The Government of Pakistan began implementing the Illegal Foreigners Repatriation Plan (IFRP) in November 2023, initially targeting undocumented Afghan nationals and later extending to documented refugees holding Afghan Citizen Cards or Proof of Registration—many of whom had lived in the country since 1979.

Afghan refugees live under constant fear of arrest, detention, eviction, loss of livelihood, and deportation. Refugees told MSF teams 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.

The policy has also undermined people’s ability to provide for their families, as people lose work and income amid fears of arrest and deportation.

Over 2.5 million Afghans have returned to Afghanistan under the IFRP so far, many involuntarily, according to UNHCR. The UN recently identified over 70,000 Afghan refugees at imminent risk if returned.

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 urges the Government of Pakistan to ensure refugees are not forcibly returned to Afghanistan under the IFRP and to establish formal exemptions for individuals with international protection needs. It is critical that individuals with protection needs are not deported and that returns are voluntary, safe, and dignified.