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In a bitterly cold bedroom at the beginning of winter in Kabul, 22-year-old Maryam sat with her young son wrapped in a red sweater as he coughed days after he was released from a hospital ward for the third time with suspected pneumonia.
Every time 10-month-old Rahmat's parents bring him home from a crowded but warmer hospital, they say he gets sick again. The parents said they are spending what they can, from their dwindling income to trying to heat a room that drops below freezing at night.
"I'm afraid, it's only the beginning of winter, what will happen?" Maryam said, adding that the family could only buy coal in small quantities and had to cut back on food to afford even that after her husband lost his construction job.
The family is among many in Afghanistan who cannot afford adequate heating and often have to choose between food and fuel as the country is gripped by an economic crisis.
Doctors and aid workers say thousands of children are being admitted to hospital with pneumonia and other respiratory illnesses caused by colds and malnutrition.
According to aid agencies, the crisis is likely to worsen. The ban on NGO workers has led to more than 180 international organizations suspending operations in the crucial winter months, saying they are unable to operate in the conservative country without female staff to reach out to women and children.
Even before that, more than half the population was dependent on humanitarian aid after the economic shock caused by the Taliban takeover in 2021 saw Afghanistan's GDP shrink by 20% last year.
Afghanistan has been hit by cuts in development spending by foreign governments, the enforcement of Western sanctions and asset freezes by the country's central bank, which have severely disrupted the banking system.
"Our patients have increased compared to the past, the main reason is the economy," said Mohammad Arif Hassanzai, head of internal medicine at the Indira Gandhi Children's Hospital in Kabul.
Hospital figures showed more than 6,700 children were admitted for pneumonia, cough, asthma and other respiratory conditions in November, compared with around 3,700 in the same month a year earlier.
The International Committee of the Red Cross (ICRC), which supports several hospitals in Afghanistan, said before the winter months that it saw a 50% increase in children under five admitted for pneumonia in 2022 compared to the previous year.
"People have been dying of pneumonia this year, including children," said Lucien Christen, ICRC spokesman in Kabul, adding that malnutrition contributes to children's weakened immune systems.
Aid workers said pollution had also worsened this year as more people burned trash and plastic for heat.
In the hospital's pneumonia ward, babies lay two or three to a bed, watched over by worried parents and a handful of stretched-out medical staff. Some mothers held small oxygen masks to their babies' faces while fathers huddled in the corridors outside.
Suddenly there was a scream. One-month-old baby Mohammad stopped breathing and his lips turned blue. His panicked uncle, who was holding the child in a green blanket, was directed to the specialist emergency unit two floors below. He threw himself down as the child's mother ran after him in tears.
In the high dependency unit, Mohammad was connected to an oxygen tube through his nose. The doctor said that he is in a critical condition and will take five days to stabilize.
His mother remained at the child's bedside. Her husband lost his job and they couldn't afford heating, she said. As she watched her son stop breathing, she said: “It was like my heart stopped.
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