Pakistan: providing medical care in the tribal zones

A Médecins Sans Frontières doctor examines a young child in the outpatient department at Sadda Hospital © Haroon Khan/MSF

The federally-administered tribal zones (FATA) were particularly unstable in 2010 and early 2011, with spikes of violence, closure of supply routes, and the near-collapse of the health system. Médecins Sans Frontières has been working in Kurram Agency since 2004 and supporting the hospitals in Alizai (a Shiite community) and Sadda (a Sunni enclave) since May 2006.

Many residents have had to flee inter-religious clashes and military operations in the FATA zones. Security is still unstable, the region is isolated and most residents find it very difficult to obtain quality medical care. People are afraid to travel on the roads that cross through their villages, so they take detours, following longer routes, and usually travel on foot. Medical personnel are lacking and vaccination programs are non-existent or operate only partially. Some communities have experienced an increase in maternal and infant malnutrition, as well as contagious diseases such as measles, whooping cough, respiratory infections and diarrhoeal illnesses. Mortality and morbidity rates are high.

Free paediatric care
Médecins Sans Frontières offers free care to children under five at the Sadda hospital, in both inpatient and outpatient departments, treating illnesses such as malnutrition, measles, cutaneous leishmaniasis, diarrhoeal illnesses, and respiratory infections. "Patients come from distant, isolated regions," says Dr Gulam Hazrat, a Médecins Sans Frontières paediatrician in Sadda. "Because of the lack of security and transportation problems, it is difficult for them to reach a healthcare facility. When they do arrive, most are suffering from serious illnesses and multiple complications."

Said has six children. He is from Sherzai and lives with other displaced persons in Laddah, approximately 2½ hours by road from the Sadda hospital.  His eight-year-old son was hurt in an accident when he fell from the top of a hill. The child was seriously injured and covered with blood. "Everyone thought that my son was dead, including me," he says. "I asked people to prepare his grave but someone noticed that he still had a pulse, so we brought him here to the Sadda hospital and were told that Médecins Sans Frontières treats children for free. My son was unconscious for a day and a half. We didn't think that he would survive. Médecins Sans Frontières saved my child and gave him good care for three days. We are very poor and cannot pay for expensive medical care but, luckily, everything is free here."

In 2011, Médecins Sans Frontières treated 3,843 children in Alizai and 36,750 children in Sadda. The nutrition program admitted 572 children, and 594 postnatal consultations were held.

Médecins Sans Frontières also supports the Ministry of Health by managing the emergency department at Sadda hospital, with its massive inflows of wounded patients, victims of road accidents, and trauma cases. Patients are transferred to the Hangu and Peshawar hospitals for acute medical, surgical, and obstetric emergencies.

Responding to crises
In 2010, during an epidemic of acute watery diarrhoea, a specialised 30-bed treatment centre and mobile clinics were set up in Sadda and the central region of Kurram. Medical kits were distributed to medical organisations, particularly during recent spikes of inter-communal violence. In 2010, Médecins Sans Frontières provided assistance to 3,500 displaced families who took refuge in several areas of Kurram Agency. In February 2011, 517 displaced families living in Turimangle, Parachinar, and Sadda received aid kits that contained blankets and personal hygiene and cooking items.

A "remote control" program
Since 2007, for security reasons and because of a lack of authorization, Médecins Sans Frontières has been unable to send international staff into the FATA areas. The activities in Sadda and Alizai are managed from Peshawar and implemented in the field by our 50 Pakistani colleagues and six Ministry of Health employees.

Médecins Sans Frontières has been working in Pakistan since 1986 and currently works in Timergara, Dargai, Hangu and Peshawar in Khyber Pakhtunkhwa (KPK) province.  In Baluchistan province, Médecins Sans Frontières operates medical programs in Quetta, Kuchlak, Dera Murad Jamali and Chaman, and in Kurram Agency, located in the federally-administered tribal areas. A project will open this year in Karachi, in Sindh province. Médecins Sans Frontières accepts only private contributions to support its programs in Pakistan and does not accept institutional, government or military funding.