worldwide surge in energy prices threatens to impose more hardship as it hampers the recovery. This week, oil prices hit a seven-year high in the United States. With winter approaching, Europeans are worried that heating costs will soar when temperatures drop. In other spots, the shortages have cut even deeper, causing blackouts in some places that paralyzed transport, closed factories and threatened food supplies.

China, electricity is being rationed in many provinces and many companies are operating at less than half of their capacity, contributing to an already significant slowdown in growth. India’s coal reserves have dropped to dangerously low levels.

And over the weekend, Lebanon’s six million residents were left without any power for more than 24 hours after fuel shortages shut down the nation’s power plants. The outage is just the latest in a series of disasters there. Its economic and financial crisis has been one of the world’s worst in 150 years.

Oil producers in the Middle East and elsewhere are lately benefiting from the jump in prices. But many nations in the region and North Africa are still trying to resuscitate their pandemic-battered economies. According to newly updated reports from the World Bank, 13 of the 16 countries in that region will have lower standards of living this year than they did before the pandemic, in large part because of “underfinanced, imbalanced and ill-prepared health systems.”

Other countries were so overburdened by debt even before the pandemic that governments were forced to limit spending on health care to repay foreign lenders.

In Latin America and the Caribbean, there are fears of a second lost decade of growth like the one experienced after 2010. In South Africa, over one-third of the population is out of work.

And in East Asia and the Pacific, a World Bank update warned that “Covid-19 threatens to create a combination of slow growth and increasing inequality for the first time this century.” Businesses in Indonesia, Mongolia and the Philippines lost on average 40 percent or more of their typical monthly sales. Thailand and many Pacific island economies are expected to have less output in 2023 than they did before the pandemic.

debt ceiling — can further set back the recovery, the I.M.F. warned.

But the biggest risk is the emergence of a more infectious and deadlier coronavirus variant.

Ms. Gopinath at the I.M.F. urged vaccine manufacturers to support the expansion of vaccine production in developing countries.

Earlier this year, the I.M.F. approved $650 billion worth of emergency currency reserves that have been distributed to countries around the world. In this latest report, it again called on wealthy countries to help ensure that these funds are used to benefit poor countries that have been struggling the most with the fallout of the virus.

“We’re witnessing what I call tragic reversals in development across many dimensions,” said David Malpass, the president of the World Bank. “Progress in reducing extreme poverty has been set back by years — for some, by a decade.”

Ben Casselman contributed reporting.

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Rohingya on Bangladesh Island of Bhashan Char Seek to Leave

DHAKA, Bangladesh — Its name translates into “floating island,” and for up to 100,000 desperate war refugees, the low-slung landmass is supposed to be home.

One refugee, Munazar Islam, initially thought it would be his. He and his family of four fled Myanmar in 2017 after the military there unleashed a campaign of murder and rape that the United Nations has called ethnic cleansing. After years in a refugee camp prone to fires and floods, he accepted an invitation from the government of neighboring Bangladesh to move to the island, Bhasan Char.

Mr. Islam’s relief was short lived. Jobs on the island were nonexistent. Police officers controlled the refugees’ movements and sometimes barred residents from mingling with neighbors, or children from playing together outside. The island was vulnerable to flooding and cyclones and, until relatively recently, would occasionally disappear underwater.

So, in August, Mr. Islam paid human smugglers about $400 to ferry his family somewhere else.

“When I got the chance, I paid and left,” said Mr. Islam, who asked that his location not be revealed because leaving Bhasan Char is illegal. “I died every day on that island, and I didn’t want to be stuck there.”

Myanmar.

worsened storms and sent sea levels rising. Human Rights Watch, in a recent report, said refugees and humanitarian workers alike fear that inadequate storm and flood protection could put those on the island at serious risk.

Nevertheless, the Bangladesh government has moved ahead with resettling Rohingya refugees there. They have built housing for more than 100,000 people, with a series of red-roofed dormitories checkering more than two square miles of the western side of the island.

The number of people trying to escape the island has become a growing problem. About 700 have tried to flee, according to the police, sometimes paying $150 per person to find rides on rickety boats. The police have arrested at least 200 people who attempted to leave.

The police cite safety concerns. In August, a boat carrying 42 people capsized, leaving 14 people dead and 13 missing.

“When we catch them, we send them back to the island,” said Abul Kalam Azad, a police officer in the port city of Chattogram on the southeastern coast of Bangladesh. “They say they are mostly upset for not having any job in Bhasan Char. They are eager to work and earn money.”

Some simply want to see their families again.

Last year, Jannat Ara left her hut in Cox’s Bazar for a dangerous sea journey to take a job in Malaysia that would provide food for eight members of her family. Her boat was intercepted by the Bangladesh navy. She was sent to Bhasan Char, where she lived with three other women.

Alone and desperate to leave, in May she seized the first chance she could get to escape. Her parents paid around $600 for the journey back to Cox’s Bazar, she said. She traveled for hours in pitch dark before arriving back at the camp.

“Only Allah knows how I lived there for a year,” Ms. Ara said. “It is a jail with red roof buildings and surrounded by the sea from all sides. I used to call my parents and cry every day.”

Human rights groups have questioned whether the refugees at Bhasan Char have enough access to food, water, schooling and health care. In an emergency, they say, the island also lacks an ability to evacuate residents.

“The fear is always there,” said Dil Mohammad, a Rohingya refugee who arrived on the island in December. “We are surrounded by the sea.”

But the biggest worry, Mr. Mohammad said, is the education of his children.

“My elder son used to go to the community school when we were in Cox’s Bazar,” he said, “but he is about to forget everything he learned, as there is no option for him to study in Bhasan Char.”

The fear of being stuck on the vulnerable island without any means of getting out has led to protests against Bangladeshi authorities by the refugees. The protests began in May, when U.N. human rights investigators paid a visit. They continued in August after the boat incident, with protesters carrying signs criticizing the Bangladesh government and appealing to the U.N. to get sent back to Cox’s Bazar.

Mr. Islam, the Rohingya refugee who fled in August, was one of the protesters. But he was already thinking about getting out.

He lost three cousins during a killing spree carried out by the Myanmar military in Rakhine state in 2017. Once they arrived in Cox’s Bazar, he and his family built a hillside hut out of sticks and plastic tarpaulins and shared it with another family of three.

During hot summer nights, Mr. Islam said, he and the other man slept outside so that their children and wives could sleep comfortably inside.

The promise of an apartment on Bhasan Char held appeal. In January, while other families were forced to go there, he volunteered. They carried a few blankets and two bags of clothes.

He came to regret the decision. When he arrived back at Cox’s Bazar in August, he saw it with new eyes.

“I felt,” he said, “as if I was walking into my home.”

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Singapore Struggles to Reopen After Vaccinations

The country’s experience has become a sobering case study for other nations pursuing reopening strategies without first having had to deal with large outbreaks in the pandemic. For the Singapore residents who believed the city-state would reopen once the vaccination rate reached a certain level, there was a feeling of whiplash and nagging questions about what it would take to reopen if vaccines were not enough.

“In a way, we are a victim of our own success, because we’ve achieved as close to zero Covid as we can get and a very, very low death rate,” said Dr. Paul Tambyah, an infectious diseases specialist at National University Hospital. “So we want to keep the position at the top of the class, and it’s very hard to do.”

vaccinated people are already gathering at concerts, festivals and other large events. But unlike Singapore, both of those places had to manage substantial outbreaks early in the pandemic.

Lawrence Wong, Singapore’s finance minister and a chair of the country’s Covid-19 task force, said the lesson for “Covid-naive societies” like Singapore, New Zealand and Australia is to be ready for large waves of infections, “regardless of the vaccine coverage.”

up against the Delta variant, Mr. Wong said.

“In Singapore, we think that you cannot just rely on vaccines alone during this intermediate phase,” he said. “And that’s why we do not plan an approach where we reopen in a big bang manner, and just declare freedom.”

highest since 2012, a trend that some mental health experts have attributed to the pandemic. People have called on the government to consider the mental health concerns caused by the restrictions.

“It’s just economically, sociologically, emotionally and mentally unsustainable,” said Devadas Krishnadas, chief executive at Future-Moves Group, a consultancy in Singapore. Mr. Krishnadas said the decision to reintroduce restrictions after reaching such a high vaccination rate made the country a global outlier.

granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for mandates in both the public and private sectors. Such mandates are legally allowed and have been upheld in court challenges.

