Since the beginning of August, intense fighting has broken out in the northern part of South Kivu province. More than 20 villages have been burned and looted, and more than 25,000 people have been forced to abandon their homes, in fear of their lives, seeking refuge in the towns of Shabunda and Katshungu and in the surrounding bush.

Médecins Sans Frontières teams were already at work in the south Shabunda area, where they had been providing medical care since late-June to 20,000 displaced people. When this second wave of displaced people reached the Katshungu and Shabunda regions in early August, Médecins Sans Frontières was quick to respond, setting up two health centres in Mbangayo and Lupinbi, in the town of Shabunda, and another one close to the hospital in Katshungu. “Since we opened these health centres, our teams have been seeing large numbers of patients every day. They are carrying out around 200 consultations per day in each health centre,” says Patrick Wieland, Médecins Sans Frontières’ head of operations for DRC. “Mainly we are seeing respiratory tract infections, sexually transmitted infections and worms, related to the displaced people’s bad living conditions.”

Cholera has also broken out in the town of Shabunda, due to a lack of clean water and the poor conditions in which the displaced people are living. Médecins Sans Frontières teams responded to the outbreak, which began on 17 August, by immediately setting up a cholera treatment centre in Shabunda’s hospital, where they are seeing more than 30 new patients each day. Up until 29 August, Médecins Sans Frontières teams provided medical care to 290 cholera patients. Two people have died from the disease. Most of the cholera patients are displaced people living with host families in the town, though some come from surrounding areas.

With the number of cholera cases continuing to increase steadily, Médecins Sans Frontières plans to scale up its activities, despite some major challenges. “The biggest challenge that we are facing is logistical,” says Patrick Wieland. “Shabunda is a very isolated area, and the only way to get our staff and medical supplies there is by cargo plane. Because of the cholera outbreak, we have already sent three planes with around 8,200 kg of supplies, and we plan to send one more plane carrying two tons of supplies, and probably a car too.” He adds: ”There are no cars in Shabunda, and the roads are in a very bad condition, so our teams move around on motorbikes or bicycles.”

Médecins Sans Frontières is currently the only humanitarian organisation providing emergency medical care in the Shabunda region. Mostly due to the logistical challenges, humanitarian aid is difficult to reach this isolated area. “The medical needs of the displaced people in the Shabunda area are enormous. More needs to be done to respond to this emergency,” says Patrick Wieland.       

Médecins Sans Frontières provides emergency medical care throughout North and South Kivu, running hospitals, mobile clinics, vaccination campaigns and cholera programmes, and providing treatment and psychosocial care to victims of sexual violence.

Major concerns about waterborne diseases, malnutrition, shelter and clean, safe water prevail as teams rush to establish new bases in Hyderabad and Sukkur in a bid to access flood affected communities on either side of the Indus River. Priorities for Médecins Sans Frontières include water supply, medical care for dehydration, acute watery diarrhoea and distribution of essential non-food items and shelter.

More than a year and a half after the Israeli military operation ‘Cast Lead’ (January 2009), the health situation in the Gaza Strip remains fragile. Despite the opening of crossing points and aid sent by international NGOs, there are still chronic shortages of certain medical supplies and drugs. Some one hundred items remain totally unavailable at the Department of Health’s central pharmacy.

Health consequences of the embargo. Since the war, only one power station remains operational - the lack of adequate fuel supplies, however, means that it cannot run at full capacity and power shortages are a daily occurrence. In health facilities, the running of emergency generators is also affected by the unpredictable fuel entry permits and they are forced, at times, to reduce the healthcare services they provide. Likewise, travel for health workers, patients and ambulances is also difficult… Another health consequence of the embargo is that people have no choice but to use electric generators and low-quality, contraband bottled gas, which are a source of serious domestic accidents.    

Those injured receive treatment in our postoperative care programme (opened in 2007) or in Ministry of Health facilities. Their condition requires reconstructive surgery, but Gaza lacks services of this type. Only two hospitals can provide such treatment: the Al Shifa and Nasser hospitals, as well as a few private clinics and surgeons. Over 500 patients are due to wait between 12 and 18 months for surgery. Médecins Sans Frontières has therefore decided to open a reconstructive surgery project to treat its patients and reduce the Ministry of Health’s waiting list.

