At the home of a Pakistani rickshaw driver, a knock broke the silence of a cold November night, followed by a desperate plea: "My wife is giving birth. Could you take her to the hospital? If we leave our home, the police will detain us. Please help us."
On the other side of the door stood an Afghan refugee couple, the wife in labor. Due to Pakistan’s widespread deportations of Afghans, the couple feared leaving their home, even for urgent medical care. The family faced the unimaginable: giving birth without support, in isolation, and under extreme stress.
Even though the family had no money, the driver agreed to rush the woman to the hospital.
"As a human being, I felt their pain,” he told a Doctors Without Borders/Médecins Sans Frontières (MSF) team in Balochistan province. "I witnessed everything. She was screaming all the way to the hospital. She delivered her baby in my rickshaw — it was full of blood. I cannot describe it in words. It broke me, listening to her screaming and driving at the same time. I was in mental trauma."
At the MSF facility, the staff cared for the woman and her baby, who thankfully were healthy and safe after the frightening delivery. Their experience, however, is not uncommon among Afghans in Pakistan. With refugees facing barriers to accessing necessary medical attention, the need for immediate humanitarian aid has never been more urgent.
The mass deportation of Afghan refugees from Pakistan has become a catastrophic humanitarian crisis, deepening the suffering of an already vulnerable community. These deportations leave many refugees without shelter in holding camps with little to no facilities, health care, or means of survival. Average temperatures are around 50°F, falling below 40°F during nights and early mornings. The fear of arrest and detention prevents many from seeking medical care. This fear leads to trauma-induced miscarriages, untreated illnesses, and the refusal of medical care due to a lack of documentation.
Pakistan’s deportation drive against Afghans
Since the late 1970s, Pakistan has been home to millions of refugees fleeing decades of conflict, persecution, and instability in Afghanistan. Over time, many have established communities, livelihoods, families, and small businesses to survive in protracted displacement.
According to the UN Refugee Agency, as of October 2025, more than 2.18 million Afghans were estimated to be living in Pakistan, and many were either born in Pakistan or had spent most of their lives in the country. However, in November 2023, the government of Pakistan began implementing the Illegal Foreigners Repatriation Plan, primarily affecting the large Afghan refugee population.
The deportation drive began by targeting undocumented Afghans, then expanded its scope to include holders of the Afghan citizen card, which previously allowed Afghan citizens to stay in Pakistan. Most recently, Afghans with proof of registration cards, who had been granted temporary legal status by the government of Pakistan in collaboration with the United Nations, have also been subject to forced repatriation.
Deportations have surged since September 2025, coinciding with the arrival of winter, which has sharply worsened the situation for Afghan refugees. The policy is now indiscriminately forcing the return of all Afghan people, regardless of their status in Pakistan.
A baby’s final moments
In November, a baby in critical condition was brought to MSF’s facility in Balochistan, close to the border with Afghanistan. The family had been referred from a holding center. “I approached and saw the baby, and he was gasping,” shares an MSF staff member. “Those were his last moments. I had never seen the last moments of any person before. I was shocked. With a very heavy heart, I asked the doctor what happened and the doctor told me that the baby was in critical condition: ‘We tried our best. We provided oxygen, but there was no pulse. Nothing.’”
The baby was only 5 months old and had suffered all night in the cold weather. The family had been trying to care for the baby throughout the night because no health services were available, and a medical referral would only be possible in the morning when an aid organization started providing basic services.
Afghan refugees fear seeking care amid Pakistan deportations
Read more“At the holding center, there is no sanitation, no clean water, no food — conditions that leave refugees exposed to the harshest of elements,” says an aid worker from the holding center. “We were also traumatized to learn about the death of this baby.”
“We informed the father about the baby’s death,” shares another MSF staff member. “He said that the baby had been suffering all night. These conditions are unbearable. Nobody should have to endure them. As a human, I feel their situation. I feel their pain.”
Cold can be a silent killer
“We don’t have a home in Afghanistan, and nowhere to stay if we are deported,” says one Afghan woman. “Now that winter has started, and we are a family with kids, we do not know what to do."
One Afghan man mentioned that refugee families are facing significant delays in crossing the Afghanistan-Pakistan border, with food shortages and children vulnerable to the cold weather. “Because of the deep winter season and the bitter cold, my children suffered and fell sick,” he says.
“My family and I are exposed to cold weather on a daily basis,” shares another refugee, who lives within the local community but is not going out to work out of fear. “We don’t have anything to keep ourselves warm. I’m afraid of deportation. If we are forced to return to Afghanistan, the challenges will double. I’m afraid for my wife and children.”
For vulnerable communities, winter without shelter is deadly. Freezing temperatures sharply increase illness and death, particularly among malnourished children. Cold exposure forces the body to burn more calories just to survive, yet malnourished children have no reserves to keep warm, so they deteriorate rapidly. Their immunity weakens, making respiratory infections both common and dangerous, with minor illnesses quickly turning fatal. Without access to medical care, urgent shelter, protection, and nutrition, winter becomes a silent killer.
The holding centers often lack necessities like water and sanitation, and the people held there are lucky if they even receive two meals a day, as food stocks are often too low to supply enough meals. The need for blankets and winter kits is increasing.
“Lives are at stake,” says Xu Weibing, MSF head of mission in Pakistan. “Afghan families are being forced to choose between living in fear of deportation and danger upon return. Pakistan should ensure no one is forced back into harm, and the international community must urgently step up humanitarian and protection support. Mobilizing humanitarian aid is critical to provide immediate relief to Afghan refugees living within local communities and people who are being deported, ensuring those affected have access to food, shelter, and essential services. In parallel, the issue of forced returns must be addressed, with a focus on providing safe relocation to third countries and protecting vulnerable groups from further harm. Safety, dignity, and humanity are not optional.”
Deported with a dead body
Health challenges, both physical and psychological, are contributing to higher levels of morbidity and mortality. “My wife was three months pregnant when the police detained me for the first time,” shares an Afghan refugee. “That night, when I was detained, she became terribly afraid and upset. When I was released and came home the next day, she was still distraught. She told me that she had started bleeding very heavily because of stress and deep sadness. I rushed her to the doctor, but we were too late. My wife had already had a miscarriage.” The man and his wife were detained and forced to return to Afghanistan.
In October 2025, an Afghan refugee came to the MSF facility for postnatal care. She had delivered her baby at the holding camp, but the baby was stillborn. After receiving care, she was sent back to the holding camp and brought to the MSF facility again the next morning unconscious, accompanied by her mother and father-in-law. Her mother-in-law told the MSF team, “When she was delivering the baby, we had nothing to cover her. She gave birth in front of everyone.”
The mother’s condition was critical, and she was referred to Quetta for specialized care. She remained in the hospital in Quetta for four days, but the family could not afford to provide her with better treatment, and she died.
Just after her death, the family was told it was their turn to cross the border. They were deported to Afghanistan with her dead body.