  • College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
  • Schools. California became the first state to issue a vaccine mandate for all educators and to announce plans to add the Covid-19 vaccine as a requirement to attend school, which could start as early as next fall. Los Angeles already has a vaccine mandate for public school students 12 and older that begins Nov. 21. New York City’s mandate for teachers and staff, which went into effect Oct. 4 after delays due to legal challenges, appears to have prompted thousands of last-minute shots.
  • Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get vaccinated. Mandates for health care workers in California and New York State appear to have compelled thousands of holdouts to receive shots.
  • Indoor activities. New York City requires workers and customers to show proof of at least one dose of the Covid-19 for indoor dining, gyms, entertainment and performances. Starting Nov. 4, Los Angeles will require most people to provide proof of full vaccination to enter a range of indoor businesses, including restaurants, gyms, museums, movie theaters and salons, in one of the nation’s strictest vaccine rules.
  • At the federal level. On Sept. 9, President Biden announced a vaccine mandate for the vast majority of federal workers. This mandate will apply to employees of the executive branch, including the White House and all federal agencies and members of the armed services.
  • In the private sector. Mr. Biden has mandated that all companies with more than 100 workers require vaccination or weekly testing, helping propel new corporate vaccination policies. Some companies, like United Airlines and Tyson Foods, had mandates in place before Mr. Biden’s announcement.
  • “I think a lot of times we are so focused on wanting to get good results that we just have tunnel vision,” she said.

    Ms. Ng lives across from a testing center. Almost daily, she watched a constant stream of people go in for tests, a strategy that many public health experts say is a waste of resources in such a highly vaccinated country.

    “Freedom Day — as our ministers have said — is not the Singapore style,” said Jeremy Lim, an associate professor at the National University of Singapore and an expert on health policy, referring to England’s reopening in the summer. But moving too cautiously over the potential disadvantages of restrictions is a “bad public health” strategy, he said.

    The government should not wait for perfect conditions to reopen, “because the world will never be perfect. It’s so frustrating that the politicians are almost like waiting for better circumstances,” Dr. Lim said.

    Sarah Chan, a deputy director at Singapore’s Agency for Science, Technology and Research, said she had a fleeting taste of what normal life was like when she arrived in Italy last month to visit her husband’s family.

    No masks were required outdoors, vaccinated people could gather in groups, and Dr. Chan and her son could bop their heads to music in restaurants. In Singapore, music inside restaurants has been banned based on the notion that it could encourage the spread of the virus.

    Dr. Chan said she was so moved by her time in Italy that she cried.

    “It’s almost normal. You forget what that’s like,” she said. “I really miss that.”

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    Inside United Airlines’ Decision to Mandate Coronavirus Vaccines

    Scott Kirby, the chief executive of United Airlines, reached a breaking point while vacationing in Croatia this summer: After receiving word that a 57-year-old United pilot had died after contracting the coronavirus, he felt it was time to require all employees to get vaccinated.

    He paced for about half an hour and then called two of his top executives. “We concluded enough is enough,” Mr. Kirby said in an interview on Thursday. “People are dying, and we can do something to stop that with United Airlines.”

    The company announced its vaccine mandate days later, kicking off a two-month process that ended last Monday. Mr. Kirby’s team had guessed that no more than 70 percent of the airline’s workers were already vaccinated, and the requirement helped convince most of the rest: Nearly all of United’s 67,000 U.S. employees have been vaccinated, in one of the largest and most successful corporate efforts of the kind during the pandemic.

    The key to United’s success, even in states where vaccination rates are at or below the national average, like Texas and Florida, was a gradual effort that started with providing incentives and getting buy-in from employee groups, especially unions, which represent a majority of its workers.

    praise from President Biden, who weeks later announced that regulators would require all businesses with 100 or more workers to require vaccinations or conduct weekly virus testing. And the company drew scorn from conservatives.

    Other mandates are producing results, too. Tyson Foods, which announced its vaccine requirement just days before United but has provided workers more time to comply, said on Thursday that 91 percent of its 120,000 U.S. employees had been vaccinated. Similar policies for health care workers by California and hospitals have also been effective.

    charge its unvaccinated employees an additional $200 per month for health insurance.

    United had been laying the groundwork for a vaccine mandate for at least a year. The airline already had experience requiring vaccines. It has mandated a yellow fever vaccination for flight crews based at Dulles International Airport, near Washington, because of a route to Ghana, whose government requires it.

    In January, at a virtual meeting, Mr. Kirby told employees that he favored a coronavirus vaccine mandate.

    Writing letters to families of the employees who had died from the virus was “the worst thing that I believe I will ever do in my career,” he said at the time, according to a transcript. But while requiring vaccination was “the right thing to do,” United would not be able to act alone, he said.

    The union representing flight attendants pushed the company to focus first on access and incentives. It argued that many flight attendants couldn’t get vaccinated because they were not yet eligible in certain states.

    Mr. Kirby acknowledged that widespread access would be a precondition. The airline and unions worked together to set up clinics for staff in cities where it has hubs like Houston, Chicago and Newark.

    was calling on all employers to do so. A mandate would strike workers as unfair and create unnecessary conflict, the flight attendants’ union argued.

    “The more people you get to take action on their own, the more you can focus on reaching the remaining people before any knock-down, drag-out scenario,” said Sara Nelson, the president of the Association of Flight Attendants, which represents more than 23,000 active workers at United.

    In May, the pilots reached an agreement that would give them extra pay for getting vaccinated and the flight attendants worked toward an agreement that would give them extra vacation days. Both incentives declined in value over time and typically expired by early July.

    vaccinated by Oct. 25 or within five weeks of a vaccine’s formal approval by the Food and Drug Administration, whichever came first. The timing was intended to ensure that the airline had adequate staffing for holiday travel, said Kate Gebo, who heads human resources.

    This time, the unions were more resigned.

    “For those 92 percent of pilots who wanted to be vaccinated, we captured $45 million in cash incentives,” said Captain Insler, whose union is challenging the decision to fire employees who don’t comply. “For those who did not want to be vaccinated, we were able to hold off a mandate for several months.”

    The success of the incentives — about 80 percent of United’s flight attendants were also vaccinated by the time the airline announced its mandate in August — inspired the company to expand them to all employees, offering a full day’s pay to anyone who provided proof of vaccination by Sept. 20.

    The company hadn’t surveyed its workers, but estimated that 60 to 70 percent were already vaccinated. Getting the rest there wouldn’t be easy.

    Margaret Applegate, 57, a 29-year United employee who works as a services representative in the United Club at San Francisco International Airport, helps illustrate why.

    Ms. Applegate normally does not hesitate to get vaccines, noting that her late father was a doctor and that her daughter does research in nutritional science.

    Her daughter urged her to get vaccinated, but she remained deeply ambivalent. Friends and co-workers “were feeding me stories about horrible things happening to people with the vaccine,” she said. She worried about the relatively new technology behind the Pfizer and Moderna vaccines, and whether her heart condition could pose complications, though her cardiologist assured her it wouldn’t.

    six employees sued United, arguing that its plans to put exempt employees on temporary leave — unpaid in many circumstances — are discriminatory. United has delayed that plan for at least a few weeks as it fights the suit.

    Still, United’s vaccination rate has continued to improve. There was another rush before the deadline to receive the pay incentive and one more before the final Sept. 27 deadline. Toward the end of September, the company said 593 people had failed to comply. By Friday, the number had dropped below 240.

    “I did not appreciate the intensity of support for a vaccine mandate that existed, because you hear that loud anti-vax voice a lot more than you hear the people that want it,” Mr. Kirby said. “But there are more of them. And they’re just as intense.”

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    How Asia, Once a Vaccination Laggard, Is Revving Up Inoculations

    Then came the Delta variant. Despite keeping their countries largely sealed off, the virus found its way in. And when it did, it spread quickly. In the summer, South Korea battled its worst wave of infections; hospitals in Indonesia ran out of oxygen and beds; and in Thailand, health care workers had to turn away patients.

    With cases surging, countries quickly shifted their vaccination approach.

