This story was supported by the Pulitzer Center.
DOHA, QATAR — On a sunny morning in April, the airy lobby of the outpatient clinic at the hospital is buzzing with patients arriving for their appointments. In the midst of all the activity, a nondescript man wearing a navy tracksuit pushes a little girl with pink glasses in a small wheelchair. She sports two pigtails secured with Hello Kitty hair ties and a fuzzy jacket, also pink — the requisite color “for girls,” she later says in English she learned from the Cocomelon YouTube channel, her favorite.
Outside Sidra Medicine, the sun bears down on a line of bronze sculptures depicting a human fetus at various stages of development. The installation, which the artist Damien Hirst named “The Miraculous Journey,” presents an impressive introduction to the hospital, a glassy Cesar Pelli-designed building in the Education City area of Doha. The medical and research facility is one of the only places six-year-old Ifat and her father, Najeebullah Nasiri, have seen since they arrived in Qatar’s capital over a year ago after fleeing Afghanistan. They are only allowed to leave the U.S.-run army base in Doha where they’ve been living to attend hospital appointments.
Ifat is in a bright mood, bubbling over with snippets of English phrases, extensively listing her many likes and dislikes: cats, yes; dogs, no. Her little sister, Surwat, yes; if Ifat is given a lollipop, she wants a second to take home for Surwat. But also, no, because Surwat is too “noisy.” America, yes, because it means living in her own house, sleeping on a Hello Kitty bed, and going to school. But Qatar, no. Qatar does not have a school she can go to. It’s where she has been living but it’s not home.
On this white-hot Thursday, Ifat is at Sidra for occupational therapy. After undergoing three surgeries to separate fingers that have fused together, she needs to exercise her fine motor skills to combat the stiffness in her hands, so her therapist guides her as she stacks colorful, hollow blocks over a wooden stick. The trouble with her hands is among the many complications of Dystrophic Epidermolysis Bullosa, a rare genetic disorder that blisters skin so severely that the resulting lesions can resemble third degree burns. In Ifat’s serious case, the fragility extends to internal membranes like the throat lining, and makes it impossible to eat solid food. Her corneas also become dry and inflamed, which has happened over a dozen times since she’s lived in Qatar. On such days, her eyes barely open and she is a shell of herself, her father, Najeeb, says.
After the appointment, in the sitting area across from the hospital café, Najeeb fans out medical reports to demonstrate his daughter’s long history of care, which before the pandemic — and before they fled Afghanistan — included visits to India and Pakistan for treatment. One recent report from Sidra notes that Ifat runs the risk of developing skin cancer later in life, or other complications if her disease and symptoms are not properly managed in a clean environment — no easy task in the tiny dorm room they now call home. To occupy his daughter, Najeeb hands her his phone, but she shoves it back initially, chiding him in a stream of Dari for not having the right app open. The error duly corrected, the videos start streaming, and she watches, rapt — giggling at the screen in spurts, occasionally peppering her dad with questions he answers in soft monosyllables.
“This waiting is the main thing that is difficult … with a sick child in this [120] degrees hot weather in Qatar,” Najeeb says.
Two years after the chaotic withdrawal of American troops from Afghanistan, the world has turned its gaze toward other global catastrophes — new wars, fresh threats to democracy, rising inflation. In the United States, even if individual members of Congress continue to express concerns about the fate of Afghans still waiting to be resettled, the legislative body as a whole seems to have moved on. But for those Afghans in the pipeline, the bureaucracy grinds on haltingly, bewildering and traumatizing in the name of process.
When Najeeb and his wife, Atefa, escaped Kabul with their two children in April 2022, they believed that they would be processed for resettlement to America quickly. After all, Najeeb had been working for the U.S. Embassy when it shuttered in August 2021. Plus, their little girl’s sensitive health situation, they reasoned, was sure to put them on a fast track. They were manifested for a U.S.-run evacuation flight to Qatar in April, 2022, which seemed a positive sign for their hopes of resettling in America. In Doha, an expedited processing site for Afghan refugees, their case would surely move forward quickly.
