Stories of Survival: Early Marriage and Organ Sales in Afghanistan

War, poverty and the quiet return of survival strategies in Afghanistan that were once in decline

Dr **Mariam Noori trained as a doctor at a time when Afghan women could still study, work, and move freely.

It was a different time in the country’s turbulent history - not entirely stable, but more open than what followed.

By the time I came to hear her story, that world had narrowed considerably.

Many of the women she trained alongside had already left the country. Those who remained were working within tightening constraints, in a system already stretched thin.

Noori was working in Nuristan, a remote province in eastern Afghanistan. It is, by all accounts, breathtaking - once a hotspot for the gung-ho, waterproof trouser wearing, “I travelled around the world on a bike” type of tourist.

But by virtue of its rurality and its immense mountains, Nuristan is defined as a “white zone”, where permanent healthcare services barely exist.

Over 100 kilometres away, in Asadabad, Noori’s husband and their second child were at home, struggling - as millions are - to afford food.

Afghanistan is heavily reliant on imports from its neighbours. When those neighbours are a) Pakistan, with whom you’re in open conflict and b) Iran, currently fighting none other than the USA and Israel, supply chains begin to look more like fault lines.

Price inflation of basic goods – often by a magnitude of five – is pushing Afghans to the brink in a context of widespread unemployment, poverty and malnutrition. Not to mention the active conflict.

Then came Eid al-Fitr. The promise of a ceasefire. A brief pause in the violence, and with it, the reopening of roads that are otherwise patrolled, contested, or simply too dangerous to attempt.

For Noori, it was an opportunity to see her family; to travel home bringing the food and supplies they needed.

So she set off by car with her two-year-old son.

But neither made it back home.

Their vehicle came under fire, and both were killed. Their bodies were left on the roadside for two days before villagers made the perilous journey to retrieve them – perilous both because of the mountainous terrain but also the lurking threat of further attacks.

We know war is brutal. It’s unfair, its destructive and all too often innocent civilians are caught in the crossfire.

But the narrative and the numbers can easily calcify into a tragic but all too recognisable pattern.

What we hear less about are the moments on either side of the gunshot.

The calculations, impossible but necessary, that weigh survival against danger; those which lead people to be in the wrong place at the wrong time.

From the conversations I’ve had with those working on the ground, Noori’s death doesn’t only reflect brutality of war in its most immediate sense. It is also about something slower, more suffocating: the gradual constriction of livelihoods, until the choices available are no longer really choices at all.

“The current situation is more dire than ever before,” **Zahir Karim tells me.

He has spent decades working in Afghanistan’s aid system.

Families, he says, are turning to “negative coping mechanisms” - a phrase that feels so sterile and bureaucratic relative to what it contains.

Early marriage is rising again, he reports. Girls as young as twelve are being married off. This emerges not a continuation of some static cultural tradition, but as an economic strategy. Fewer mouths to feed. A potential source of income.

In more extreme cases, the body itself becomes a resource.

Before 2024, organ selling in Afghanistan was already a known phenomenon. There were clinics where kidneys could be sold for a few thousand dollars. The Taliban later banned the practice, citing violations of dignity and Islamic law.

But Karim tells me it is returning, only now underground, less visible and more dangerous.

Now, as a commissioning editor reminded me, early marriage and organ selling in Afghanistan have been documented previously. The latter was especially well covered in 2022 – including an illustrated piece by my journo icon Alex Crawford.

If you follow Afghanistan closely, you will have heard versions of these stories. But most haven’t / don’t.

And what matters here is not novelty. It is trajectory.

These are practices that had declined over the past two decades. Their return is not incidental. It is a regression, driven by war, economic collapse and a spiralling humanitarian crisis.

“We’re going backwards”, one of my sources tells me. The past decade’s modest but important progress on social metrics is being eroded.

And as ever, the burden is not evenly distributed. Women and children absorb the worst of it.

Karim describes how, when organ selling was more common, husbands would register their wives’ “availability” at clinics.

At home, **Farid Rahimi, a nutrition expert, tells me that women often eat last, after the men, after the children, sometimes surviving on scraps, sometimes skipping meals entirely.

He adds that when women and children are diagnosed with malnutrition, they are proscribed therapeutic foods - nutrient dense products designed to prevent life threatening deterioration or “stunting”.

But according to Rahimi , “a mother might bring these supplementary foods back home and the father might say, ‘I really enjoy these - let me have them’”.

Or they are sold.

There is, he explains, a market for these products. They become a kind of currency - tradable, immediately useful in a way that long-term health is not.

Such trades are agentic and desperate in equal measure.

Like Dr Noori’s journey, it’s an example of the needs-must calculations families are now forced to make with alarming regularity.

Rahimi reminds me that when the Taliban recaptured Kabul in 2021, all Afghans could hope for was stability.

“The only thing people were happy about when this regime came back in to run the country was that things would become a bit more peaceful”, explains Rahimi.

“Despite everything else, we wouldn’t be losing our family members anymore. But now even that has gone away, because now once again we live in an active conflict zone.”

Pakistan has been at war with Afghanistan since late February over concerns the Taliban is sheltering militant groups responsible for attacks in Islamabad and other areas.

According to the UN, over 115,000 people have been displaced from eastern provinces since the fighting began.

This has compounded an existing displacement crisis sparked by the mass expulsion of around 3 million Afghans from Iran and Pakistan.

Many were made to leave their homes within 15 minutes, arriving in Afghanistan with nothing.

They returned to a country that was already struggling to support 22 million people in need of humanitarian assistance.

3.7 million children under five are acutely malnourished. More than a million pregnant or breastfeeding women face the same.

The system is not built to absorb this.

Mohammad Abid Hemat, founder of the consultancy Life Line Legal, puts it plainly: Afghanistan’s humanitarian infrastructure does not have the resources.

Currently only a fraction of needs are being met a) because the aid system is severely cash strapped and b) because the international community’s Taliban-wariness continues to influence funding distribution.

In every conversation I had with aid officials in Afghanistan, there was a similar undercurrent of frustration and concern. It stems from a sense that their country is being forgotten, their needs deprioritised and their civilians folded into the politics of a government they did not choose.

“The people of Afghanistan should not be sacrificed. They are civilians, they are human” Karim tells me.

“The international community must not look away”.

It is the kind of sentence now sounds familiar. And this may be precisely the problem.