies

Atefeh Aghaei is a public health specialist with a PhD in health promotion education and behavior from Arnold School of Public Health, University of South Carolina. She is a multidisciplinary expert in health communication, mental health, and social sciences with a second PhD in communication science from the University of Tehran where she worked as an assistant professor in 2019 and 2020. She currently works as a mental health team lead with a professional background in health program coordination and health and wellness promotion. Her research interests and publications are in the fields of women's studies, mental health, health policy, well-being of refugees and immigrants, social determinants of health, and health of vulnerable populations.

Ben Roth is an associate professor at the University of South Carolina College of Social Work where he serves as the Associate Dean for Curriculum. His research focuses on immigrant youth and barriers to social mobility, including poverty, legal status, and discrimination. His research has been funded by the U.S. Department of Housing and Urban Development, the Spencer Foundation, the W.T. Grant Foundation, among others. He earned his PhD at the University of Chicago and his Master in Social Work at Hunter College.

Patrick Marius Koga, MD, MPH, FRSPH, is an associate professor and director of Ulysses Refugee Health Research Program in the Department of Public Health Sciences at University of California (UC) Davis School of Medicine. In the past 30 years his research has centered on transcultural psychiatry, including evaluations of newly arriving Afghan, Iraqi, Iranian, Syrian, and Congolese refugees. A former dean of International Medicine in Cambridge, United Kingdom, and associate clinical professor of Psychiatry at Tulane School of Medicine, Koga's work spans Kyrgyzstan, Afghanistan, Russia, Iran, Türkiye, and the Arab Region. His research range covers GIS mapping of vulnerability and resilience in war and disaster trauma, mHealth, idioms of distress, Ulysses Syndrome, cultural retooling, domestic violence, brain waste, and the overmedicalization of social suffering. Koga is a member of the World Psychiatric Association, Transcultural Psychiatry Section, the Athena Network, UC Global Health Institute, and a Fellow of the Royal Society for Public Health in London, United Kingdom.

Xiaoming Li is Professor and South Carolina SmartState Endowed Chair in Clinical Translational Research in the Department of Health Promotion, Education, and Behavior at the University of South Carolina (USC) Arnold School of Public Health. He leads the South Carolina SmartState Center for Healthcare Quality (CHQ) and the USC Big Data Health Science Center (BDHSC). He received his doctoral degree in educational psychology from the University of Minnesota, Minneapolis. His work, experience, and competencies are mainly in global health and health disparities research. His specific areas of research include HIV behavioral prevention and intervention, and social stigma, mental health, and resilience-based psychosocial intervention for people living with HIV and their children. He has worked in the United States, China, Namibia, India, Zambia, the Bahamas, Vietnam, and Nigeria on HIV-related research and was the founding editor-in-chief of the journal Health Psychology and Behavioral Medicine. In 2019, he was elected as a Fellow of the Association for Psychological Science.

Shan Qiao is an associate professor in the Department of Health Promotion, Education, and Behavior at the University of South Carolina (USC) Arnold School of Public Health, core-faculty of the South Carolina SmartState Center for Healthcare Quality (CHQ) and the USC Big Data Health Science Center (BDHSC). She received her doctoral degree in public health from Johns Hopkins University Bloomberg School of Public Health. Her research interests focus on health education and behavior interventions leveraging the power of data science and artificial intelligence technology in the context of HIV prevention and treatment as well as health disparities and inequity areas. She has conducted multiple projects funded by the National Institutes of Health and Centers for Disease Control in the United States, China, and Zambia.

References

United Nations High Commissioner for Refugees. Refugee statistics. 2022. Accessed December 31, 2022. https://www.unhcr.org/refugee-statistics/

Kamrava

. Multipolarity and instability in the Middle East. Orbis. 2018;62(4):598–616.

Instability in Afghanistan. Global conflict tracker. Accessed January 14, 2025. https://cfr.org/global-conflict-tracker/conflict/war-afghanistan

Refuge

Welcome

OA.