    Sydney, Australia, announced a lockdown in June after an unvaccinated limousine driver caught the Delta variant from an American aircrew. Then, Prime Minister Scott Morrison, who had previously said vaccination “was not a race,” called in July on Australians to “go for gold” in the country’s inoculation drive.

    He moved to overcome a supply shortage, compounded by the slow regulatory approval. In August, Australia bought one million Pfizer doses from Poland; this month, Mr. Morrison announced a purchase of a million Moderna shots from Europe.

    When the Delta outbreak emerged, fewer than 25 percent of Australians over the age of 16 had received a single shot. In the state of New South Wales, which includes Sydney, 86 percent of the adult population has now received a first dose, and 62 percent of adults are fully vaccinated. The country expects to fully inoculate 80 percent of its population over the age of 16 by early November.

    “There was great community leadership — there were people from across the political divide who came out to support vaccination,” said Greg Dore, an infectious-disease expert at the University of New South Wales. “It really helped us turn around a level of hesitancy that was there.”

    Many governments have used incentives to encourage inoculations.

    In South Korea, the authorities eased restrictions in August on private gatherings for fully vaccinated people, allowing them to meet in larger groups while maintaining stricter curbs for others. Singapore, which has fully vaccinated 82 percent of its population, previously announced similar measures.

    Researchers there have also analyzed the pockets of people who refuse to be inoculated and are trying to persuade them.

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    Phony Diagnoses Hide High Rates of Drugging at Nursing Homes

    The handwritten doctor’s order was just eight words long, but it solved a problem for Dundee Manor, a nursing home in rural South Carolina struggling to handle a new resident with severe dementia.

    David Blakeney, 63, was restless and agitated. The home’s doctor wanted him on an antipsychotic medication called Haldol, a powerful sedative.

    “Add Dx of schizophrenia for use of Haldol,” read the doctor’s order, using the medical shorthand for “diagnosis.”

    But there was no evidence that Mr. Blakeney actually had schizophrenia.

    Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.

    one in 150 people.

    Schizophrenia, which often causes delusions, hallucinations and dampened emotions, is almost always diagnosed before the age of 40.

    “People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”

    refuge of last resort for people with the disorder, after large psychiatric hospitals closed decades ago.

    But unfounded diagnoses are also driving the increase. In May, a report by a federal oversight agency said nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition.

    hide serious problems — like inadequate staffing and haphazard care — from government audits and inspectors.

    One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are on antipsychotic medications.

    According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia diagnoses.

    To determine the full number of residents being drugged nationally and at specific homes, The Times obtained unfiltered data that was posted on another, little-known Medicare web page, as well as facility-by-facility data that a patient advocacy group got from Medicare via an open records request and shared with The Times.

    The figures showed that at least 21 percent of nursing home residents — about 225,000 people — are on antipsychotics.

    The Centers for Medicare and Medicaid Services, which oversees nursing homes, is “concerned about this practice as a way to circumvent the protections these regulations afford,” said Catherine Howden, a spokeswoman for the agency, which is known as C.M.S.

    “It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” she said. “We will continue to identify facilities which do so and hold them accountable.”

    significant drop since 2012 in the share of residents on the drugs.

    But when residents with diagnoses like schizophrenia are included, the decline is less than half what the government and industry claim. And when the pandemic hit in 2020, the trend reversed and antipsychotic drug use increased.

    For decades, nursing homes have been using drugs to control dementia patients. For nearly as long, there have been calls for reform.

    In 1987, President Ronald Reagan signed a law banning the use of drugs that serve the interest of the nursing home or its staff, not the patient.

    But the practice persisted. In the early 2000s, studies found that antipsychotic drugs like Seroquel, Zyprexa and Abilify made older people drowsy and more likely to fall. The drugs were also linked to heart problems in people with dementia. More than a dozen clinical trials concluded that the drugs nearly doubled the risk of death for older dementia patients.

    11 percent from less than 7 percent, records show.

    The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.

    Caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression. But many nursing homes are chronically understaffed and do not pay enough to retain employees, especially the nursing assistants who provide the bulk of residents’ daily care.

    Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs. That suggests that some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff. (Homes with staffing shortages are also the most likely to understate the number of residents on antipsychotics, according to the Times’s analysis of Medicare data.)

    more than 200,000 since early last year and is at its lowest level since 1994.

    As staffing dropped, the use of antipsychotics rose.

    Even some of the country’s leading experts on elder care have been taken aback by the frequency of false diagnoses and the overuse of antipsychotics.

    Barbara Coulter Edwards, a senior Medicaid official in the Obama administration, said she had discovered that her father was given an incorrect diagnosis of psychosis in the nursing home where he lived even though he had dementia.

    “I just was shocked,” Ms. Edwards said. “And the first thing that flashed through my head was this covers a lot of ills for this nursing home if they want to give him drugs.”

    Homes that violate the rules face few consequences.

    In 2019 and 2021, Medicare said it planned to conduct targeted inspections to examine the issue of false schizophrenia diagnoses, but those plans were repeatedly put on hold because of the pandemic.

    In an analysis of government inspection reports, The Times found about 5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications. Nursing home officials told inspectors that they were dispensing the powerful drugs to frail patients for reasons that ranged from “health maintenance” to efforts to deal with residents who were “whining” or “asking for help.”

    a state inspector cited Hialeah Shores for giving a false schizophrenia diagnosis to a woman. She was so heavily dosed with antipsychotics that the inspector was unable to rouse her on three consecutive days.

    There was no evidence that the woman had been experiencing the delusions common in people with schizophrenia, the inspector found. Instead, staff at the nursing home said she had been “resistive and noncooperative with care.”

    Dr. Jonathan Evans, a medical director for nursing homes in Virginia who reviewed the inspector’s findings for The Times, described the woman’s fear and resistance as “classic dementia behavior.”

    “This wasn’t five-star care,” said Dr. Evans, who previously was president of a group that represents medical staff in nursing homes. He said he was alarmed that the inspector had decided the violation caused only “minimal harm or potential for harm” to the patient, despite her heavy sedation. As a result, he said, “there’s nothing about this that would deter this facility from doing this again.”

    Representatives of Hialeah Shores declined to comment.

    Seven of the 52 homes on the inspector general’s list were owned by a large Texas company, Daybreak Venture. At four of those homes, the official rate of antipsychotic drug use for long-term residents was zero, while the actual rate was much higher, according to the Times analysis comparing official C.M.S. figures with unpublished data obtained by the California advocacy group.

    make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.

    But prescriptions of Depakote and similar anti-seizure drugs have accelerated since the government started publicly reporting nursing homes’ use of antipsychotics.

    Between 2015 and 2018, the most recent data available, the use of anti-seizure drugs rose 15 percent in nursing home residents with dementia, according to an analysis of Medicare insurance claims that researchers at the University of Michigan prepared for The Times.

    in a “sprinkle” form that makes it easy to slip into food undetected.

    “It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.

    In the early 2000s, Depakote’s manufacturer, Abbott Laboratories, began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as “chemical restraints,” according to a federal whistle-blower lawsuit filed by a former Abbott saleswoman.

    According to the lawsuit, Abbott’s representatives told pharmacists and nurses that Depakote would “fly under the radar screen” of federal regulations.

    Abbott settled the lawsuit in 2012, agreeing to pay the government $1.5 billion to resolve allegations that it had improperly marketed the drugs, including to nursing homes.

    Nursing homes are required to report to federal regulators how many of their patients take a wide variety of psychotropic drugs — not just antipsychotics but also anti-anxiety medications, antidepressants and sleeping pills. But homes do not have to report Depakote or similar drugs to the federal government.

    “It is like an arrow pointing to that class of medications, like ‘Use us, use us!’” Dr. Maust said. “No one is keeping track of this.”

    published a brochure titled “Nursing Homes: Times have changed.”

    “Nursing homes have replaced restraints and antipsychotic medications with robust activity programs, religious services, social workers and resident councils so that residents can be mentally, physically and socially engaged,” the colorful two-page leaflet boasted.

    Last year, though, the industry teamed up with drug companies and others to push Congress and federal regulators to broaden the list of conditions under which antipsychotics don’t need to be publicly disclosed.

    “There is specific and compelling evidence that psychotropics are underutilized in treating dementia and it is time for C.M.S. to re-evaluate its regulations,” wrote Jim Scott, the chairman of the Alliance for Aging Research, which is coordinating the campaign.

