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South Asian Earthquake: 6-month Overview of MSF Operations
April 21, 2006
MSF Response to the Disaster
The day after the October 8, 2005, earthquake devastated parts of Pakistani- and Indian-administered Kashmir, Doctors Without Borders/Médecins Sans Frontières (MSF) started to deliver emergency aid and rapidly organized more assistance. At the peak of MSF's intervention, from mid-October to mid-November 2005, more than 150 international and 450 national staff provided emergency care in 18 permanent sites in Pakistan and 3 in India. MSF teams brought nearly 2,000 metric tons of medical and relief supplies to these areas.
In Pakistan, MSF concentrated its relief efforts in the districts of Mansehra (
), Bagh, and Muzaffarabad (
). MSF worked in the districts of Srinagar, Baramullah, and Kupwara of
. MSF has been present in both Pakistani– and Indian– administered Kashmir since 2000.
In the immediate aftermath of the earthquake, tens of thousands of wounded were in immediate need of medical assistance. However, a lot of victims were cut off from any help as roads had been destroyed or blocked by landslides. Thousands of wounded had to be evacuated by helicopter, while others were not able to reach hospitals till several weeks later.
The massive influx of wounded people put an enormous strain on the heavily damaged health infrastructure. In the Azad Kashmir and the North–West Frontier Province of Pakistan only 199 out of 564 health facilities remained fully functional after the earthquake.2 Not only were buildings destroyed or damaged, but there was also a significant shortage of medical staff and an enormous need for medical material and equipment. Hospitals were rapidly overloaded with trauma patients, most of them requiring orthopedic care. Patients were often treated in makeshift hospitals and clinics, or along the road. Due to poor operating conditions and a lack of post-operative care many patients developed complications that later required additional surgery.
Local responders were primarily responsible for carrying out the immediate response to the emergency: the local population mobilized to rescue the injured and local health structures were the first to care for the wounded. On a national level, the health authorities deployed medical personnel from across the country to the affected areas, and the Pakistani army mobilized helicopters and carried out evacuations. People from around the country and abroad, as well as local nongovernmental organizations (NGOs) and associations, carried out donations and organized ad-hoc distributions. Foreign governments, the United Nations agencies, and foreign NGOs set up field hospitals, clinics, and carried out relief distributions. Though there was a lot of national and international mobilization, relief efforts were hampered by the remoteness of many locations, the damage to the infrastructure, and the deteriorating weather conditions.
One of the main worries was the approaching winter and the impact this would have on the people who had been left homeless. It was feared that if hundreds of thousands of people did not descend from the mountains to lower areas they wouldn’t receive enough assistance to be prepared for the cold winter months. A medical and logistical race took place to treat as many wounded people as possible and get tents, blankets, and other relief materials in place before the winter.
The destruction of roads, and the difficult mountainous terrain meant that tens of thousands of people became completely dependant on helicopters to bring basic relief items. Distributions were slow due to the limited capacity of helicopters and because the affected population was not concentrated in one place but dispersed in many villages. A fleet of helicopters from various armies, UN agencies, and private contractors were deployed for the distribution of basic relief material as well as the evacuation of the wounded. MSF also hired two helicopters in order to lessen its logistical dependency on others and set its own priorities in visiting the various project areas.
Fortunately the winter was milder than anticipated and in certain regions people came down from the mountains to settle in camps where distributions were easier to organize. Although in some areas the conditions were very harsh, there was no medical emergency due to the winter. By the end of the winter, the bulk of aid had been distributed, and the wounded had been treated. Many organizations reduced their activities or left the country.
Since the month of March and the arrival of spring, the government is organizing the return of the displaced to their villages.
MSF Relief Operations by Region
Azad Kashmir (Pakistan–administered Kashmir)
Locations where MSF provided assistance
An MSF clinic located in Muzafarrabad, Pakistan. 2006 Photo © Eddy Van Wessel
According to the federal authorities more than 40,000 people died in this part of Pakistan and another 70,000 were injured. It was by far the worst hit area, with much of the capital Muzaffarabad destroyed. Also Bagh, a town nearby, was severely damaged. Remote villages in the mountains took the hardest toll, with many of them completely destroyed or for weeks cut off from the outside world.
MSF was about to start a maternal health project in Lamnian, a small village in the mountains, when the earthquake struck. Despite considerable damage to the health structures, the MSF team that was present during the earthquake immediately re-oriented their work towards providing emergency assistance.
Within a day following the earthquake, MSF started relief efforts in Muzaffarabad, the capital of the region, and set up several clinics throughout the heavily damaged city. Within a week, 74 international MSF staff had arrived in Muzzafarabad. MSF started working in the hospital of Muzaffarabad, which also became the main hub for the distribution of medical and relief supplies into the Kashmir mountains. Four days after the quake additional resources were flown into Lamnian and nearby Hattian villages by helicopter. From Muzaffarabad more assessments were carried out in the region, including the town of Bagh, where another MSF program was opened.
