In Pakistan, Doctors Without Borders/Médecins Sans Frontières (MSF) is providing medical assistance to a vulnerable population suffering the effects of political instability, poor access to adequate health care, and natural disasters. Having been present in the country since 1988, today MSF largely focus its activities in the northwest of the country where armed conflict is raging on both sides of the border and millions of displaced remain in need of medical care.
Pakistan suffers from some of the highest infant and maternal mortality rates in the region. There is poor access to good quality, affordable health services, particularly in remote rural areas. Women and children tend to be most affected by the shortage of medical staff and unaffordable health services.
Since 2007, the difficult living conditions in remote regions have been compounded by the escalation of fighting between Pakistani armed forces and armed opposition groups. In some areas this has been exacerbated by a rise in sectarian violence. Since August 2008, more than two million people have been displaced by fighting raging in the North West Frontier Province and the Federally Administered Tribal Areas. Insecurity and travel restrictions are limiting access to medical services and humanitarian aid. Recently, this has impeded MSF teams from providing medical support to communities displaced around Tank and Dera Ismael Khan districts by the fighting in South Waziristan, where there is an acute need for assistance. MSF is currently working on obtaining authorization to start medical activities in Dera Ismael Khan.
In a region where Western powers involved in counter-insurgency strategies are also major donors, the provision of humanitarian aid has largely been linked with political objectives. MSF completely disassociates itself from these policies, and its teams strive to clarify that MSF is a private medical organization, independent of political, religious and economic objectives.
MSF emphasizes its independence
In a region where Western powers involved in counter-insurgency strategies are also major donors, the provision of humanitarian aid has largely been linked with political objectives. MSF completely disassociates itself from these policies, and its teams strive to clarify that MSF is a private medical organization, independent of political, religious and economic objectives. In Pakistan, MSF does not accept funding from any government and relies solely on private donations from the general public to carry out its work.
Despite the difficulties, MSF currently provides free emergency medical and relief services in over a dozen sites in the North West Frontier Province, in the Federally Administered Tribal Areas and in Balochistan Province. MSF is prepared to respond to emergencies with 750 national and international staff.
Lower Dir District
Since August 2008, several waves of displaced people have sought refuge from violence and arrived in the Lower Dir district in Pakistan’s North West Frontier Province. Most of the displaced have come from neighboring Bajaur Agency and Maidan District where conflict between armed opposition groups and the Pakistani army has forced hundreds of thousands to flee their homes.
In May 2009, around one million people fled fighting in Swat Valley and Buner District. More than 80 percent of the displaced stayed with host families but MSF helped local health clinics and hospitals to cope with the massive influx of people and provided medical care, tents and relief items such as soap and blankets to 500 displaced families staying in a camp in Mazdurabad. In the medical complex in Mardan, MSF ran a 40-bed inpatient department, and managed activities in the emergency room. MSF also set up a cholera treatment ward. In November 2009, more than 3,000 consultations were carried out in the emergency room; some 817 patients were hospitalized and 1,672 patients were treated for cholera.
During the summer of 2009, MSF logistical teams also helped set up three camps for displaced people in Sumer Bagh, Sadbar Kalley, and Munda, including provision of latrines, showers and other water and sanitation facilities. MSF medical teams offered free medical care to 1,500 displaced families in these camps as well as in a rural health center in Munda and a hospital in Sumer Bagh. Some 2,500 cholera patients were treated in three cholera treatment units set up by MSF in the area.
In July 2009, families started to return to Swat and Buner. By the last week of October, the vast majority of displaced population had returned home and the three camps were closed followed by the conclusion of MSF projects in Mardan in November 2009.
In early November 2009, however, another wave of displaced people arrived and MSF resumed its support of Munda camp, distributing tents and basic hygiene items such as soap and blankets to arriving families. Access to clean water, showers and latrines was also ensured. MSF medical teams currently provide free medical care to the 400 families staying in this camp and 900 others staying in a building next to the market place in Munda, as well as to the host population directly affected by the conflict.
In the Lower Dir city of Timurgara, MSF supports the hospital, which is the district referral hospital, situated 13 miles from Munda. About 1,100 patients are treated each week in the hospital’s emergency room, both by ministry of health personnel and by MSF teams. MSF is currently developing a new operating theatre and setting up a sterilization and waste management system for the entire hospital.
