Post-earthquake health-related quality of life in Afghanistan: a cross- sectional study

Background: Earthquakes are among the most destructive natural disasters, causing severe physical, psychological, and social disruption. Assessing health-related quality of life (HRQoL) among survivors is essential for evidence-based recovery planning, particularly in resource-limited settings such as Afghanistan. This study evaluated HRQoL and its sociodemographic and clinical determinants among survivors of the 2023 Herat earthquake. Methods: A community-based cross-sectional study was conducted among 902 adult survivors in five earthquake-affected districts of Herat Province. Data were collected through structured face-to-face interviews between February and March 2024. HRQoL was assessed using the WHOQOL-BREF, and associations between HRQoL domains (physical, psychological, social, environmental) and independent variables were analyzed using chi-square tests. Results: Low HRQoL was reported by 38.3% of participants in the physical domain, 36.7% in the psychological domain, 28.3% in the environmental domain, and 25.7% in the social domain. Women reported significantly lower physical (44.2% vs. 30.3%; p = 0.002) and psychological (42.4% vs. 29.5%; p = 0.006) HRQoL compared with men. Widowed/divorced individuals had the highest prevalence of low HRQoL (physical: 51.5%; psychological: 48.5%; p < 0.001). Participants from households with >10 members reported nearly double the prevalence of low physical HRQoL compared with those from ≤5-member households (49.2% vs. 26.8%; p < 0.001). Low monthly income (<10,000 AFN), unemployment, chronic illness (physical: 56.8% vs. 33.5%; p < 0.001), and earthquake-related injuries (52.3% vs. 34.1%; p < 0.01) were also significantly associated with impaired HRQoL. Conclusion: Survivors of the Herat earthquake experienced substantial impairments in physical and psychological well-being. Women, widowed/divorced individuals, low-income households, and those with injuries or chronic illnesses were disproportionately affected. Targeted psychosocial support, economic assistance, and long-term rehabilitation strategies are urgently required to improve HRQoL and strengthen community resilience in earthquake-affected regions.