The floods that hit Pakistan in 2010 affected around 14 million people. The waters swept down from the mountainous northeast into the heavily populated river valleys and plains, driving desperate people ahead of them. In a country already suffering gaps in healthcare provision the need for assistance grew enormously.

In the Federally Administered Tribal Areas (FATA) and Khyber Pakhtunkhwa province, Médecins Sans Frontières teams continued to provide emergency services for people caught up in fighting between government forces and armed opposition groups. Further south, in Balochistan, Médecins Sans Frontières worked with Afghan refugees and Pakistanis, assisting with a range of medical services, mother and child healthcare and nutrition programmes.

Floods

As the exceptional monsoon rains fell, rivers broke their banks, washing away bridges, roads, villages and livelihoods. Food and safe water were in short supply. The risks of illness and contagion, and the sheer number of vulnerable people completely exposed to the elements were major challenges for the relief effort.

Médecins Sans Frontières staff fanned out to identify the areas and communities most in need. At the height of the flood response, more than 1,600 staff were supporting hospitals, treating injuries and illnesses, running mobile clinics and distributing tents, shelter materials, and washing and cooking kits. One of the most urgent needs was for safe drinking water and our teams quickly engaged in trucking water, distributing up to 2.1 million litres a day. Set against the requirements of so many uprooted people, even these figures were dwarfed by the scale of the disaster.

By October, the waters had largely retreated and staff reduced some of its activities, but at the end of the year teams were still providing medical care and water and sanitation services in Sindh, where the waters were slowest to retreat. Staff were working to provide shelters for the winter and to support the nutritional needs of children whose families had lost their farms or incomes. Our team also started running mobile clinics, and distributing safe water and relief kits in the camps where people had taken refuge in the city of Karachi. Overall in the emergency, Médecins Sans Frontières conducted over 100,000 consultations in five hospitals, seven mobile clinics and six diarrhoea treatment centres.

Surgery

Fighting continued in the northern regions of the country before, during and after the floods, as it had for the last five years. In Khyber Pakhtunkhwa and FATA, the violence shut down hospitals, access roads and the transport of medical supplies. Even if emergency patients found their way to hospital, the limitations of nursing care and low standards of equipment and hygiene did not ensure good quality services. More than one million people depended on Médecins Sans Frontières to provide free emergency surgery. In Khyber Pakhtunkhwa, we worked in the emergency department and operating theatre in Dargai in Malakand district, where staff cared for around 130 patients each month. Our team started working again in Swat after having left in April 2009, when security incidents had made it difficult for staff to work safely. In May 2010, the team returned and was soon treating around 6,000 patients a month. In Timurgara in Lower Dir, there were some 4,200 patients in Médecins Sans Frontières’ emergency facilities every month. A new project covering emergency department services and emergency surgery was opened in Hangu district, close to the tribal areas, and treated around 1,300 patients a month. In the town of Chaman, Balochistan province, on the Afghan border, our team supported the emergency department of the district hospital, ensuring that hospital staff could treat and stabilise patients and provide immediate lifesaving care.

Maternal and child health

Emergency obstetric care is only available in urban areas of Pakistan, often because of a severe shortage of trained female staff. Women traditionally give birth at home and Médecins Sans Frontières has been working to reduce the risks by improving access to screening, the availability of skilled birth attendants, and provision of emergency obstetric and neonatal care. In Dargai, Timurgara, Hangu, Kuchlak, Chaman and Dera Murad Jamali hospitals our staff are equipped to carry out deliveries and can perform caesarean sections in some facilities. In 2010, more than 7,100 women delivered in an Médecins Sans Frontières facility or an Médecins Sans Frontières-supported hospital; 481 delivered via caesarean section.

Cutaneous leishmaniasis

In Quetta, the capital of Balochistan, and also in Kurram Agency, in FATA, many people suffer from cutaneous leishmaniasis, the most common form of leishmaniasis, a parasitic disease transmitted by sand flies, which causes ulcer-like lesions and can lead to severe disfigurement. In 2010, Médecins Sans Frontières launched programmes to provide the simple but lengthy treatment required for the disease, and treated more than 400 people.