In May, a Médecins Sans Frontières team -consisting of Dr. Remy Zilliox, a plastic surgeon who works in the burns unit in Lyon, Dr Mathilde Berthelot, G.P., and Olivier Munnier, a logistics officer specialised in biomedical equipment- led assessments at Nasser Hospital, in order to set up this programme and define the terms of our collaboration with the health authorities in Gaza.

Médecins Sans Frontières will work with part of the hospital surgical team, to which it will add an expatriate surgeon, anaesthetist and theatre nurse. The aim is to share skills, both in surgery and anaesthesia and also postoperative care. Three days a week will be dedicated to surgery, the other two will be devoted to pre-operative examinations and medical monitoring.

Final preparations. Nasser hospital already has most of the necessary equipment. The surgical equipment will be supplied by Médecins Sans Frontières. The Médecins Sans Frontières operating theatre, sterilisation room and laundry room (where we will ensure sterilisation and washing of our surgical materials), have been upgraded and our pharmacy has been supplied with specialised equipment.

In June, the Memorandum of Understanding was signed. Our theatre nurse is on site to supervise the setting up of the programme. The triage of 70 patients on the Médecins Sans Frontières waiting list and their pre-operative examinations are underway. The first surgeries were carried out at the beginning of August.

The articles and commentaries allege anti-Israel sentiment expressed by Médecins Sans Frontières staff and the staff’s refusal to work with their Israeli counterparts. Médecins Sans Frontières has carried out a thorough internal investigation with its team in DRC and has found no basis for the allegations made against it in the various publications.

Any accusation that Médecins Sans Frontières places politics above the best interests of our patients is vehemently rejected.

The fact is that during the intervention in DRC, both the Médecins Sans Frontières and Israeli teams on the ground collaborated extremely well and appreciated each other’s contributions to assist patients. Both medical teams shared - and worked together toward - the common goal of providing the best possible treatment to those most in need. Cooperation continues with the exchange of medical data on the 64 remaining burn patients in our care.

Both Dr. Eyal Winkler, who led the Israeli team from the Sheba Medical Center, and Gila Garaway, who escorted the team, have reassured Médecins Sans Frontières that there was good collaboration and co-operation throughout the five-day intervention and they have rejected any suggestion that this was not the case. Media reports and commentaries alleging otherwise are unfounded and irresponsible.

Médecins Sans Frontières’ humanitarian action is guided by the principles of alleviating the suffering of victims of violence, epidemics, and natural disasters through the provision of impartial and neutral medical assistance that is independent of political, religious, or other interests. All Médecins Sans Frontières staff members are obliged to respect medical ethics and international humanitarian law, as well as to display a general attitude and conduct characterised by neutrality, impartiality, and non-discrimination. Any deviation from these principles by a Médecins Sans Frontières staff member is deemed unacceptable.

Regarding references in some of the coverage to Médecins Sans Frontières’ work in the Palestinian Territories: Médecins Sans Frontières routinely describes publicly the humanitarian impact of hostilities on civilians, as witnessed by our medical teams on the ground. Operating under the rubric of international humanitarian law and the Geneva Conventions, Médecins Sans Frontières pays particular attention in conflict situations to the measures taken by belligerents to spare civilians during the conduct of hostilities.

These principles were the basis for Médecins Sans Frontières speaking out in January 2009 during “Operation Cast Lead,” the Israeli military response to rocket attacks against Israel. Médecins Sans Frontières teams working in Gaza indeed observed a significantly high number of civilians wounded and killed in a very short period of time. Contrary to references in some coverage, however, Médecins Sans Frontières representatives never stated that the consequences of the Israeli military offensive in January 2009 resulted in a greater overall toll than the violence in Sudan’s Darfur region.

Médecins Sans Frontières also has a track record of speaking out when its teams have witnessed civilians injured or killed as a result of internecine Palestinian violence in Gaza, as it did in June 2007, for example.