Numerous official and makeshift camps for the homeless started appearing in and around Bagh and Muzzafarabad as the majority of the population of Muzzafarabad and Bagh had become homeless and thousands of homeless people from the mountains also arrived in search of assistance. MSF concentrated work primarily on the makeshift camps giving special attention to the water and sanitation needs by constructing latrines and water taps, providing water on a daily basis, and promoting hygiene.
In months following the earthquake, more roads became accessible, significantly improving access to smaller villages. Following the initial emergency response to treat the wounded and to distribute relief items, attention was given to reconstructing health facilities. MSF built a permanent hospital in Hattian, which was handed over to the Pakistani health authorities in April 2006. In Bagh, MSF set up a temporary hospital to replace the destroyed hospital in Bagh until the main hospital can be reconstructed.
Mansehra, Kaghan, Gangwal, Balakot
Referral hospital, surgery, mental health care, physiotherapy, basic health consultations; vaccinations
Distribution of tents, blankets, plastic sheeting, kitchen sets, and heaters; water-and-sanitation activities.
Patients in an MSF run clinic in Mansehra, Pakistan. April 2006. Photo © Paolo Pellegrin/Magnum Photos
Although less affected than the region of Kashmir, the earthquake also had devastating consequences in this province. Provincial government authorities estimated 38,000 deaths, although federal government estimates have been lower. The main affected towns were Balakot, Batagram, and Mansehra, as well as numerous villages in the mountains which were extremely difficult to access.
Initially, the bulk of MSF activities focused on providing relief to the population living in mountainous areas inaccessible by road. Relief items distribution, medical consultations, and measles-vaccination campaigns were carried out primarily in Kaghan Valley, and on a punctual basis in Syrian and Allai Valley.
By the end of the first month after the quake, MSF began focusing its activities on Mansehra town, where thousands of wounded were arriving. It is estimated that in Mansehra district alone, 10,000 people were severely wounded.
The Mansehra district referral hospital was partially damaged by the earthquake and was completely overloaded by the number of wounded. The wounded were housed in tents in the hospital courtyard or simply left on mattresses in the open air, as there was no more capacity to accommodate them. Under these conditions, the district hospital was unable to provide proper nursing care for the wounded. Neither was it able to fulfill its role as a referral hospital for the rest of the population in the district as all other hospital services were not functioning.
MSF set up a nine-module inflatable hospital next to the Mansehra District Hospital. The 120-bed hospital had 4 operation rooms, an emergency room and an intensive-care unit, and provided orthopedic care for the injured. Many patients had developed complications and needed additional surgery because of the lack of surgical care or post-operative care at the time of their injury. Psychosocial care and physiotherapy was also provided for the patients. Medical villages were created in Mansehra town for 100 patients and their families, in order to discharge patients who no longer needed hospitalization but still required follow up. An additional physiotherapy post was set up in Balakot for follow-up of trauma patients.
The Mansehra District Hospital was able to return to its role as a referral hospital for the district as the other hospital services (such as pediatric and maternity care) started functioning again.
By the second month after the earthquake, thousands of people came down from the mountain villages to settle around Batagram, Mansehra, and Balakot. MSF decided to focus its relief on the people living in makeshift camps along the Mansehra–Balakot road, by identifying specific needs they had in terms of access to water, sanitation facilities, heating, and basic material needs (such as tents, hygiene kits, and blankets). Distributions were carried out for more than 18,000 families living in camps.
Surgery, kidney dialysis
Coordination and forwarding of medical and non-medical staff and relief goods.
In the capital two tower blocks collapsed, killing 48 people, but the rest of the city was not damaged. Islamabad quickly became the main port of entry for foreign relief as well as the referral site for complicated injuries.
MSF provided some assistance to hospitals in Islamabad where specialized medical staff joined existing Pakistani medical teams.
Srinagar, Uri, Tangdhar
Basic health consultations; mental health consultations
Distribution of relief items; provision of clean drinking water
Despite its proximity to the epicenter, the effects of the earthquake were significantly less on the Indian-administered side of Kashmir.
According to the Indian authorities approximately 1,400 people died and around 5,000 people were injured in the Indian-administered region. Some 140,000 people were believed to be homeless. The worst affected areas were the districts of Baramullah and Kupwara, close to the Line of Control with Pakistan-administered Kashmir.
MSF worked in this part of Kashmir before the earthquake. The existing mental health project quickly expanded its work to carry out distribution of relief items and medical supplies. Some 25,000 people received assistance through the distribution of mattresses, cooking sets, tool kits, tents, and blankets. On average, MSF teams conducted 60 to 120 consultations a day when the mobile teams visited locations in Kupwara district.
For more data on MSF's medical and relief operations
In the provincial capital, MSF donated surgical material to the hospital while psychosocial counselors provided support to 400 wounded children who had been evacuated and were in shock due to the loss of family members.
1 Data according to the National Plan of Action of the Islamic Republic of Pakistan