“Then, we lost everything:” Afghan evacuee experiences of operation. Published online 2023. https://watson.brown.edu/files/watson/imce/news/ResearchBriefs/2023/RDC%20Report_FINAL.pdf

Sengoelge

Nissen

Solberg

. Post-Migration stressors and health-related quality of life in refugees from Syria resettled in Sweden. Int J Environ Res Public Health. 2022;19(5):2509. doi:https://doi.org/10.3390/ijerph19052509

Stempel

Sami

Koga

Alemi

Smith

Shirazi

. Gendered sources of distress and resilience among Afghan refugees in northern California: A cross-sectional study. Int J Environ Res Public Health. 2017;14(1):25. doi:https://doi.org/10.3390/ijerph14010025

Abbas

. The return of the Taliban: Afghanistan after the Americans left. Published online 2023. https://books.google.com/books?hl=en&lr=&id=5bu2EAAAQBAJ&oi=fnd&pg=PP1&dq=The+Taliban,+who+ruled+Afghanistan+from+the+mid-1990s+until+2001+and+resumed+control+in+2021,+were+initially+empowered+in+part+by+U.S.+geopolitical+strategies+during+the+Cold+War,+particularly+in+the+context+of+the+Soviet-Afghan+war&ots=DwNxFUaA2r&sig=WGE_Q-b1GFU1jiA1tNO08T8Aa7U

Camacho Rodriguez

The Afghanistan puzzle: Analyzing us intervention and its regional consequences. Published online 2024. https://burjcdigital.urjc.es/items/16287e84-14f0-4261-a1d1-84208e92f90f

Dahel Mohamed Tayeb

. Taliban taking over. August 2021. Published online 2023. https://dspace.univ-guelma.dz/jspui/handle/123456789/15546

10.

Afghanistan Refugee Crisis Explained. July 2023. Accessed November 4, 2023. https://www.unrefugees.org/news/afghanistan-refugee-crisis-explained/

11.

Shahnan

Hussain

. US–Afghanistan relations post-withdrawal: Is there a future? J Asian Secur Int Aff. 2024;11(3):301–319.

12.

Alemi

Panter-Brick

Oriya

, et al. Afghan Mental health and psychosocial well-being: Thematic review of four decades of research and interventions. BJPsych Open. 2023;9(4):e125.

13.

Stewart

. Social support in refugee resettlement. In: Simich

Andermann

, eds. Refuge and Resilience: Promoting Resilience and Mental Health among Resettled Refugees and Forced Migrants. Springer Netherlands; 2014:91–107.

14.

Working with refugees: Afghan backgrounder. CORE. October 26, 2021. Accessed January 16, 2025. https://www.coresourceexchange.org/working-with-afghans/

15.

DeSa

Gebremeskel

Omonaiye

Yaya

. Barriers and facilitators to access mental health services among refugee women in high-income countries: A systematic review. Syst Rev. 2022;11(1):62.

16.

Ramos

. Considerations in designing trauma-focused interventions for displaced Afghan women. Front Glob Womens Health.2023 Feb 23;3:893957. doi:https://doi.org/10.3389/fgwh.2022.893957

17.

Kern

Bynum

JPW

Pincus

. Care fragmentation, care continuity, and care coordination-how they differ and why it matters. JAMA Intern Med. 2024;184(3):236–237.

18.

Mathema

. Rebuilding the U.S. Refugee Program for the 21st Century A New Vision To Create a More Resilient Refugee Program. Center for American Progress. October 26, 2020. Accessed January 7, 2024. https://www.americanprogress.org/article/rebuilding-u-s-refugee-program-21st-century/

19.

Worabo

Parke

Muck

. Refugee Healthcare Needs: Perceptions of Health and Social Service Professionals in South Texas. Tex Public Health J. 2019;71(4):13–18. https://www.researchgate.net/publication/336251939_Refugee_Healthcare_Needs_Perceptions_of_Health_and_Social_Service_Professionals_in_South_Texas

20.

Batalova

JBJ

. Afghan immigrants in the United States. 2024. Accessed March 15, 2024. https://www.migrationpolicy.org/article/afghan-immigrants-united-states

21.

Braun

Clarke

. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health. 2021;13(2):201–216.

22.

Stempel

Alemi

. Challenges to the economic integration of Afghan refugees in the U.S. J Ethn Migr Stud. 2021;47(21):4872–4892.