    The lobbying was financed by drug companies including Avanir Pharmaceuticals and Acadia Pharmaceuticals. Both have tried — and so far failed — to get their drugs approved for treating patients with dementia. (In 2019, Avanir agreed to pay $108 million to settle charges that it had inappropriately marketed its drug for use in dementia patients in nursing homes.)

    Ms. Blakeney said that only after hiring a lawyer to sue Dundee Manor for her husband’s death did she learn he had been on Haldol and other powerful drugs. (Dundee Manor has denied Ms. Blakeney’s claims in court filings.)

    During her visits, though, Ms. Blakeney noticed that many residents were sleeping most of the time. A pair of women, in particular, always caught her attention. “There were two of them, laying in the same room, like they were dead,” she said.

    In his first few months at Dundee Manor, Mr. Blakeney was in and out of the hospital, for bedsores, pneumonia and dehydration. During one hospital visit in December, a doctor noted that Mr. Blakeney was unable to communicate and could no longer walk.

    “Hold the patient’s Ambien, trazodone and Zyprexa because of his mental status changes,” the doctor wrote. “Hold his Haldol.”

    Mr. Blakeney continued to be prescribed the drugs after he returned to Dundee Manor. By April 2017, the bedsore on his right heel — a result, in part, of his rarely getting out of bed or his wheelchair — required the foot to be amputated.

    In June, after weeks of fruitless searching for another nursing home, Ms. Blakeney found one and transferred him there. Later that month, he died.

    “I tried to get him out — I tried and tried and tried,” his wife said. “But when I did get him out, it was too late.”

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    Companies Stay Quiet on Texas’ New Abortion Law

    On Friday, some Silicon Valley technology companies began speaking out, too.

    Lyft’s chief executive, Logan Green, said the company would pay the legal costs of any drivers who faced lawsuits under the law. “TX SB8 threatens to punish drivers for getting people where they need to go — especially women exercising their right to choose,” he wrote on Twitter.

    Uber’s chief executive, Dara Khosrowshahi, said on Twitter that his company would also cover its drivers’ legal expenses.

    And Jeremy Stoppelman, the chief executive of Yelp, issued a statement. “The effective ban on abortions in Texas not only infringes on women’s rights to reproductive health care, but it puts their health and safety at greater risk,” he said. “We are deeply concerned about how this law will impact our employees in the state.”

    A couple executives tried to find a middle ground, cheering on democracy and opposing discrimination while remaining silent on the Texas law.

    Mr. Musk, who said he has moved to Texas and was investing a lot in the state through Tesla and SpaceX, was among them. “In general, I believe government should rarely impose its will upon the people, and, when doing so, should aspire to maximize their cumulative happiness,” he wrote on Twitter in response to Mr. Abbott’s comments. “That said, I would prefer to stay out of politics.”

    Hewlett Packard Enterprise, based in Houston, declined to comment on the ban, but said the company “encourages our team members to engage in the political process where they live and work and make their voices heard through advocacy and at the voting booth.”

    A spokesman for the company added that its medical plan allowed employees to seek abortions out of state, and would pay for lodging for such a trip.

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    Live Updates: Security Threats at Kabul Airport Prompt Multiple Warnings

    U.S. Embassy warned Americans to stay away from the Kabul airport and told anyone outside the perimeter to “leave immediately,” citing unnamed security threats.

    The British and Australian governments issued similar warnings, with Australian officials describing “an ongoing and very high threat of terrorist attack.”

    The warnings came as the last of the estimated 1,500 Americans and countless other foreigners still in Afghanistan try to make it to the airport to leave before the U.S. withdrawal on Aug. 31. Thousands of Afghan nationals are camped outside the perimeter of the airport in desperate attempts to escape on the last flights out, some with documents allowing them to leave.

    A senior U.S. official, who spoke on the condition of anonymity about confidential assessments, confirmed that the United States was tracking a “specific” and “credible” threat at the airport from the Islamic State affiliate in Afghanistan, which has carried out dozens of attacks in recent years, many targeting ethnic minorities and other civilians.

    The U.S. Embassy in Kabul cited three areas of particular concern in its advisory.

    “U.S. citizens who are at the Abbey Gate, East Gate, or North Gate now should leave immediately,” the statement said, without further detail.Marise Payne, Australia’s foreign minister, said at a news conference Thursday that the Taliban will allow Australian citizens and visa holders to leave safely but added, “Our travel advice remains: You should not come to Hamid Karzai airport because it is not safe to do so, and if you are in Kabul, you should shelter in place, move to a safe location and await further advice.”

    The U.S. government has been warning about potential security threats at the airport, and access to the airport has been adjusted accordingly, with some gates temporarily closed.

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    Blinken Provides Update on U.S. Rescue Mission in Afghanistan

    Secretary of State Antony J. Blinken gave details on the number of U.S. citizens and Afghan nationals rescued so far, as well as the number of Americans still in Afghanistan who want to leave.

    Since Aug. 14, more than 82,300 people have been safely flown out of Kabul. In the 24-hour period from Tuesday to Wednesday, approximately 19,000 people were evacuated on 90 U.S. military and coalition flights. Our first priority is the evacuation of American citizens. Since Aug. 14, we have evacuated at least 4,500 U.S. citizens, and likely more. More than 500 of those Americans were evacuated in just the last day alone. Now, many of you have asked how many U.S. citizens remain in Afghanistan who want to leave the country. Based on our analysis, starting on Aug. 14, when our evacuation operations began, there was then a population of as many as 6,000 American citizens in Afghanistan who wanted to leave. Over the last 10 days, roughly 4,500 of these Americans have been safely evacuated, along with immediate family members. Over the past 24 hours, we’ve been in direct contact with approximately 500 additional Americans and provided specific instructions on how to get to the airport safely. From my perspective, from the president’s perspective, this effort does not end on Aug. 31. It will continue for as long as it takes to help get people out of Afghanistan who wish to leave.

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    Secretary of State Antony J. Blinken gave details on the number of U.S. citizens and Afghan nationals rescued so far, as well as the number of Americans still in Afghanistan who want to leave.CreditCredit…Victor J. Blue for The New York Times

    WASHINGTON — About 1,500 American citizens remain in Afghanistan, and about a third of them are in contact with the U.S. government and hope to leave in the coming days, Secretary of State Antony J. Blinken said on Wednesday.

    Some of the remaining 1,000 may not want to leave, Mr. Blinken said, describing an ever-changing estimate that the Biden administration has tried to pin down as American troops wind down an evacuation effort that has overwhelmed the airport in Kabul, the capital.

    That number does not include legal permanent American residents or green card holders, he said.

    Mr. Blinken said more than 4,500 U.S. citizens have so far been flown out of Afghanistan since Aug. 14, as the Taliban bore down on Kabul. He said the State Department has sent more than 20,000 emails and made 45,000 phone calls to identify and locate Americans in Afghanistan ahead of an Aug. 31 withdrawal of U.S. troops from the country after 20 years of war.

    But Mr. Blinken sought to assure that any Americans or Afghans who have worked with the U.S. mission and want to leave after that date should be free to do so. “That effort will continue every day,” he said.

    U.S. and allied planes flew an additional 19,200 people out of Kabul in the past 24 hours, officials said on Wednesday, as the Biden administration made substantial inroads into evacuating American citizens and Afghans who worked for the United States over the last 20 years.

    More than 10,000 people were still inside the international airport in Kabul awaiting flights out of the country on Wednesday, and Afghans with proper credentials continued to be cleared into the airfield, Pentagon officials said.

    With President Biden’s Aug. 31 deadline for the withdrawal of American troops rapidly approaching, tens of thousands of Afghans who qualify for special immigration visas are also waiting to be evacuated.

    As of 3 a.m. in Washington, the United States had evacuated about 82,300 people from Kabul’s international airport since the government fell to Taliban forces.

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    ‘We Are Working as Fast as We Can’: U.S. Rushes Evacuations

    A Pentagon spokesman said U.S. and allied forces would work “all the way to the end” to evacuate Americans and vulnerable Afghans from Kabul, but that the priority would shift to flying out American troops and equipment in the mission’s final days.

