At the same time, the physical and psychological effects of war have substantially increased the need for medical care. Infant, child, and maternal mortality rates are among the highest in the world. In rural areas, one in five children dies before reaching age five. Because of poor sanitation and insufficient potable water supply, infectious and parasitic diseases such as malaria and diarrhea are very common. Malnutrition and poor nutrition also are pervasive. The drought of 1999–2002 exacerbated these conditions. An estimated 800,000 Afghans are disabled. No statistics are available on the prevalence of human immunodeficiency virus (HIV). However, in 2006 the United Nations Development Programme estimated that an HIV/acquired immune deficiency syndrome (AIDS) epidemic could occur in Afghanistan because of the high incidence of intravenous drug use, unsafe blood transfusion procedures, large numbers of refugees, poor health facilities, and illiteracy. In 2006 the government estimated that 200 to 300 citizens were currently infected. Despite large-scale international assistance, in 2004 the World Health Organization did not expect Afghanistan’s health indicators to improve substantially for at least a decade.
Welfare: Largely because of protracted military conflict, Afghanistan in 2004 had the highest proportion of widows and orphans in the world. Large numbers of disabled individuals and former members of regional militias also lack a means of support. In 2004 the World Bank estimated that 20 percent of families lacked a secure food supply and another 50 to 60 percent were on the verge of severe poverty. However, the government provides very little welfare protection. Most of the welfare activity in the country has been provided by international nongovernmental organizations (NGOs), such as the Afghan Health and Development Services, Afghan Women’s Education Center, and Humanitarian Assistance for the Women and Children of Afghanistan, and by United Nations organizations. Several NGOs also work with Afghan refugees in other countries, especially Pakistan.