Gul Meena Hotak was on her regular rounds, going door-to-door giving polio vaccinations in the eastern Afghan city of Jalalabad, when she heard gunshots. The 22-year-old’s immediate concern was for the safety of her friend Negina and other colleagues nearby. “Negina and my supervisor were in a neighbourhood close by when a gunman approached and shot at them. My supervisor escaped with gunshot injuries, but Negina was killed on the spot,” Hotak said. Traumatised and afraid, Hotak went back to her office where she learned other colleagues had been targeted by a separate bomb attack. Two more female polio workers – Samina and Basira, who like Negina, were known by only one name – died in Jalalabad city. No group has claimed responsibility for the murderous attacks on 30 March, part of a wave of assassinations in Afghanistan since the US signed a deal with the Taliban last year. The Afghan Independent Human Rights Commission recorded 2,250 assassinations in 2020 – an increase of 169% since 2019. After the killings, vital polio campaigns across the province were put on hold, and remain suspended in at least three districts including Jalalabad city. “The situation in the south and eastern provinces has been problematic for many years because of the bans imposed by the Taliban as well as the Islamic State, which briefly controlled parts of the country. They didn’t permit the door-to-door vaccination campaigns,” Merjan Rasekh, head of public awareness of the ministry of health’s polio eradication programme, said. Afghanistan is, alongside Pakistan, one of the last two countries in the world where polio is endemic. The Taliban, Rasekh said, were not against vaccinations as such but did mistrust the campaigns, fearing that the polio workers are being used to gather intelligence on their whereabouts. “But the recent killings of female workers were shocking and unprecedented in the history of our immunisation activities,” he said. The increase in violence has been aimed at women active in public life. In Jalalabad city there had been six killings in the four months before the polio workers were targeted. “We had received no threats or warning [ahead of the attack], but violence and assassinations are becoming part of our everyday life. They are killing female journalists, activists every day,” said Hotak, who now fears for her life. Even without the security issues, female workers in Afghanistan face many challenges. In a deeply conservative society, working women are breaking stereotypes and cultural norms. “We get harassed, abused; some use abusive language. There are times when people kicked us out of their neighbourhoods, but we continue our job,” Hotak said. As a result of the killings, many Afghan women have quit their jobs. “There is tremendous pressure on women (from their families), and many of our volunteers are unwilling to rejoin the campaigns. At least half of them are now afraid of stepping out of their homes,” said Hotak. Enikass TV, a media outlet in the eastern province, asked its female employees to temporarily stop coming into work after four female staff were murdered. Forcing women out of public life would, undoubtedly, have an adverse impact on society, in this case on the campaign against polio, Rasekh said. “In the Afghan context, the female workers are among the most important frontline workers. Because culturally, Afghan mothers in conservative households are not allowed to go outside or allow a male worker inside the house to vaccinate their children. But female vaccinators can directly enter the households and even convince caregivers who may have doubts about the vaccines.” With fewer women willing to volunteer or work in the campaign, the polio department fears a rise in cases in the coming months and a reversal of years of progress. The country has already had 56 cases – the highest in 20 years – during the pandemic lockdowns. “We only had two cases in the eastern region in 2020, thanks to the efforts of the many women polio workers. But now we are very concerned about an increase in cases if women are not able to resume due to security problems,” said Dr Jan Mohammad, a coordinator for the national campaign. But despite the challenges, some refuse to step back. “Yes, I am scared, but I can’t give up now because it is a matter of life and death for these children,” said Hotak, who is determined to return to work as soon as the campaign resumes. “If we leave the country to the hands of the insurgents, they will destroy it.”