But spring turned into a summer of anxious waiting and watching, and summer to winter. Now, as the family faces another winter in limbo in their cramped, shipping container-like room at the Camp As Sayliyah army base, the door to America appears to close on them. (The State Department did not respond to specific questions about the Nasiri case, citing confidentiality of visa records.)
What makes it worse, Najeeb says, is to log their indefinite wait time in units of his little girl’s daily suffering — trapped in the monotony of drab, bad days. Watching Ifat pray for her ticket to America has been excruciating. “Why she’s saying ‘America, America’ — because everyone is talking in the base about going to America,” Najeeb says in imperfect but clearly discernible English. “This type of thinking … obviously, I don’t like. I try to busy her because it gets more difficult for us every time she is asking to go to America.”
The Special Immigrant Visa, which allows Afghans and Iraqis who served the U.S. military or mission during the wars in Iraq and Afghanistan to move to the U.S., has its roots in the 2006 defense budget law, and was formalized in 2009. While the program has historically enjoyed bipartisan support, it was among the many casualties of the Trump administration’s crackdown on immigration. Amid bans on immigrants from Muslim countries and extreme vetting that can stretch on for years, the SIV backlog grew — and SIV interviews for applicants in Afghanistan slowed to a trickle. They resumed in February 2021, weeks before President Joe Biden announced plans to withdraw all American troops from the country. The State Department boosted consular processing capacity to Kabul in the months that followed; the first SIV evacuation flight left in July of that year.
Najeeb worked as a financial assistant for the diplomatic security force employed by the U.S. Embassy in Kabul between March 27, 2020, and Aug. 14, 2021, according to a letter his employer at the federal contractor GardaWorld sent to the Department of State. Having seen acquaintances languish with the yearslong SIV processing backlog, he was initially skeptical of the utility of applying when the U.S. announced plans to withdraw. Plus, he hadn’t seriously considered that his family would have to leave their home behind.
But something happened on Aug. 15, 2021, that made the prospect of leaving their home not just real — but imminent. The Taliban captured Kabul. The U.S. suspended relocation flights for SIV applicants and also disbanded its relocation task force. The Americans “lost control of the gates and wall” of Camp Alvarado at the Kabul International Airport, according to a June State Department Office of Inspector General report, and moved its consular operations to a safer location within the airport.
Three days later, Najeeb went to the Kabul International Airport to see if he could get his family on one of the outgoing flights. He saw there a mad rush — people shoving each other to get a spot on the plane. Over the cloud of panic, the Taliban fired gunshots into the air to force order, but all that did was sow further fear. Najeeb couldn’t even get near the departure area. But even if he had, he knew it would be impossible for Ifat to travel safely under such conditions. Surwat, too, was less than a year old at that time. So Najeeb and his family stayed behind and recalibrated their exit strategy.
But things continued to deteriorate. Reuters reported on Aug. 22 that seven people were killed in the airport crowd crush. The threats only escalated after that: A suicide bomber attacked the airport resulting in the deaths of 170 Afghans and 13 U.S. military personnel on Aug. 26. The U.S. retaliated with a drone strike three days later, killing 10 civilians. A State Department review of the withdrawal later found “insufficient senior-level consideration of worst-case scenarios.”
On Aug. 31, the U.S. suspended all consular operations in Kabul as a security measure and moved some operations to the embassy in Doha, Qatar. Still, the U.S. secretary of State announced that 123,000 people had been successfully evacuated by the end of that month. This included almost 37,000 Afghans who were applicants for the SIV visa. In October, the disbanded evacuation task force was revamped as the Coordinator for Afghan Relocation Efforts. Flights from Afghanistan to Qatar resumed and started sending SIV beneficiaries and applicants to Doha for further processing “with the cooperation of the Taliban,” per the OIG report.