    Ninety flights total yesterday that left the Kabul airport, that is accounted for 19,000 evacuees now safely out of Afghanistan within a 24-hour period. Since the U.S. and coalition forces began the evacuation, to date, approximately 88,000 have safely departed from Afghanistan. We will continue to evacuate needed populations all the way to the end. If if, if we have to, and we need to, if you’re an evacuee, that we can get out, we’re going to continue to get you out right up until the end. But in those last couple of days, we’re going to try to preserve as much capability as we can at the airport, as you might imagine. So in those last couple of days, we will begin to prioritize military capabilities and military resources to move out. That doesn’t mean that if you’re an evacuee and you need to get out, that we’re not going to try to get you out, but that we will have to reserve some capacity in those last couple of days to prioritize the military footprint leaving. We know there are a lot of desperate people who want to leave, and that’s why we are working as fast as we can. And you saw the numbers that we continue to be able to get out. We’re working as fast as we can to get out American citizens, Special Immigrant Visa applicants and vulnerable Afghans.

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    A Pentagon spokesman said U.S. and allied forces would work “all the way to the end” to evacuate Americans and vulnerable Afghans from Kabul, but that the priority would shift to flying out American troops and equipment in the mission’s final days.CreditCredit…Victor J. Blue for The New York Times

    John F. Kirby, the chief Pentagon spokesman, told reporters that American officers in Kabul, including the top commander, Rear Adm. Peter G. Vaseley, were talking daily with Taliban counterparts to ensure safe passage of Americans and Afghan allies with proper credentials.

    Experts predict that hundreds of thousands of Afghans will be targeted by the Taliban if they stay, including Afghan security forces, government officials, women’s rights advocates and other defenders of democracy. Those Afghans are desperately hoping to join the U.S. military’s airlift before it begins to wind down, potentially as soon as this weekend.

    For the third time in a week, American military helicopters rescued Americans inside Kabul. On Tuesday, about 20 American citizens who were flown onto the airfield from a location inside the city, Maj. Gen. William Taylor told reporters. A similar flight rescued 169 Americans from a Kabul hotel meeting place last week.

    Though Mr. Biden has vowed to stick to the Aug. 31 exit plan, as the Taliban have demanded, he also has instructed Mr. Blinken and Defense Secretary Lloyd J. Austin to draw up plans to push back the date if necessary.

    The Taliban have warned of potential reprisals should the United States renege on its promise to withdraw its forces by the deadline, and Mr. Biden on Tuesday noted the danger to American troops should they remain much longer.

    Beyond the Taliban, extremists affiliated with the Islamic State are also believed to pose a threat to the evacuation effort that has drawn crowds of people to Kabul’s airport gates, clamoring to be allowed on one of the flights that are departing every 45 minutes.

    “I’m determined to ensure that we complete our mission,” Mr. Biden said at the White House on Tuesday. “I’m also mindful of the increasing risks that I’ve been briefed on and the need to factor those risks in. There are real and significant challenges that we also have to take into consideration.”

    But the dwindling hours are weighing heavily on the minds of people seeking to flee Afghanistan and members of Congress who want the United States to retain a presence there until Americans and high-risk Afghans can get out.

    The Pentagon spokesman, Mr. Kirby, said that the military would put high priority on flying out American troops and equipment in the mission’s final days. “There will be a transition more toward getting military assets out as we get closer to the end, but again, we’re going to continue to work the evacuation mission right up until the last day,” he said.

    Zabihullah Mujahid, a senior Taliban official, after a briefing in the Ministry of Information and Culture in Kabul on Tuesday.
    Credit…Jim Huylebroek for The New York Times

    KABUL, Afghanistan — In his first sit-down interview with a Western media outlet since the Taliban took full control of Afghanistan, one of the group’s leaders on Wednesday offered a portrait of a group intent on rebuilding a country shattered by decades of war.

    “We want to build the future, and forget what happened in the past,” the spokesman, Zabihullah Mujahid, said in an interview with The New York Times. He rejected widespread fears that the Taliban are already exacting vengeance on those who opposed them and want to reimpose the harsh controls on women that made them notorious when they ruled the country 20 years ago.

    The interview came just a day after Mr. Mujahid warned the women of Afghanistan that it might be safest for them to remain home until more rank-and-file Taliban fighters have been trained in how not to mistreat them.

    It was a notable acknowledgment of the many changes to Afghan society that greeted the Taliban when they re-entered a city they had not controlled for two decades.

    Many of those changes involve women. Not only have they been free to leave home unaccompanied — dressed as they see fit — they have also returned to school and jobs, and their images can be seen on everything from billboards to TV screens.

    On Wednesday, Mr. Mujahid suggested that longer-term, women would be free to resume their daily routines.

    Concerns that the Taliban would once again force them to stay in their homes or cover their faces are baseless, he said. He added that the requirement they be accompanied by a male guardian, known as a mahram, was misunderstood. It applies only to journeys of three days or longer, he said.

    “If they go to school, the office, university, or the hospital, they don’t need a mahram,” said Mr. Mujahid, who also serves as the Taliban’s chief spokesman.

    He also offered assurances to Afghans trying to leave the country, saying — contrary to news reports based on his news conference on Tuesday, including in The Times — that those with valid travel documents would not be prevented from entering the airport.

    “We said that people who don’t have proper documents aren’t allowed to go,” Mr. Mujahid said. “They need passports and visas for the countries they’re going to, and then they can leave by air. If their documents are valid, then we’re not going to ask what they were doing before.”

    He also denied allegations that the Taliban have been searching for former interpreters and others who worked for the American military, and claimed that they would be safe in their own country. And he expressed frustration at the Western evacuation efforts.

    “They shouldn’t interfere in our country and take out our human resources: doctors, professors and other people we need here,” Mr. Mujahid said. “In America, they might become dishwashers or cooks. It’s inhuman.”

    For the past decade, Mr. Mujahid had been a key link between the militants and the news media, but remained faceless. On Wednesday, he granted the interview at the Ministry of Information and Culture as Taliban leaders and other Afghan power brokers were engaging in protracted discussions about the future shape of the country.

    Mr. Mujahid is seen as likely to be the future minister of information and culture. Fluent in both Pashto and Dari, the country’s principal languages, Mr. Mujahid, 43, described himself as a native of Paktia Province and a graduate in Islamic jurisprudence from the well-known Darul Uloom Haqqania madrasa in Pakistan.

    Despite the tense situation at the airport on Wednesday, where thousands of people were still crowded around most entrance gates, Mr. Mujahid expressed hope that the Taliban would build good relations with the international community, pointing out areas of cooperation around counterterrorism, opium eradication and the reduction of refugees to the West.

    Although he sought to convey a much more tolerant image of the Taliban, Mr. Mujahid did confirm one report: Music will not be allowed in public.

    “Music is forbidden in Islam,” he said, “but we’re hoping that we can persuade people not to do such things, instead of pressuring them.”

    Matthieu Aikins and

    Selling bread on a street in Kabul on Saturday.
    Credit…Victor J. Blue for The New York Times

    The Americans are all but gone, the Afghan government has collapsed and the Taliban now rule the streets of Kabul. Overnight, millions of Kabul residents have been left to navigate an uncertain transition after 20 years of U.S.-backed rule.

    Government services are largely unavailable. Residents are struggling to lead their daily lives in an ecconomy that, propped up for the past generation by American aid, is now in free fall. Banks are closed, cash is growing scarce, and food prices are rising.

    Yet relative calm has reigned over Kabul, the capital, in sharp contrast to the chaos at its airport. Many residents are hiding in their homes or venturing out only cautiously to see what life might be like under their new rulers.

    Even residents who said they feared the Taliban were struck by the relative order and quiet, but for some the calm has been ominous.

    A resident named Mohib said that streets were deserted in his section of the city, with people hunkering down in their homes, “scared and terrorized.”

    “People feel the Taliban may come any moment to take away everything from them,” he said.

    Outside the international airport in Kabul on Wednesday. The biggest immediate threat to the Americans and the Taliban as the United States escalates its evacuation is ISIS-K, the Islamic State’s affiliate in Afghanistan.
    Credit…Jim Huylebroek for The New York Times

    WASHINGTON — The United States has been battling the Taliban and their militant partners in Afghanistan, Al Qaeda and the Haqqani network, for 20 years.

