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MSF in Pakistan, 2006
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On October 8, 2005 an earthquake measuring 7.6 on the Richter scale hit northeast Afghanistan, the north of Pakistan and northwest India. The epicenter was approximately 100 kilometres north of the Pakistani capital Islamabad, causing massive destruction in surrounding regions and killing an estimated 76,000 people.
The largest impact was in the north of Pakistan, where almost 80,000 people were wounded and another three million people were affected, many of whom instantly became homeless. The earthquake triggered a massive emergency relief operation by MSF, operating in both Pakistan and India.
In the immediate aftermath of the earthquake many victims were cut off from help, as mountain roads had been destroyed or blocked by landslides. Thousands of critically wounded had to be evacuated by helicopter, and others were not able to reach hospitals until several weeks later. The local population began to rescue injured people, and local health structures were the first to provide medical care. National health authorities deployed medical personnel from across the country whilst the Pakistani army mobilised helicopters, carried out evacuations, and loosened restrictions allowing a massive influx of international support.
The number of wounded put enormous strain on the heavily damaged health infrastructure. In the Azad Kashmir and the North Western Frontier Province of Pakistan only 199 out of 564 health facilities remained fully functional after the earthquake. Patients were often treated in makeshift hospitals and clinics, or along the road.
MSF, already present on both sides of the Line of Control between Pakistan and India-administered Kashmir, immediately switched to emergency mode. Within six months, MSF undertook over 116,000 outpatient consultations to treat minor wounds and general pathologies and to identify more severe cases for referral to inpatient facilities. Over 30,000 people were vaccinated against diseases such as measles. Three hospitals were also set up to provide surgery and post-operative care for earthquake victims in Mansehra, Bagh and Hattian. Mental health treatment was integrated from the start of the MSF intervention, with over 11,000 consultations taking place in the first few months alone.
Though many actors were involved in providing aid, relief efforts were hampered by the remoteness of many locations, the damage to the infrastructure and deteriorating weather conditions. On 119 sites MSF conducted water and sanitation activities — constructing just over 1400 latrines and distributing around 30,000 hygiene kits from October to April. Still, water and sanitation remained a major problem for those who could not yet return home.
One of the main worries was the approaching winter and its potential impact on those whose homes had been destroyed. A medical and logistical race took place to treat as many wounded people as possible and to deliver tents, blankets and other non-food items before winter. MSF sent almost 2000 tonnes of medical and relief items to the affected area, benefiting approximately 83,000 families.
A fleet of helicopters from various armies, UN agencies and private contractors were deployed to distribute basic relief material and evacuate the wounded, and MSF hired two helicopters to lessen its logistical dependency on others and set its own priorities in visiting the various project areas.
Although conditions were harsh in some areas, no new medical emergencies arose during the winter, despite the presence of some 20,000 people from the destroyed cities of Muzaffarabad, Bagh and Mansehra dependent on medical, shelter, water and sanitation assistance. MSF continued to help those in the displaced camps around Muzaffarabad and Bagh by running a hospital and clinics, trucking in water and constructing permanent latrines.
Ongoing programs throughout Pakistan
Despite the intense activity required in the aftermath of the earthquake, MSF’s regular programs in Pakistan continued throughout 2005/2006. MSF handed over its primary healthcare projects to the local Taraqee Foundation in the Mohammed Kheil Afghan refugee camp in western Baluchistan province in April 2006 after performing approximately 40,000 consultations. At the same time MSF started a project in Kuchlak, a slum at the outskirts of Quetta, where tens of thousands of Pashtuns from Afghanistan reside after having fled their country. Here MSF conducts about 130 mother and child consultations a day and screens for malnutrition.
In Kuram district, following the repatriation/ relocation of most Afghan refugees, support to the Shasho hospital stopped in September 2005 and in April 2006 was redirected to inpatient and outpatient paediatric care at the nearby Alizai hospital. As in Kuram district, mother and child health was also the focus of MSF’s basic healthcare program in Leepa Valley and Lamnian, close to the Line of Control between Pakistan and India-administered Kashmir. By July 2006, MSF’s permission to work near the Line of Control was retracted and activities in Leepa valley came to an end. By then, MSF had conducted almost 15,000 consultations, of which several hundred were for pregnant women.
MSF has worked in Pakistan since 2000.