Millions of Afghans have had their lives permanently changed by the U.S. war, which marked its 15th anniversary on Oct. 7 — an unpropitious date that came and went with little attention in the media, and virtually no acknowledgment by major American politicians. More than a decade of nonstop war has pushed Afghanistan to the brink of catastrophe. And things are getting worse, not better.

At least 220,000 Afghans were killed in the first 12 years of the war, in a conservative estimate, according to a report by the Nobel Prize-winning organization International Physicians for the Prevention of Nuclear War.