    But the biggest immediate threat to both the Americans and the Taliban as the United States escalates its evacuation at the Kabul airport before an Aug. 31 withdrawal deadline is a common rival that is lesser known: Islamic State Khorasan, or ISIS-K, the terrorist group’s affiliate in Afghanistan.

    Created six years ago by disaffected Pakistani Taliban, ISIS-K has carried out dozens of attacks in Afghanistan this year. American military and intelligence analysts say threats from the group include a bomb-laden truck, suicide bombers infiltrating the crowd outside Hamid Karzai International Airport and mortar strikes against the airfield.

    These threats, coupled with new demands by the Taliban for the United States to leave by Aug. 31, probably influenced President Biden’s decision on Tuesday to stick to that deadline. “Every day we’re on the ground is another day we know that ISIS-K is seeking to target the airport and attack both U.S. and allied forces and innocent civilians,” Mr. Biden said.

    The threats lay bare a complicated dynamic between the Taliban, Al Qaeda and the Haqqani network, and their bitter rival, ISIS-K, in what analysts say portends a bloody struggle involving thousands of foreign fighters on both sides.

    A United Nations report in June concluded that 8,000 to 10,000 fighters from Central Asia, the North Caucasus region of Russia, Pakistan and the Xinjiang region in western China have poured into Afghanistan in recent months. Most are associated with the Taliban or Al Qaeda, the report said, but others are allied with ISIS-K.

    “Afghanistan has now become the Las Vegas of the terrorists, of the radicals and of the extremists,” said Ali Mohammad Ali, a former Afghan security official. “People all over the world, radicals and extremists, are chanting, celebrating the Taliban victory. This is paving the way for other extremists to come to Afghanistan.”

    Adam Nossiter contributed reporting from Paris.

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    Chancellor Angela Merkel said that Germany would continue to support Afghans remaining in the country after the U.S. withdraws troops and ends its evacuation mission.CreditCredit…Tobias Schwarz/Agence France-Presse — Getty Images

    Germany will maintain support for Afghans who remain in their country after the deadline for the U.S. troop withdrawal and evacuation mission passes in six days, Chancellor Angela Merkel said on Wednesday. She also called for talks with the Taliban to preserve progress made in Afghanistan in the last two decades.

    Speaking to a session of Parliament convened to discuss the Taliban’s rapid takeover of Afghanistan, the chancellor defended Germany’s decision to join the international intervention there in 2001.

    “Our goal must be to preserve as much as possible what we have achieved in terms of changes in Afghanistan in the last 20 years,” Ms. Merkel told lawmakers. “This is something the international community must talk about with the Taliban.”

    She cited changes such as improved access to basic necessities, with 70 percent of Afghans now having access to clean drinking water and 90 percent having access to electricity, in addition to better health care for women.

    “But what is clear is that the Taliban are reality in Afghanistan and many people are afraid,” Ms. Merkel said. “This new reality is bitter, but we must come to terms with it.”

    Germany pulled its last contingent of soldiers, about 570 troops, out of Afghanistan in June, but several hundred Germans were still engaged in development work funded by Berlin, and the German government believed they would be able to remain in Afghanistan after the withdrawal of U.S. and international forces.

    Ms. Merkel defended her government’s decision to leave development workers on the ground, saying that they had hoped to continue to provide essential support for Afghans after the troop withdrawal, and that an earlier retreat could have appeared as if they were abandoning people.

    “At that time there were very good reasons to stand beside the people in Afghanistan after the troops were gone,” Ms. Merkel said.

    But the opposition leaders criticized her government for not developing a plan to bring people to safety in the spring, when other European countries were evacuating citizens and Afghan support staff.

    “The situation in Afghanistan is a catastrophe, but it did not come out of nowhere,” said Christian Lindner, the head of the Free Democratic Party, which together with the Green Party petitioned Parliament in June to begin evacuations of German staff and Afghans who could be in danger.

    Ms. Merkel did not apologize, instead calling for a deeper examination of where the West went wrong in Afghanistan and what lessons could be learned. That will be the work of the next government, as she is stepping down after the German elections on Sept. 26.

    “Many things in history take a long time. That is why we must not and will not forget Afghanistan,” said Ms. Merkel, who was raised in communist East Germany.

    “Even if it doesn’t look like it in this bitter hour,” she said, “I remain convinced that no force or ideology can resist the drive for justice and peace.”

    A C-17 military transport plane taking off from the international airport in Kabul, Afghanistan, on Saturday.
    Credit…Jim Huylebroek for The New York Times

    When President Biden briefly referred to the Berlin airlift — the operation 73 years ago to feed a city whose access had been choked off by the Soviet Union — in describing the United States’ evacuation efforts in Afghanistan, he was revealing the inspiration for a broader plan to redeem America’s messy exit.

    After 10 days of missed signals, desperate crowds and violence around Hamid Karzai International Airport in Kabul, Mr. Biden and his team are eager to shift the narrative about the chaotic end of America’s longest war.

    Jake Sullivan, his national security adviser, said on Monday that the scores of rescue flights the United States was initiating each day were likely to be regarded as “one of the largest airlifts in history.”

    “There is no other country in the world who could pull something like this off — bar none,” he said.

    As of Tuesday evening, 12,000 people had been evacuated from Kabul during the previous 12 hours, Biden said. That brought the total number evacuated since the end of July to 75,900 people, the president said.

    The comparison to the rescue operation in Berlin is not a bad one. Berlin had been divided since the end of World War II, and tensions were growing. The United States and Britain took to the sky to carry in material by plane.

    The two countries managed to get just shy of 300,000 flights into Berlin over 11 months, from June 24, 1948, to May 11, 1949, and the State Department’s record notes that “at the height of the campaign, one plane landed every 45 seconds at Tempelhof Airport,” which until recently was Berlin’s main air hub.

    People protest the situation in Afghanistan in front of the European headquarters of the United Nations in Geneva last week.
    Credit…Martial Trezzini/KEYSTONE, via Associated Press

    The United Nations leadership faced growing anger from staff unions Wednesday over what some called its failure to protect Afghan co-workers and their families, who remain stuck in Afghanistan at the mercy of the Taliban even as the majority of the organization’s non-Afghan staff have been relocated to other countries.

    Many of the Afghan employees, their foreign colleagues say, are in hiding or are reluctant to keep working, fearful of reprisals by triumphant Taliban militants who may perceive them as apostates, traitors and agents of foreign interference.

    That fear has persisted even though the Taliban’s hierarchy has indicated that the U.N. should be permitted to work in the country unimpeded during and after the forces of the United States and NATO withdraw, a pullout that is officially scheduled for completion in less than a week.

    An internal U.N. document reported by Reuters on Wednesday said Taliban operatives had detained and beaten some Afghan employees of the United Nations. Stéphane Dujarric, a spokesman for Secretary General António Guterres, did not confirm or deny the report but said it was “critical is that the authorities in charge in Kabul and throughout Afghanistan realize that they have the responsibility to protect U.N. premises and for the safety of U.N. staff.”

    Mr. Guterres has repeatedly said the U.N. fully supports the Afghan staff, who are said to number between 3,000 and 3,400, and that he is doing everything in his power to ensure their safety. Mr. Dujarric said about 10 percent of those Afghan workers are women, who are especially at risk of facing Taliban repression.

    The secretary general reiterated his assurances during a private virtual town hall meeting on Wednesday with staff members, said Mr. Dujarric, who told reporters that Mr. Guterres “understands the staff’s deep anxiety about what the future holds.”

    But rank-and-file staff members of the United Nations have grown increasingly skeptical of Mr. Guterres’s pronouncements. A resolution passed on Tuesday by the U.N. staff union in New York urged Mr. Guterres to take steps that would enable Afghan staff members to avoid “unacceptable residual risks by using evacuation from Afghanistan as soon as possible.”

    U.N. officials have said they are powerless to issue visas to Afghan personnel without cooperation from other countries willing to host them. U.N. officials also have said the organization remains committed to providing services in Afghanistan, where roughly half the population needs humanitarian aid. Such services, including food and health care, are impossible to conduct without local staff.

    The town hall was held a few days after a second batch of non-Afghan U.N. staff had been airlifted from Kabul. Many of the roughly 350 non-Afghan U.N. personnel who had been in the country, including Deborah Lyons, head of the U.N. Assistance Mission for Afghanistan, are now working remotely from Almaty, Kazakhstan.

