Watson Institute for International and Public Affairs
Costs of War

Afghan Civilians

Afghan villagers sit near the bodies of children who were reported to have been killed during a NATO airstrike in Kunar province on April 7, 2013. (Photo: Reuters)

The war in Afghanistan continues destroying lives, due to the direct consequences of violence and the war-induced breakdown of public health, security, and infrastructure. Civilians have been killed by crossfire, improvised explosive devices (IEDs), assassinations, bombings, and night raids into houses of suspected insurgents. Even in the absence of fighting, unexploded ordnance from previous wars and United States cluster bombs continue to kill. 

Hospitals in Afghanistan are treating large numbers of war wounded, including amputees and burn victims. The war has also inflicted invisible wounds. In 2009, the Afghan Ministry of Public Health reported that fully two-thirds of Afghans suffer from mental health problems.

Prior wars and civil conflict in the country have made Afghan society extremely vulnerable to the indirect effects of the current war. Those war effects include elevated rates of disease due to lack of clean drinking water, malnutrition, and reduced access to health care. Nearly every factor associated with premature death — poverty, malnutrition, poor sanitation, lack of access to health care, environmental degradation — is exacerbated by the current war. 

While Afghanistan has benefited from investments in health care that may ameliorate some of the effects of war, the results are mixed, with improvement in some areas, such as infant mortality, balanced by continuing or growing needs in other elements of public health.

About 241,000 people have been killed in the Afghanistan and Pakistan war zone since 2001. More than 71,000 of those killed have been civilians.

Key Findings

  • As of April 2021, more than 71,000 Afghan and Pakistani civilians are estimated to have died as a direct result of the war.

  • Many Afghans dealing with ill health and war wounds find it difficult to get to hospitals and clinics because violence makes roads unsafe.

  • The war has exacerbated the effects of poverty, malnutrition, poor sanitation, lack of access to health care, and environmental degradation on Afghans’ health.


  • The US government and United Nations should ensure that civilian deaths and injuries, both as a direct result of war and as an indirect consequence of violent conflict, are included in public reporting of war deaths. It should also include a tally of children killed.

(Page updated as of April 2021)