Before the Taliban took over, Najeeb says, he and his family enjoyed a wonderful life. They lived in an apartment on the same block as his parents and felt financially comfortable. They spent weekends visiting friends and relatives nearby, sitting in their yards and chatting for hours. Some days, they took the girls out to parks, arcades, restaurants, shopping centers. Atefa would put on a smart salwar-kameez, wrap a matching chador around her head and wear bright lipstick. The parents would take photos of the girls sitting riding toy horses, in ball pits, on park benches. They were happy, Najeeb says — save for the fact that the medical care Ifat needed was not available in Afghanistan.
When Ifat was born, her hands and legs were raw “like red meat,” Najeeb remembers, but doctors in Kabul couldn’t seem to figure out why. So Najeeb took her to India, where at just 21 days old, she was diagnosed with EB. Kids born with this genetic abnormality are sometimes deemed “butterfly children,” because their skins are fragile like the wings of butterflies. Living with EB, or caring for a loved one who has it, is a daily ordeal. Wounds have to be properly bathed and bandaged — a task that is physically excruciating for the children and mentally torturous for the caregivers. The immense emotional cost and social isolation associated with EB is well-documented. Ifat’s condition is particularly serious. To get appropriate care for her, the Nasiri family made multiple trips to India and Pakistan before the pandemic. Even on these rather grim excursions, the parents would try to show Ifat, and later her little sister, the local tourist spots and treat them to milkshakes and fries at McDonald’s. They sometimes thought how much easier it would be to live in a place where medical care for Ifat was readily available, but they weren’t sure how to leave their home.
Once the Taliban took over, it became too unsafe for them to stay. Worried, Najeeb spoke to his employers, who told him they would give him documents so he could file an SIV application. His company had liaised with the State Department regarding many at-risk employees and assured Najeeb that his young family, too, was on the evacuation list. This was vital — because of Najeeb’s U.S. government job, his family was a potential target for the Taliban. But waiting for the proper documents to even apply for an SIV took longer than expected.
Sourcing employment verification documentation had always been a burdensome part of the multi-step SIV application process — and only became more so after the U.S. withdrawal. If HR departments dissolved or supervisors died, moved on, or, say, were kidnapped by insurgents, the process could come to a standstill. And even after applicants filed, they were likely to run into delays. In 2018, Iraqis and Afghans sued after being made to wait much longer than the Congress-mandated nine months to have their applications processed — sometimes for years — which, they argued, kept them in constant, imminent danger. The class of plaintiffs waited, on average, 2.5 years just for the first stage, the Chief of Mission approval, and another five, for the final decision.
“It all sounds very formal and legalistic,” says Adam Bates, supervisory policy counsel at the International Refugee Assistance Project, which represented SIV applicants in the lawsuit. “But this process is a lot more like spending eight years at the DMV than a formal legal proceeding.”
The State Department said that as of April 2023, SIV applicants are being relocated to Albania from Afghanistan for expedited processing and that automation has helped speed things along. In its report for the second quarter of this year, the department noted an average processing time of 270 days, or just under nine months, for SIV processing, but the OIG has since criticized the department’s quarterly tallies as “inconsistent and potentially flawed.”
That same OIG review, released this August, found that despite attempts to increase staffing and automate communications, 840,000 SIV visa applicants and their family members remained in Afghanistan as of April this year. “Without additional dedicated resources to address the situation, the backlog in SIV applications will remain a significant challenge,” the watchdog agency concluded.
Meanwhile, it wasn’t until March 2022, eight months after the Taliban takeover, that Najeeb was finally able to file for the SIV. Since he already had a visa for Pakistan that was soon expiring, and because the U.S. was intermittently running flights to and out of the neighboring country to evacuate Afghans, his employers advised him to fly there and wait. The month after he applied for his SIV, he hopped on a plane with his family for the short trip to Islamabad.
On the other side of the world, in the U.S., an Afghan evacuation-related group chat involving several nonprofits and State Department liaisons buzzed daily with new activity. One day in March 2022, an official flagged a family with a medical condition — the Nasiris — that needed some additional attention. Details of what the condition, later called a “derm issue,” entailed, were initially left vague. Task Force Nyx,