    The unequal treatment of non-Afghan and Afghan personnel working for the U.N. has become an increasingly bitter sore point between management and staff at the global organization. An online petition started this past weekend by staff union members calling on Mr. Guterres to do more to help Afghan employees and their families had, as of Wednesday, garnered nearly 6,000 signatures.

    Correction: 

    An earlier version of this item misidentified the U.N. staff union organization that passed a resolution urging the U.N. secretary general to help Afghan employees evacuate Afghanistan. It was the U.N. staff union in New York, not the coordinating committee of the association of staff unions.

    A defaced beauty shop window display in Kabul on Sunday.
    Credit…Victor J. Blue for The New York Times

    When the Taliban were last in power, Afghan women were generally not allowed to leave their homes except under certain narrowly defined conditions. Those who did risked being beaten, tortured or executed.

    In the days since the Taliban swept back into control, their leaders have insisted that this time will be different. Women, they say, will be allowed to work. Girls will be free to attend school. At least within the confines of their interpretation of Islam.

    But early signs have not been promising, and that pattern continued on Tuesday with a statement from a Taliban spokesman that women should stay home, at least for now. Why? Because some of the militants have not yet been trained not to hurt them, he said.

    The spokesman, Zabihullah Mujahid, called it a “temporary” policy intended to protect women until the Taliban could ensure their safety.

    “We are worried our forces who are new and have not been yet trained very well may mistreat women,” Mr. Mujahid said. “We don’t want our forces, God forbid, to harm or harass women.”

    Mr. Mujahid said that women should stay home “until we have a new procedure,” and that “their salaries will paid in their homes.”

    His statement echoed comments from Ahmadullah Waseq, the deputy of the Taliban’s cultural affairs committee, who told The New York Times this week that the Taliban had “no problem with working women,” as long as they wore hijabs.

    But, he said: “For now, we are asking them to stay home until the situation gets normal. Now it is a military situation.”

    During the first years of Taliban rule, from 1996 to 2001, women were forbidden to work outside the home or even to leave the house without a male guardian. They could not attend school, and faced public flogging if they were found to have violated morality rules, like one requiring that they be fully covered.

    The claim that restrictions on women’s lives are a temporary necessity is not new to Afghan women. The Taliban made similar claims the last time they controlled Afghanistan, said Heather Barr, the associate director of women’s rights at Human Rights Watch.

    “The explanation was that the security was not good, and they were waiting for security to be better, and then women would be able to have more freedom,” she said. “But of course in those years they were in power, that moment never arrived — and I can promise you Afghan women hearing this today are thinking it will never arrive this time either.”

    Brian Castner, a senior crisis adviser at Amnesty International who was in Afghanistan until last week, said that if the Taliban intended to treat women better, they would need to retrain their forces. “You can’t have a movement like the Taliban that has operated a certain way for 25 years and then just because you take over a government, all of the fighters and everyone in your organization just does something differently,” he said.

    But, Mr. Castner said, there is no indication that the Taliban intend to fulfill that or any other promises of moderation. Amnesty International has received reports of fighters going door to door with lists of names, despite their leaders’ public pledges not to retaliate against Afghans who worked with the previous government.

    “The rhetoric and the reality are not matching at all, and I think that the rhetoric is more than just disingenuous,” Mr. Castner said. “If a random Taliban fighter commits a human rights abuse or violation, that’s just kind of random violence, that’s one thing. But if there’s a systematic going to people’s homes and looking for people, that’s not a random fighter that’s untrained — that’s a system working. The rhetoric is a cover for what’s really happening.”

    In Kabul on Wednesday, women in parts of the city with minimal Taliban presence were going out “with normal clothes, as it was before the Taliban,” said a resident named Shabaka. But in central areas with many Taliban fighters, few women ventured out, and those who did wore burqas, said Sayed, a civil servant.

    Ms. Barr, of Human Rights Watch, said that in the week since the Taliban said the new government would preserve women’s rights “within the bounds of Islamic law,” the Afghan women she has spoken to offered the same skeptical assessment: “They’re trying to look normal and legitimate, and this will last as long as the international community and the international press are still there. And then we’ll see what they’re really like again.”

    It might not take long, Ms. Barr suggested.

    “This announcement just highlights to me that they don’t feel like they need to wait,” she said.

    The New York Times’s Afghanistan staff and their families arriving at Benito Juárez International Airport in Mexico City on Wednesday.
    Credit…Azam Ahmed/The New York Times

    A group of Afghans who worked for The New York Times, along with their families, touched down safely early Wednesday — not in New York or Washington, but at Benito Juárez International Airport in Mexico City.

    Mexican officials, unlike their counterparts in the United States, were able to cut through the red tape of their immigration system to quickly provide documents that, in turn, allowed the Afghans to fly from Kabul’s embattled airport to Qatar.

    The documents promised that the Afghans would receive temporary humanitarian protection in Mexico while they explored further options in the United States or elsewhere.

    “We are right now committed to a foreign policy promoting free expression, liberties and feminist values,” Mexico’s foreign minister, Marcelo Ebrard, said in a telephone interview.

    He cited a national tradition of welcoming people including the 19th-century Cuban independence leader José Martí, German Jews and South Americans fleeing coups, and he said that Mexico had opened its doors to the Afghan journalists “in order to protect them and to be consistent with this policy.”

    But the path of the Afghan journalists and their families to Mexico was as arbitrary, personal and tenuous as anything else in the frantic and scattershot evacuation of Kabul.

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    A group of former mujahedeen fighters and Afghan Army commandos rallied 70 miles north of Kabul in the Panjshir Valley, the last area of Afghanistan not under Taliban control.CreditCredit…Jim Huylebroek for The New York Times

    Just days after the Taliban swept into Kabul and toppled Afghanistan’s government, a group of former mujahedeen fighters and Afghan commandos said they had begun a war of resistance in the last area of the country that is not under Taliban control: a narrow valley with a history of repelling invaders.

    The man leading them is Ahmad Massoud, the 32-year-old son of the storied mujahedeen commander Ahmad Shah Massoud. And their struggle faces long odds: The resistance fighters are surrounded by the Taliban, have supplies that will soon start dwindling and have no visible outside support.

    For now the resistance has merely two assets: the Panjshir Valley, 70 miles north of Kabul, which has a history of repelling invaders, and the legendary Massoud name.

    Spokesmen for Ahmad Massoud insist that he has attracted thousands of soldiers to the valley, including remnants of the Afghan Army’s special forces and some of his father’s experienced guerrilla commanders, as well as activists and others who reject the Taliban’s Islamic Emirate.

    The spokesmen, some of whom were with him in the Panjshir Valley and some who were outside the country drumming up support, said that Mr. Massoud has stocks of weapons and matériel, including American helicopters, but needs more.

    ‘‘We’re waiting for some opportunity, some support,” said Hamid Saifi, a former colonel in the Afghan National Army, and now a commander in Mr. Massoud’s resistance, who was reached in the Panjshir Valley by telephone on Sunday. “Maybe some countries will be ready for this great work. So far, all countries we talked to are quiet. America, Europe, China, Russia, all of them are quiet.’’

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    Pelosi: ‘Real Concern’ Over Lawmakers’ Kabul Trip

    Speaker Nancy Pelosi urged lawmakers not to travel to Afghanistan against government advisement, after Representatives Seth Moulton and Peter Meijer, both veterans, secretly flew to Kabul unauthorized to witness evacuations.

    There’s a real concern about members being in the region. And so, with the, shall we say, shall we say, knowledge of the Secretary of Defense as to what the risk would be to these members, the resources necessary to facilitate their visit and to protect them was an opportunity cost of what we needed to do to be evacuating as many people as possible. Point is, is that we don’t want anybody to think that this was a good idea and that they should try to follow suit. Again, I haven’t — I’ve been busy — it’s an important thing we want to make sure they were safe for themselves, but also for what consequences could flow and ramification if something happened to them while they were there. So they have to make their own case as to why they went and this or that. But it is, it was not, in my view, a good idea.