When working in conflict areas, Médecins Sans Frontières assesses the level of needs and local response capacities on each conflicting side. Israel has a comprehensive and advanced emergency response capability and medical infrastructure. While Médecins Sans Frontières has offered its services within Israel, including during the 2006 conflict between Israel and Hezbollah, to date the organisation’s assistance has not been required there.

FURTHER READING

The floods that first struck Pakistan on 22nd July 2010 and subsequently devastated villages and communities across all provinces of Pakistan are leaving hundreds of thousands displaced and vulnerable. Affected communities and community-based organisations are responding quickly to the crisis. However, the needs are so high, that more than one month after the floods first arrived, too many people have received too little assistance.
 
The response to date has taken place in a highly political environment and has been influenced by national and international political agendas. Some donor countries have openly mobilised support for this crisis based on their own national security interests. US Senator John Kerry has stated that “obviously there is a national security interest” in providing assistance to Pakistan.  

“Humanitarian assistance in any conflict environment must be based on principles of independence and neutrality. Warring parties, governments, and political parties, cannot claim these principles” said Thomas Conan, Médecins Sans Frontières representative in Pakistan. “We therefore do not accept any funds from donor governments for our work in Pakistan and Afghanistan. Our reliance on private funds that are gathered from the general public worldwide ensures that we remain strictly independent from any government or military and allows us to be responsive to the needs that we identify”.

Since the beginning of the crisis, Médecins Sans Frontières has conducted more than 16,664, consultations, delivered over 540,000 litres of clean water per day and distributed 14,675 packages of relief items, in addition to 4,855 tents.

An increase in the emergency response, particularly with regards to safe water and access to health facilities, is what is needed to ensure that those who have been left vulnerable from the floods are able to recover, and to prevent a deterioration of the medical situation. “Considering the conditions people are living in now, in particular the lack of access to safe drinking water and adequate sanitation, the risk of gastroenteritis or waterborne diseases such as cholera is a real concern,” said Dr Ahmed Mukhtar, Médecins Sans Frontières Medical Coordinator in Pakistan. As a result, Médecins Sans Frontières is scaling up its activities in the treatment of diarrhoea by putting in place 6 diarrhoea treatment centres, and focussing on the provision of safe drinking water. However, “more needs to be done” continued Dr Mukhtar, “and it should be done based on these very real medical needs – not political agendas”.

Médecins Sans Frontières is an international medical humanitarian organisation providing emergency medical assistance to people in need, independent of any military or political groups and irrespective of race, religion, ideology, or politics.

Since 1988 Médecins Sans Frontières has been providing medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care and natural disasters.

Médecins Sans Frontières volunteers currently conduct medical activities in more than 15 locations in Khyber Pakhtunkhwa, Federally Administered Tribal Areas, Punjab, Balochistan and Sindh provinces. With more than 1,200 national and 100 international staff in Pakistan,  Médecins Sans Frontières is currently  scaling up its rapid response to the flood disaster.

To ensure the independence of our medical work, Médecins Sans Frontières relies solely on private financial donations to fund its activities in Pakistan and does not accept funding from any government, donor agency, nor from any military or politically affiliated group.

For the past 39 years Médecins Sans Frontières medical teams have been providing medical treatment to populations  affected by armed conflict, epidemics, natural catastrophes or a lack of general healthcare in over 60 countries around the world including in Pakistan, Sri Lanka,  Afghanistan, Somalia, Iraq, Colombia, Uganda and Sudan among many others. For more information, visit www.msf.org

I am reminded of Joseph Conrad’s novel Heart of Darkness as the boat makes its way upstream. I am on the Dhure River in western Ethiopia and our destination is a village called Lol Kuach where we will conduct a mobile clinic. I have been in Ethiopia for three months and I am based in the small town of Mathar about eight kilometres from the Sudanese border. This part of Ethiopia is very remote and is home to the Nuer, a predominantly cattle herding people.

Médecins Sans Frontières opened its project in Mathar in November 2009 in response to conflict which had displaced many people. The main objective of the project is to provide health care to vulnerable populations and respond to emergencies. In conjunction with local health authorities, Médecins Sans Frontières is managing the health centre in Mathar. This health centre provides both outpatient and inpatient care. The project also conducts mobile clinics. As a nurse, my role in this mission is two-fold; I manage the pharmacy and supervise mobile clinic activities. The mobile clinic team consists of 12 national staff and includes nurses, health officers, logistic assistants, translators and drivers.