23.

Wang

FKH

Rodriguez-Delgado

Kemp

. Tens of thousands of Afghans have resettled across the U.S. Now, the challenge is making a home. PBS NewsHour. February 3, 2022. Accessed December 30, 2022. https://www.pbs.org/newshour/nation/tens-of-thousands-of-afghans-have-resettled-across-the-u-s-now-the-challenge-is-making-a-home.

24.

Braun

Clarke

. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

25.

Corbin

Strauss

Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (Knight V, ed.). Sage publications; 2014.

26.

Ayres

Kavanaugh

Knafl

. Within-case and across-case approaches to qualitative data analysis. Qual Health Res. 2003;13(6):871–883.

27.

Goliaei

Gonzalez

Rios

Pokhrel

Burke

. Post-Resettlement food insecurity: Afghan refugees and challenges of the new environment. Int J Environ Res Public Health. 2023;20(10):5846. doi:https://doi.org/10.3390/ijerph20105846

28.

Sastre

Haldeman

. Environmental, nutrition and health issues in a US refugee resettlement community. MEDICC Rev. 2015;17(4):18–24.

29.

Leung

JK.

A Qualitative Analysis on the Transitions of Afghan Refugee Families to the U.S. and Their Parenting Experiences. search.proquest.com, 2020. https://search.proquest.com/openview/9f0fba722dd600b33c745b815732e3f2/1?pq-origsite=gscholar&cbl=18750&diss=y

30.

Hagstrom

Pereira

. Financial inclusion of individuals who arrived as refugees to the United States. J Int Dev. 2021;33(4):752–779.

31.

Dolan

Sherlock

. Family support through childcare services: Meeting the needs of asylum-seeking and refugee families. Child Care in Practice. 2010;16(2):147–165.

32.

Hamari

Konttila

Merikukka

Tuomikoski

Kouvonen

Kurki

. Parent support programmes for families who are immigrants: A scoping review. J Immigr Minor Health. 2022;24(2):506–525.

33.

Sætermo

Kristensen

. Personal, peaceful, progressive: Integration workers’ narratives of refugee settlement and the rural. Sociol Ruralis. 2024;6:149–167. doi:https://doi.org/10.1111/soru.12464

34.

Konyndyk

Huang

. A practical vision for US development reform. 2017. Accessed January 8, 2024. https://cgdev.org/sites/default/files/practical-vision-us-development-reform.pdf

35.

Nine

Najm

Allan

Gronholm

. Mental health stigma among community members in Afghanistan: A cross-sectional survey. Int J Soc Psychiatry. 2022;68(7):1470–1485.

36.

Shir Mohammad

Education as an Empowerment Tool for Afghan Women. Published online 2018. https://lup.lub.lu.se/student-papers/record/8968735/file/8968737.pdf

37.

Azizi

Lane

Boyce

. Afghan Women refugees enduring domestic violence despite finding sanctuary in the UK. J Int Migr Integr. 2024;25:759–774. doi:https://doi.org/10.1007/s12134-023-01098-6

38.

Benard

Jones

Oliker

Thurston

Stearns

Cordell

Economic participation and women. In: Women and Nation-Building. 1st ed. RAND Corporation, 2008:81–106.

39.

Grant

. Coronavirus, refugees, and government policy: The state of U.S. Refugee resettlement during the coronavirus pandemic. World Med Health Policy. 2020;12(3):291–299.

40.

Brown

Scribner

. Unfulfilled promises, future possibilities: The refugee resettlement system in the United States. J Migr Hum Secur. 2014;2(2):101–120.

41.

SIGAR 61st Quarterly Report to Congress, https://www.sigar.mil/interactive-reports/sigar-quarterly-report-2023-10-30/ (2023, accessed 8 January 2024).

42.

Brell

Dustmann

Preston

. The labor market integration of refugee migrants in high-income countries. J Econ Perspect. 2020;34(1):94–121.

43.

Amir

Khawaja

. Impact of US involvement & withdrawal from Afghanistan on Afghan refugees in Pakistan. Indus J Soc Sci. 2025;3:110–121. doi:https://doi.org/10.59075/ijss.v3i1.564

44.