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    Speaker Nancy Pelosi urged lawmakers not to travel to Afghanistan against government advisement, after Representatives Seth Moulton and Peter Meijer, both veterans, secretly flew to Kabul unauthorized to witness evacuations.CreditCredit…Victor J. Blue for The New York Times

    Two members of Congress secretly flew to Kabul without authorization on Tuesday to witness the frenzied evacuation of Americans and Afghans, infuriating Biden administration officials and prompting Speaker Nancy Pelosi to urge other lawmakers not to follow their example.

    The two members — Representatives Seth Moulton, Democrat of Massachusetts, and Peter Meijer, Republican of Michigan, both veterans — said in a statement that the purpose of their trip was “to provide oversight on the executive branch.” Both lawmakers have blistered the Biden administration in recent weeks, accusing top officials of dragging their feet on evacuating American citizens and Afghan allies.

    “There is no place in the world right now where oversight matters more,” they said.

    Credit…Erin Schaff for The New York Times
    Credit…Anna Moneymaker for The New York Times

    But administration officials were furious that Mr. Moulton and Mr. Meijer had entered Afghanistan on an unauthorized, undisclosed trip, arguing that efforts to tend to the lawmakers had drained resources badly needed to help evacuate those already in the country.

    The trip was reported earlier by The Associated Press.

    Mr. Moulton and Mr. Meijer said that they had left Afghanistan “on a plane with empty seats, seated in crew-only seats to ensure that nobody who needed a seat would lose one because of our presence,” and that they had taken other steps to “minimize the risk and disruption to the people on the ground.” They were in Kabul for less than 24 hours.

    Still, Ms. Pelosi pressed other lawmakers not to do the same.

    “Member travel to Afghanistan and the surrounding countries would unnecessarily divert needed resources from the priority mission of safely and expeditiously evacuating Americans and Afghans at risk from Afghanistan,” Ms. Pelosi wrote in a letter. She did not refer to Mr. Moulton and Mr. Meijer by name.

    In their statement on Tuesday night, the congressmen sharpened their criticism of the administration’s handling of the evacuation, saying that “Washington should be ashamed of the position we put our service members in” and that the situation they had witnessed on the ground was more dire than they had expected.

    “After talking with commanders on the ground and seeing the situation here, it is obvious that because we started the evacuation so late,” they wrote, “that no matter what we do, we won’t get everyone out on time.”

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    They Still Live in the Shadow of Theranos’s Elizabeth Holmes

    Women at tech start-ups wrote to her thanking her for saying what they had been feeling, Ms. Esponnette said.

    Lola Priego, 30, the founder of Base, which offers at-home blood and saliva tests that are processed at traditional labs, hears a Theranos comparison at least once a week, she said. The references come directly or indirectly from potential partners, advisers, investors, customers and reporters, she said.

    She said she understood the need for skepticism, since new health care companies should be looked at critically to prevent malpractice. Often the comparisons stopped after people learned that Base works with Quest Diagnostics, a multinational company, for analysis of its tests.

    “But the additional bias and skepticism is challenging to overcome,” Ms. Priego said.

    The biggest blow came from a scientific adviser whom Ms. Priego said she had tried to recruit in 2019. The adviser took the meeting only to tell her that bringing technology into health care was doing a disservice to the industry, just like Theranos. It caused Ms. Priego to question whether she could hire the caliber of advisers she had hoped for.

    “It was quite demoralizing,” she said. She has since recruited six advisers.

    In July, Verge Genomics struck a three-year partnership with the pharmaceutical giant Eli Lilly to work on drugs for the treatment of amyotrophic lateral sclerosis, or A.L.S., Ms. Zhang said. The company also published a paper about its methods in a scientific journal last year and recruited a chief science officer this year.

    It was a relief to have something to show to those who were doubtful, Ms. Zhang said.

    “The most fragile part of the company is the earliest stage, when you have to buy into the people, the vision and the idea,” she said. Reflecting on Ms. Holmes and Theranos, she added, “It’s where these types of associations can be really harmful and curtail potential.”

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    Taliban Quash Afghanistan Protests, Tightening Grip on Country

    The Taliban cracked down on protests that erupted in at least four cities in Afghanistan on Thursday and rounded up opponents despite promises of amnesty, even as fearful workers stayed home and thousands of people continued a frenzied rush to leave the country.

    Even as the Taliban moved to assert control, hundreds of protesters took to the streets for a second day to rally against their rule, this time marching in Kabul, the capital, as well as other cities. Again, the Taliban met them with force, using gunfire and beatings to disperse crowds. And again the actions of Taliban foot soldiers undermined the leadership’s suggestions that, having taken power, they would moderate the brutality they have long been known for.

    The police officers who served the old government have melted away, and instead armed Taliban fighters are operating checkpoints and directing traffic, administering their notions of justice as they see fit, with little consistency from one to another.

    according to witnesses and a security assessment prepared for the United Nations. Though the Taliban have said there would be no reprisals, there have been arrests, property seizures and scattered reports of reprisal killings.

    city after city with remarkable speed once most U.S. forces had withdrawn, brushed aside the demoralized and disorganized Afghan security forces, and swept into Kabul on Sunday. Now they are learning that while conquest may have been swift, governing a vibrant, freethinking society is not so easy.

    The anti-Taliban protests have been a remarkable display of defiance of a group that has a long history of controlling communities through fear and meeting dissent with lethal force. The protests also offered evidence that while tens of thousands are now seeking escape, some of those left behind would try — for now, at least — to have a voice in the country’s direction, despite the growing crackdown.

    independence from Britain in 1919. It was not clear whether the victims had been shot or had died in a stampede.

    There were even demonstrators waving the flag in Kandahar, the southern city that is considered the birthplace of the Taliban. In the southeastern city of Khost, the group imposed a curfew, a day after demonstrations and clashes there. The protests on Thursday in Kabul included one near the presidential palace, and another that drew about 200 people before the Taliban used force to break it up.

    The events, led primarily by young men and women, were a wholly new experience for Taliban insurgents who have spent the last 20 years mostly in the mountains and rural districts of Afghanistan and Pakistan.

    Islamic Emirate of Afghanistan — the same name they used a generation ago.

    The tricolor flag flown by the collapsed government, taken down by the Taliban and replaced by their own banner, has become a repeated flash point, with people in multiple cities beaten for displaying it. On Wednesday, the Taliban fired on demonstrators waving the flag in the eastern city of Jalalabad, with reports of two or three people killed.

    she said on Twitter.

    She added that after the Taliban spokesman’s first news briefing, held on Tuesday, when he insisted that the rights of the media and women would be respected, she had not expected much good to come.

    “I had low expectations but now it has become clear that there is a gap between action and words,” Ms. Atakpal said.

    Residents of Kabul were feeling their way under the new regime gingerly. The streets were quiet, largely empty of traffic, interrupted by occasional bursts of gunfire and the roar of American military planes patrolling and conducting the round-the-clock evacuation.

    their origin story and their record as rulers.

    One woman complained that popular Turkish television serials were no longer airing, after cable companies closed down their services. The Taliban, which banned all television during their previous time in power, have since embraced media as a propaganda tool, and cable companies were already anticipating new rules on morally acceptable content in accordance with the militants’ strict interpretation of Islamic law.

    Mr. Shesta said he was deleting photos from his cellphone of him meeting with the former president, Ashraf Ghani, and other government officials, many of whom have fled the country. Mr. Ghani left the capital on Sunday, and several of his senior officials traveled to Turkey on Monday.

    At the Kabul airport, which is still controlled by U.S. troops, the Taliban are in charge outside its blast walls and used force and intimidation to control access, beating people back and firing their rifles.

    Norwegian Center for Global Analyses, cited multiple reports that the Taliban had a list of people to question and punish, as well as their locations. Military and police personnel and people who worked for investigative units of the toppled government were particularly at risk, according to the document, which was dated Wednesday.

    Already, the Taliban were going door to door and “arresting and/or threatening to kill or arrest family members of target individuals unless they surrender themselves to the Taliban,” said the document, which was seen by The New York Times.

    It contained a reproduced letter dated Aug. 16 from the Taliban to an unnamed counterterrorism official in Afghanistan who had worked with U.S. and British officials and then gone into hiding.

    The letter instructed the official to report to the Military and Intelligence Commission of the Islamic Emirate of Afghanistan in Kabul. If not, it warned, the official’s family members “will be treated based on Shariah law.”

    Victor J. Blue, Helene Cooper and Jim Huylebroek contributed reporting.

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