During the dry season, getting to Lol Kuach is a fairly straight forward matter. Now that the rains have arrived and road travel is no longer possible, our journey is a little more complicated. We travel upstream until our passage is blocked by water hyacinth which completely chokes the river. We unload the boat and wade through ankle deep water for 20 minutes to reach dry land. We carry all our equipment. But the river is not quite finished with us – after a further 20 minute walk we again reach the river bank where we load our equipment and ourselves into a dugout canoe for the final leg of our journey.

We arrive in Lol Kuach and are greeted by the excited cries of children calling ‘Kawayi Kawiyi’ (white person). Lol Kuach has become home to people displaced by conflict in Akobo, a region south of Mathar. When people are forced to flee their homes suddenly and in large numbers, the impact on health can be great. Displacement can cause food insecurity, poor water and sanitation and inadequate maternal and child care. Other consequences are more subtle and less obvious.  For the people of Lol Kuach, the primary concern is one of access to health care – flooding and tensions limit their access to our clinic in Mathar.

Our clinic is conducted under a large tree in the centre of the village. People are registered, screened and consultations provided. We see a diverse range of clinical conditions. Today we see a person with leprosy and many people with malaria. Now that the weather is cooler, we see many children with lower respiratory tract infections. The health care needs here are great – the mobile clinic team is constantly challenged to triage the most severely ill people. Before our clinic is completed, we have identified three people who will return with us to Mathar for inpatient treatment.   

Through mobile clinics I have been given unique access to Nuer culture. The Nuer are very mobile, moving with the seasons in search of pasture and water for their cattle. This mobility has implications for our service – particularly for people who are being treated on an outpatient basis. One of the more interesting exercises I have undertaken is to map these seasonal population movements. This will hopefully give us some idea where to find people at various times during the year.  

This is my third field placement with Médecins Sans Frontières but in many ways it feels like my first. This is Médecins Sans Frontières at its best – bringing health care to people who are affected by both conflict and a lack of health services. While our working day is often long and our living conditions basic, our activities here are valuable and I feel privileged to be a part of this project.

Improving Access to Clean Water and Sanitation

To curb the possible outbreak of waterborne diseases, Médecins Sans Frontières is stepping up clean water distribution activities in the main towns and remote villages of Khyber Pakhtunkhwa’s  Charssada, Swat, Nowshera, Lower Dir and Dargai. In the coming days, Médecins Sans Frontières will also start water and sanitation activities in the provinces of Sindh and Balochistan.

In the coming days, teams are planning to assess the water supply system of Dera Murad Jamali town in Baluchistan and Sukkur in Sindh province, in order to ensure that the public water supply plant undertakes chlorination before it reaches population.

Across Pakistan, Médecins Sans Frontières is now providing at least 540,000 litres of clean through different fixed and mobile water points including trucks, tanks, tap stands, and house-to-house distribution. Team are also providing containers and buckets to families who do not have enough water containers, and helping the local communities to clean up and rehabilitate contaminated wells.

"It's worrisome that some families with small pumps at home have started using their water source again. This is not good because the water is still contaminated, and this can lead to many waterborne diseases. We will continue to provide safe water until we can put in place a  system to check if the water is good enough for daily use." explained Muhammad Shakeel, a member of Médecins Sans Frontières’ water and sanitation team in Nowshera.

Health Workers: A Vital Component

Health promotion workers are playing a crucial role in raising people’s awareness about health risks.  For example, during distributions, they show people how to use water purification tablets to obtain safe drinking water at home. Relief packages distributed typically include 20 purification tablets, which when used properly, means that a family of seven can have safe, clean water for a period of two weeks.

For example, in Dera Murad Jamali, Balochistan province, Médecins Sans Frontières is concerned that in addition to the current poor hygiene conditions the already existing malnutrition situation is only getting worse. So health workers are also raising awareness about malnutrition issues, as well as health and hygiene messages. Médecins Sans Frontières is currently treating at least 300 children under five years old with severe malnutrition in its already existing emergency feeding program for children under-five in the area.

