Afghanistan has been caught in conflict since 1978. Several generations of Afghans have never known life without instability and insecurity. 18 million Afghans are in need of humanitarian aid, with over 11.1 million Afghans living with some degree of food insecurity. Afghanistan's government has struggled to provide clean water, electricity, safe roads and education services for its people. Violent conflict and natural disasters continue to cause internal displacement. Furthermore, Afghan refugees are increasingly threatened by forced returns, as countries like Pakistan and Iran send refugees back. In 2019 there was a reported 31% increase in airstrikes and a 39% increase in casualties. Attacks on hospitals and other healthcare facilities by Taliban forces have made these facilities not readily accessible. Due to the Coronavirus pandemic, which began in 2020, the number of people in Afghanistan requiring humanitarian assistance rose more than 30%, a total that includes 5.1 million children.