November 28, 2005
In Bagh and Mansehra, Doctors Without Borders/Médecins Sans Frontières (MSF) supports district hospitals disrupted by the earthquake. The organization's field hospitals there focus primarily on surgery, emergencies and intensive care with a view to enable other departments of the district hospitals (pediatrics, maternity, etc.) to start functioning again.
MSF teams are ensuring primary health care in areas where the Pakistani health structures have been severely damaged, and are following up on the situations in tented settlements where victims continue to gather. MSF's teams carry out an average of one thousand consultations every day in 12 permanent sites. The teams are discovering that poor living conditions, rather than the earthquake itself, are causing increasing numbers of pathologies.
To avoid possible outbreaks of disease, MSF is vaccinating children against measles and polio and the wounded against tetanus. The organization continues to provide mental health support to traumatized victims.
MSF is also improving hygiene conditions in settlements housing internally displaced people (IDP), of and is addressing water supply issues in several additional locations.
Distribution of relief goods (non-food items):
MSF has now completed the distribution of 8,700 family tents, 10,932 construction kits–including iron sheets, plastic sheeting and construction tools (see sidebar)–and 129,917 blankets to earthquake survivors in remote areas of Pakistani Kashmir and in the country's North West Frontier Province. Thousands of relief items such as cooking kits (11,304) and hygiene kits (25,634) have been distributed as well. These distributions will continue through the coming weeks, in order to ensure that families have a shelter for the winter.
Staff and material:
More than 120 international staff, including doctors, nurses, surgeons, psychologists, social workers, logisticians, water and sanitation experts, together with over 350 local staff, are involved with MSF's earthquake relief operations in Pakistan. The organization has already delivered more than 1,155 tons of relief goods to Pakistan, including medical items (emergency medical kits, drugs, surgical materials, dressings, plaster, dialysis machines, high-protein food, oral rehydration solution, etc.), logistical materials (especially water and sanitation materials such as tanks, pumps and water treatment units) and shelter (tents, blankets and sleeping mats). Additional relief items such as hygiene, cooking and construction kits are being purchased locally.
DETAILS OF THE OPERATIONS IN PAKISTAN
In Bagh town, MSF has set up a tented medical facility outside the compound of the collapsed district hospital. MSF's structure, made of 25 tents, includes an operation theatre, laboratory, delivery room, intensive care unit, emergency room and an approximately 40-bed in-patient department. MSF's primary activity in the hospital is surgery. MSF has agreed with the Pakistani Ministry of Health to set up as soon as possible a more permanent 50-bed hospital.
MSF is operating permanent outpatient facilities in Bagh town, Bir Pani, Mallot and Chikhar. In each one of these locations, 50 to 100 consultations are carried out every day. Mobile medical teams regularly travel to the village of Paniali, close to Bagh town, to follow up the situation in IDP settlements there.
The organization has set up permanent outpatient facilities for consultations, vaccinations and referrals in the villages of Saidpur, Hattian, Lamnian, and Chakmukam (near Lipa). Teams travel to the surrounding settlements by foot or by car. In each one of these locations, 50 to 100 consultations, including measles and tetanus vaccinations, are carried out every day.
Mobile clinics are now operating in Charakpura, Therian, Jhandgran and Timi Bhana. A permanent clinic is running in one of the IDP sites of Muzaffarabad town and a mobile team follows up the situation in other settlements of the city. A pediatric ward has been opened in Hattian, and a permanent clinic is functioning in one of the IDP settlements of the locality. A mobile medical team also performs outreach activities by car in the environs of Muzaffarabad. Rapid transport in Muzaffarabad district is facilitated by the use of two MSF helicopters.
Mansehra (1,361,032) and Batagram (319,973) districts:
The MSF team in Mansehra continues to provide care for hundreds of patients seriously injured by the earthquake. Of these patients, 145 are still hospitalized; many were operated upon in poor conditions with little or no post-operative care, giving rise to infections and additional surgery.
MSF has now completed installation of a new, 120-bed field hospital adjacent to the district hospital building in Mansehra, in order to provide quality care for patients and to avoid further complications during their recoveries. As a result, space has been freed up in the district hospital, allowing regular services to begin functioning (the massive influx of wounded had overwhelmed the hospital wards). Medical villages have been created in Mansehra town to discharge patients who no longer need hospitalization, but who still require follow up.
