Pakistan: MSF urges protection for Afghan refugees facing forced return
Fear of arrest, detention and deportation forces many to delay seeking healthcare.
Doctors without Borders/Médecins Sans Frontières (MSF) is urging the Government of Pakistan to ensure refugees are not forcibly returned to Afghanistan under the Illegal Foreigners Repatriation Plan (IFRP) and to establish formal exemptions for individuals with international protection needs.
MSF is deeply concerned about the IFRP’s impact on refugees’ access to healthcare. Refugees have told MSF they are delaying or foregoing medical care out of fear of arrest and to avoid documentation checks at health facilities. This has led to preventable health issues, including cases of malnutrition and pregnancy complications.
“Afghan refugees live under constant fear of arrest, detention, eviction, loss of livelihood and deportation.”
Marko den Hartogh, country director in Pakistan
“My wife was three months pregnant when the police took me,” says Najib*, an Afghan refugee who was arrested when police raided his home, despite showing his Proof of Registration (PoR) card. “When I was released and came home the next day, she was still out of her mind. She told me she had started bleeding very heavily because of stress and deep sadness.
“My mind was filled with so many images: the picture of the arrest, the trauma, the mental anguish from the previous night—everything was racing through my brain. But, just to save my wife’s life, I acted despite the fear. I finally decided I had to go to the hospital, but I was terrified they would arrest me again. I rushed her to the doctor, but we were too late. My wife had already had a miscarriage.”
The policy has undermined people’s ability to provide for their families, as people lose work and income amid constant fear of arrest and deportation. In early 2026, MSF ran mobile clinics for communities with no access to healthcare in Quetta, Balochistan, and identified a high burden of acute malnutrition among children with 33.3% having acute malnutrition. Among those, 7.6% had severe acute malnutrition and 25.7% had moderate acute malnutrition. Nearly 90% of malnourished patients were Afghan refugees, most of them women and children.
The Government of Pakistan began implementing the IFRP in November 2023, initially targeting undocumented Afghan nationals. This was later extended to refugees holding Afghan Citizen Cards (ACC) or PoR—many of whom had lived in the country since 1979. In a July 10, 2026 directive, Pakistan authorities ordered the immediate arrest and accelerated deportation of all Afghan nationals without a valid visa.
“Pakistan has hosted Afghan refugees for more than 45 years despite limited international support,” says Marko den Hartogh, country director in Pakistan. “Yet Afghan refugees live under constant fear of arrest, detention, eviction, loss of livelihood and deportation. This makes it unlikely that many of the returns to Afghanistan are truly voluntary.”
More than 2.5 million Afghans have returned to Afghanistan under the IFRP so far according to the UN Refugee Agency. The UN recently identified more than 70,000 Afghan refugees at imminent risk if returned. “It is critical that individuals with protection needs are not deported and returns are voluntary, safe and dignified,” says den Hartogh.
“We urge the government of Pakistan to renew its long-standing solidarity with refugees and formally adopt mechanisms to identify and protect those at risk of harm upon return.”
Marko den Hartogh, country director in Pakistan
Between 2023 and 2026, roughly 6 million Afghans returned from Iran and Pakistan, straining Afghanistan’s fragile healthcare system. The systematic erasure of women and girls from public life, sweeping U.S. aid cuts and wider funding declines, an overstretched health system and a deepening economic crisis compound the challenges returnees face to reintegrate.
MSF assessments of informal returnee settlements in Afghanistan’s Kandahar province in October 2025 and April 2026 found a lack of basic healthcare, inadequate shelter, undernutrition and poor sanitation—increasing outbreak risk.
MSF urges countries hosting Afghan refugees to halt all involuntary returns to Afghanistan and ensure return processes do not undermine the protection and safety of refugees.
“We urge the Government of Pakistan to renew its long-standing solidarity with refugees and formally adopt mechanisms to identify and protect those at risk of harm upon return,” says den Hartogh. “This must include women and girls, children, older people, people with disabilities, those needing critical or long-term medical care, refugees awaiting resettlement and others at heightened risk of marginalization, discrimination or persecution.”
*Name changed to protect confidentiality and privacy
