Health services in Pakistan are often unaffordable and in many regions, conflict and insecurity further restrict access. In many parts of Pakistan sectarian violence is rife. Government forces are also engaged in military operations against armed opposition groups. Doctors Without Borders/Médecins Sans Frontières (MSF) programs focus mainly on meeting urgent needs among communities affected by insecurity.

Khyber Pakhtunkhwa and FATA

In Hangu, Khyber Pakhtunkhwa, where many Afghan refugees and displaced people have settled, MSF works in the hospital’s emergency department and operating theater, and a midwife supports maternity services. The team also organizes patient referral to facilities in the provincial capital Peshawar. In Timergara, MSF provides full support to the emergency department and mother and child health center, and a new building was constructed at the center to accommodate growth in patient numbers. MSF operated treatment centers in Hangu and Timergara from July until October to respond to an increase in cases of acute watery diarrhea. After more than five years supporting emergency, maternal and child healthcare in Dargai hospital, services were handed over to the Ministry of Health in August. In Peshawar, MSF runs a 30-bed hospital specializing in obstetrics and gynecology, and also conducts antenatal and postnatal consultations in 11 health centers in the district. Staff at the health centers were able to identify and refer high-risk pregnancies or obstetric emergencies to the hospital. MSF programs in Kurram Agency in the Federally Administered Tribal Areas (FATA) are staffed by Pakistani personnel, while management is based in Peshawar, with regular visits. The team provides pediatric services at hospitals in both the Shia community of Alizai and the Sunni enclave of Sadda.

Improving access to healthcare in Balochistan

Balochistan has some of the worst health indicators in Pakistan. It is frequently affected by sectarian and interethnic violence and natural disasters. MSF is mainly focused on the needs of pregnant women and children, and carries out nutrition and health promotion activities. MSF provides neonatal, obstetric and pediatric care in Chaman and Dera Murad Jamali hospitals. A team also supports the emergency department in Chaman. In Quetta, MSF runs a 60-bed pediatric hospital and is opening a network of basic health units across the city. Not far from Quetta, in Kuchlak, a team runs a mother and child health clinic that has a birthing unit. Patients also receive treatment for cutaneous leishmaniasis, a disease that produces ulcers on the body, which can cause serious disability as well as social stigma. Mental health teams provide psychological and counseling services in both Quetta and Kuchlak.

Clinic opened in Karachi

In October, in partnership with local organization SINA Health, Education and Welfare Trust, MSF opened a new clinic in Machar Colony, a settlement in Pakistan’s largest city, Karachi. The clinic provides basic healthcare and emergency services, including maternal healthcare, mental health services and stabilization for patients in a critical condition.

Response to flooding

In September, eastern Balochistan was affected by severe flooding for the third consecutive year. MSF teams set up mobile clinics providing basic health services to people who were living on the roadside or in camps, and a treatment centre for diarrhea. Safe drinking water was provided, latrines were constructed and relief items such as washing kits were distributed.

Amina’s* son was brought to the MSF nursery when he was 10 days old, weighing only 2.36 kg. He was diagnosed with tetanus.

A few days after my son was born,he started having fits and had atemperature. I delivered him under amakeshift tent near the Pat Feeder Canal.My husband used to work on ourlandlord’s land. But the water came andwe lost everything. We have no shade,no home or land. We live on the side ofthe road. Thousands of families who losttheir homes are now living there too.When my son got sick, I pawned myearrings because we had nothing left topay the doctors. However, when we cameto the MSF hospital here, we were toldthe treatment is free, so I used the moneyfrom the earrings to buy food instead.It’s been a month since I sold myearrings. Now even the food is gone.My son has been here for 25 days now.We had thought about taking him fromthe hospital and going home because wedidn’t see an immediate change in hishealth. Now, though, he opens his eyes,and can slowly start to feed.

*The patient’s name has been changed.

At the end of 2012 MSF had 1,404 staff in Pakistan. MSF started working in the country in 1986.