In nearby Malakand District, the hospital emergency room in Dargai is also supported by MSF medical staff. In August, 2,300 patients sought treatment in the hospital; 142 of them were suffering from violence-related injuries. Some patients arrived in very bad shape and 10 of them died. The constant stream of patients with violent trauma bears testimony to the ongoing violence in Malakand. MSF supports an obstetrics service, an operating theatre notably for caesarean procedures, and an inpatient department with 40 beds in the Dargai hospital.
On average, 150 women come to the hospital each month to give birth. About 700 patients are treated on a weekly basis in the emergency room.
At the end of October, the Pakistani local authorities requested all international staff to leave Malakand District due to security constraints. Pakistani staff continue to work in the hospital, which is still functional thanks to their presence, and efforts are being made to restore as soon as possible the complete return of MSF international staff to Dargai.
Since February 2009, MSF has been supporting internally displaced people living in host communities in Peshawar and neighboring Charsadda. In addition to providing traditional relief items, MSF is supporting four basic health units to provide primary health care to displaced families. More than 50,000 displaced people live in these areas, where the resident population is around 60,000 people. Approximately 1,000 primary health care consultations are carried out each week. In Peshawar, MSF has been providing support to the emergency services of Lady Reading Hospital, the main referral hospital of the region, rehabilitating a post-operation ward, a sterilization room, and constructing a new trauma operating theatre.
MSF is currently running a program in Mansehra District to respond to an epidemic of cutaneous leishmaniasis, a parasitic disease transmitted by the bite of certain species of sand flies. MSF teams estimate that in some villages 60 to 70 percent of children are infected. The treatment of these patients takes place in the town of Darband, where MSF provides support to the rural hospital. Between mid-February and November 2009, 292 cases of the disease were diagnosed. MSF medical staff work in the 30-bed ward of the hospital, where a total of 40 to 90 patients are admitted each month. Since June 2009, MSF medical teams have also been providing around 100 antenatal consultations per month and, depending on access and security, medical teams provide healthcare support to basic health units inside the Kala Dhaka valley, with an average of 150 consultations per day.
Since 2006, MSF has been providing assistance to this province, which is located on the border of Afghanistan. Sectarian tensions through 2007 and 2008 led to massive outbreaks of violence, resulting in the isolation of local communities, closure of supply routes, and the near-collapse of the state-sponsored healthcare system. The people of Kurram seek medical care for their children and families in MSF-supported clinics in the cities of Sadda and Alizai. While services dropped dramatically during peaks in the violence, today MSF sees over 2,000 pediatric cases monthly and also provides antenatal care. Moreover, MSF has responded to flooding, cholera, malnutrition, and organophosphate poisoning in the area.
In Balochistan, Pakistan's largest and least developed province, most people get very little health care. MSF provides free health care in Kuchlak, a largely Afghan refugee settlement just north of Quetta, the provincial capital. MSF medical teams carry out more than 10,000 consultations every month. The clinic is part of a MSF maternal health program and performs 300 antenatal care consultations each month. Since MSF opened its project in 2005, the number of live births in the clinic per month has climbed from 10 to an average of 170.
Besides these activities, mental health officers give 400 to 600 individual counseling sessions monthly. In September 2008, MSF started treating cutaneous leishmaniasis with 15 to 30 patients recovering from the disease per month.
In the eastern part of Balochistan, an MSF survey found concerning levels of malnutrition and MSF started an emergency feeding program for children. By October 2009, more than 630 severely malnourished children had been admitted.
In the eastern part of Balochistan, an MSF survey found concerning levels of malnutrition and MSF started an emergency feeding program for children. By October 2009, more than 630 children severely malnourished had been admitted.
Qila Abdullah District
In May 2007, MSF started assisting the Chaman hospital with mother and child health care, including emergency obstetrics, neonatal care, ante- and postnatal services, a female inpatient department, and treatment for malnourished children. The number of deliveries in the hospital has increased significantly, from an average of 35 per month in 2007 to over 200 in October 2009. Many are complicated deliveries, with patients travelling over 250 miles to access caesarian section and emergency gynecological surgery services. The nutritional program also admits around 50 malnourished children per month.
In nearby Usta Muhammad, MSF supports mother and child healthcare, particularly safe delivery in the district hospital. Between 100 and 150 babies are delivered each month in the MSF maternity ward.
MSF also responds to the natural emergencies which frequently hit Pakistan. In 2009, MSF teams responded to floods in North West Frontier Province, in 2008 to an earthquake in Ziarat, and in 2007 to a series of natural disasters in Balochistan, including post-cyclone flooding. MSF also responded to the massive earthquake in Kashmir in 2005.