True

Akbari

. Geopolitical narratives of withdrawal and the counter-narrative of women’s rights activism in Afghanistan. Glob Stud Q. 2024;4(3):1–13. doi:https://doi.org/10.1093/isagsq/ksae051

45.

Quie . Trust and coercion: Afghans navigating the politics of welcome. Coercion and Trust. 2024. doi:https://doi.org/10.4324/9781003398233-10/trust-coercion-marissa-quie

46.

Hashemi

Amiry

. Uncovering the nexus of identity and forced migration: A collaborative autoethnographic study of Afghan women’s experiences in diaspora. Comp Int Educ. 2024;53. doi:https://doi.org/10.5206/cie-eci.v53i2.17000

47.

Cooper

Atouba

Wang

. Are we all in this together? Examining nonprofits’ perceptions of governmental actors in the management of the U.S. Refugee crisis. Nonprofit Pol For. 2025;16(0):161–180. doi:https://doi.org/10.1515/npf-2023-0064

48.

Kreisberg

De Graauw

Gleeson

. Explaining refugee employment declines: Structural shortcomings in federal resettlement support. Soc Probl. 2024;71:271–290. https://academic.oup.com/socpro/article-abstract/71/1/271/6497632

49.

Koch

Rooden

. Understanding and addressing the unintended effects of aid localisation. Dev Pract. Published online January 25, 2024:1–13.

50.

Tariq

Ali

Sabir

Garai-Fodor

. Barriers to entrepreneurial refugees’ integration into host countries: A case of Afghan refugees. Sustainability. Published online 2024. https://www.mdpi.com/2071-1050/16/6/2281.

51.

Shishehgar

Gholizadeh

DiGiacomo

Davidson

. Arrived, yet in-between: Experiences of Iranian asylum-seeker women living with insecure residency in Australia. J Int Migr Integr. 2023;24:1981–2001. doi:https://doi.org/10.1007/s12134-023-01054-4

52.

Hassan

Afghanistan. Human Rights Watch. December 19, 2024. Accessed April 19, 2025. https://www.hrw.org/world-report/2025/country-chapters/afghanistan

53.

Kent Spanos

Helping our new afghan neighbors learn, earn, belong, & contribute: Bush institute policy recommendations. George W Bush Institute, Education Reform Initiative. Published online 2022. https://eric.ed.gov/?id=ED626788

Navigating Organizational Challenges and Formal Support for Afghan Refugee Women in California Amid Covid-19 and the Taliban's Takeover

Abstract

Keywords

Methods

Participants and Recruitment

Afghan Refugee Women

Refugee Service Providers

Demographics

Data Collection

Data Analysis

Results

Effective Support Services

Food/Grocery Support

COVID-Related Programs

Financial Support

Referral Services

Support Services with Gaps

Support for Empowerment

Literacy

Educational/English Support

Getting a Driver's License

Job and Technological Skills Development Programs

Support for Community Building

Community Centers/Social Gathering Spaces

Family Sponsor Programs

Coping Support

Domestic/Sexual Violence Programs

Anti-Suicide Programs

Mentorship Programs

Informational Support

Informational Workshops

Informing Women About Their Rights

Instrumental Support

Housing Support

Childcare Support/Parental Programs

Benefits Application Support

Family Reunion Services

Challenges and Barriers to Support

Facilitators of Support

Discussion

Refugee vs. Provider Perspectives on U.S. Support Systems

How to Enhance U.S. Support Systems

Reconciling Humanitarian Support with Historical Responsibility

Shared Responsibility of State and NGOs

Toward a Sustainable Future

Limitations

Implications for Policy and Practice

Enhancing Cultural Competency

Investing in Long-Term Integration and Mental Health Services

Improving Communication and Information Dissemination

Building Capacity and Sustainability

Fostering Collaborative Networks

Conducting Comprehensive Needs Assessments

Prioritizing Community Integration Over New Programs

Focusing on Basic Needs During Initial Resettlement

Conclusion

Footnotes

Declaration of Conflicting Interests

Ethics Approval Statement

Funding

ORCID iDs

Author Biographies

References