New field hospital set up for surgery, emergencies and in-patient facilities
The new field hospital, comprised of nine inflatable tents, is now fully functional. The hospital houses four operation theaters, an intensive care unit, an emergency room, and five, 88-bed capacity wards. Approximately 85 earthquake survivors have been transferred to the field hospital, vacating rooms in the Mansehra district hospital and allowing its pediatric and obstetric wards to resume work. An additional 60 patients are still being housed in three MSF tents set up within the district hospital compound.
Last week MSF medical teams, together with the Pakistani hospital staff, began working in the new operating theater, carrying out 34 surgical interventions. The teams are also working in the new intensive care unit and in the emergency room. A new dressing room has been set up in the undamaged hospital building, where an average of 50 patients gather every day. An MSF physiotherapist, together with a team of Pakistani volunteers, carries out rehabilitative care for patients who have undergone surgery, while an MSF psychological team works with traumatized earthquake victims.
Additionally, MSF will run a temporary outpatient department for the district hospital. MSF has also started to construct a blood bank, and has begun to restore the x-ray room, the laundry room and the rehabilitation wards.
Medical villages to discharge patients
In association with local organizations, MSF is installing medical villages inside Mansehra town, with a capacity to accommodate 25 families each. Three medical villages are already functional and several more are planned. Patients from Mansehra hospital who no longer require hospitalization but who cannot return home are transferred to these medical villages. MSF is providing tents, as well as water and sanitation equipment. Patients able to return home are provided with relief kits consisting of tents, blankets and cooking and hygiene sets. An MSF physiotherapist, psychologist and doctor conduct follow-up consultations with patients.
Mental health support:
MSF continues to provide mental health care to hundreds of traumatized victims in Muzaffarabad, Mansehra and Bagh districts:
– In Muzaffarabad district, mental health teams, including international and national staff, are working in the IDP sites of Hattian and Muzaffarabad town.
– In Bagh district, a mental health team of two psychologists provides psycho-social support to patients treated in MSF outpatient and inpatient facilities, and to their relatives. Community sessions, with the help of local social workers, are also organized.
– In Mansehra, an international volunteer and two Pakistani psychologists are working with hospital patients in a consultation tent.
Distribution of relief goods:
MSF is currently distributing family tents, plastic sheeting, construction kits, blankets and hygiene and cooking kits to thousands of affected people in Bagh, Muzaffarabad, Mansehra and Batagram districts:
– In Muzaffarabad District, 6,476 tents and more than 38,268 blankets have been distributed around the district capital and in the areas of Lamnian, Kai Manja, Hattian and Panjgran. In Panjgran, the ongoing distribution by helicopter is still hampered by irregular flight schedules. In addition, MSF has distributed 4,200 cooking kits and 18,554 hygiene kits in the district.
– In Bagh District, MSF has distributed 67,140 blankets and 6,714 construction kits–which include iron sheets, tools and plastic sheeting–and cooking and hygiene kits, to the Badhal, Bedi and Dharray regions.
– In Mansehra District, MSF teams carried out an assessment of all the tented camps in a 10 km radius around Mansehra town, in order to identify families still in need of relief supplies. MSF distributed 360 plastic sheets, 40 new tents (to replace inadequate ones), 4,250 blankets, 390 kitchen sets and 366 hygiene kits. In total, 971 families benefited from one or more of these items.
Water and sanitation:
In Muzaffarabad, MSF is closely following the living conditions in several sites. Water bladders have been set up, 700 latrines have been installed and hundreds of hygiene kits have been distributed to people in ten tented settlements. MSF is also supporting two truck water-points with chlorination capabilities.
In Hattian, MSF ensures the water supply to the hospital and performs water and sanitation activities for the town. MSF has also set up water supply and sanitation facilities for Bagh and Mansehra district hospitals.
Several water supply ramps have been installed in Bagh town and water and sanitation facilities have been established in the town's IDP sites. In Bir Pani, MSF is supervising operations to repair the village's water supply system. Similar activities have begun in Mallot.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)