Pakistan

Access to health care remains a challenge, especially for women and children

An MSF nurse calms a baby with severe malnutrition at the DHQ hospital, Dera Murad Jamali Balochistan, Pakistan.
PAKISTAN 2016 © SARA FARID
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This information is excerpted from MSF’s 2017 International Activity Report.

Access to health care remains a challenge in Pakistan, especially for women and children: women die from preventable complications during pregnancy and delivery, and newborn care is unavailable in many parts of the country.

Doctors Without Borders/Médecins Sans Frontières (MSF) continues to fill gaps in health care, particularly in isolated rural communities, urban slums, and areas affected by conflict.

219,700
outpatient
consultations in 2017
26,500
births
assisted
13,300
patients
treated in feeding centers

Forced closure of projects in Federally Administered Tribal Areas (FATA)

In September and November respectively, the authorities in Kurram and Bajaur informed MSF that the certificate required for carrying out medical activities in FATA would not be renewed, but gave no explanation for this decision. It is likely that the closure of these medical facilities delivering free, high-quality health care will have serious negative implications for people who rely on them.

MSF had been providing medical services in Kurram for 14 years at the time of the closure. In Sadda, MSF was responsible for the pediatric outpatient and inpatient departments. Teams also ran the neonatal unit, and treated patients with the parasitic skin disease cutaneous leishmaniasis. In Alizai, MSF ran the pediatric outpatient department and observation room. Before the projects closed in 2017, MSF teams carried out a total of 26,567 outpatient consultations in Sadda and Alizai.

In Bajaur, MSF had been supporting the outpatient, emergency, and mother and child health departments in Tehsil hospital at Nawagai since 2013. The number of people seeking health care at the hospital had continued to increase, illustrating the enormous needs in the area. Between January 1 and November 13, 2017—the day MSF left Bajaur—the teams treated 17,194 patients in the stabilization room and assisted 1,311 deliveries.

Mother and child health in Balochistan

Near the Afghan border, MSF works with the Ministry of Health at Chaman district headquarters hospital, providing reproductive, newborn, and pediatric health care. The team also manages the emergency room, and offers inpatient and outpatient nutritional support for malnourished children under the age of five.

These services are available to local residents, Afghan refugees, and people who cross the border seeking medical assistance.

In the eastern districts of Jaffarabad and Naseerabad, MSF supports an inpatient therapeutic feeding program for severely malnourished children, as well as the general pediatric and neonatal wards and reproductive health care in Dera Murad Jamali district headquarters hospital. Teams also run an outpatient therapeutic feeding program through a network of mobile clinics and outreach sites. A new site was opened in Manjo Shuri in 2017, in response to the large number of malnourished children in urgent need of care.

In 2017, MSF’s 60-bed pediatric hospital in Quetta admitted 453 newborns and 600 severely malnourished children. After six years of operations, the hospital closed in October. In Kuchlak, 20 kilometers north of Quetta, MSF manages a health center offering outpatient treatment for children, including nutritional support for under-fives, 24-hour basic emergency obstetric care and psycho-social counseling. Patients with emergency obstetric complications are referred to Quetta.

In 2017, MSF provided specialized treatment to 2,823 patients for cutaneous leishmaniasis through the Kuchlak Maternal and Child health center, the Bolan Medical Complex hospital in Quetta, and Benazir Bhutto hospital in Mari Abad.

Emergency, maternal, and newborn care in Khyber Pakhtunkhwa

MSF operates a comprehensive 24-hour emergency obstetric care service at Peshawar women’s hospital for patients referred from surrounding districts and FATA. The hospital has 24 obstetric beds and an 18-bed unit for premature and severely ill newborns requiring specialized care. In 2017, 3,687 deliveries were assisted.

In Timergara, around 200 kilometers (124 miles) north of Peshawar, MSF supports the district headquarters hospital’s emergency department and also provides comprehensive emergency obstetric care. A total of 10,607 births were assisted in 2017. The neonatal unit was expanded from 18 to 34 beds, and upgraded to include an eight-bed ‘kangaroo care’ room, where mothers carry their newborns against their chest, so that their body warmth acts as a natural incubator, helping to regulate the babies’ temperature. A total of 163,835 patients were seen in the emergency department.

Health care for Machar Colony

Karachi’s Machar Colony slum is densely populated, with around 150,000 people living in polluted conditions and facing a lack of clean water and waste disposal. MSF conducts outpatient consultations at the clinic it runs in collaboration with SINA Health Education & Welfare Trust and provides diagnosis and specialized treatment for hepatitis C, which is highly prevalent in Pakistan. In 2017, 773 patients were started on treatment and 692 completed the course. The team also manages uncomplicated births and offers mental health counseling and health promotion. At the end of 2017, MSF closed the stabilization room it had been running in the clinic.

Emergency response

In response to a dengue outbreak in Peshawar, MSF launched an awareness campaign in the affected areas in August 2017. The outreach team visited 1,720 households and delivered awareness sessions on the prevention and treatment of dengue to more than 13,500 people.