Boosting Mobile clinics and health structures

Since the first of August, Médecins Sans Frontières has provided more than 16,664 consultations to people affected by the floods in different areas across Pakistan. About half of those consultations were conducted in fourteen mobile clinics in remote or highly populated areas of Dera Murad Jamali, Khabula, Sobhatpur, Malakand, Swat, Lower Dir, Charsadda, Sukkur and Peshawar.

Due to the rise in the number of patients with Acute Watery Diarrhoea, Médecins Sans Frontières has also set up six Diarrhoea Treatment Centres (DTCs) in Swat, Lower Dir, Malakand, Hangu, Kot Addu and Dera Murad Jamali. At the same time, human resources, medical and logistics capacities to treat waterborne diseases such as cholera have been significantly increased, and Médecins Sans Frontières stands ready to open new DTCs if there is a need.

In Swat, Khyber Pakhtunkhwa, a 20-bed isolation unit has been established at the hospital in Mingora, including a tent for oral rehydration treatment as well as hygiene promotion. In Dera Murad Jamali, Baluchistan, the team has set up a 20-bed DTC in order to cope with the massive influx of patients from the neighbouring districts which are still flooded. In Kot Addu, Punjab Médecins Sans Frontières added another 70 beds to the 30-bed DTC to treat more hospitalised patients.

So far, the teams have approximately treated 1,600 cases of Acute Watery Diarrhoea.

Distributions Continue

With the threat of new floods still very present, Médecins Sans Frontières continues to provide affected people with basic necessities in order to help them maintain a minimal standard of living and prevent the spread of diseases. In Baluchistan and Khyber Pakhtunkhwa more than 14,675 relief kits and 4,855 tents have been distributed in the affected areas. A typical kit includes buckets, soap, laundry soap, tooth brush, jerry can, hygiene items for women, towel, plastic mugs, kitchen utensils, plastic sheeting, tents and mattress as well as water purification tablets. In the coming days, as teams assess new locations more relief kits and tents will be provided to those in need.

More Needs, New Activities in New Locations
 
In Balochistan and upper Sindh, the rising water levels of the Indus river have forced 90% of the people living in areas like Usta Muhammad, Dera Allar Yar and Ganakha to leave their homes behind. In south of Kashmor, and south of Sindh, floods have also forced poor families to seek refuge on higher ground, on embankments along the main canals, the railway lines or any available space they can find along the roads.

In Sukkur, Northern Sindh province, Médecins Sans Frontières has now started distributing relief items and launched three new mobile clinics to provide free medical services to the flood affected community. The mobile teams in Sindh are coming across groups of up to a thousand people at a time who are desperately in need of medical attention, especially children. Also in Sukkur, Médecins Sans Frontières is now supporting a 30-bed paediatric ward for children under 5 years of age.

In southern Sindh, Médecins Sans Frontières has set up a new office in Hyderabad to coordinate more relief activities in the area.

Exploratory teams continue their assessments to identify gaps in Khyber Pakhtunkhwa, Punjab, and Sindh and Balochistan for immediate interventions. In these new locations, teams are now preparing to respond to the immense medical and humanitarian needs of the affected population. This will be done through the continued distribution of relief items and provision of safe water, as well as the setting up of more mobile clinics and diarrhoea treatment centres.

More than 110 international staff are currently working alongside 1,200 Pakistanis in existing and flood response programs in Pakistan.

Since 1988, Médecins Sans Frontières has been providing medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care, and natural disasters in Khyber Pakhtunkhwa, the Federally Administered Tribal Areas, Balochistan, and Kashmir. Médecins Sans Frontières does not accept funding from any government for its work in Pakistan and chooses to rely solely on private donations.

Bacha Zareen
"At 8 pm the water level started rising, at 9 it was getting higher, and by 10 pm, our house was totally surrounded by water, and then all the houses were surrounded too. All of the roads were closed, we had to leave everything and run for our lives."

Médecins Sans Frontières has been working in Pakistan since 1988.
Teams on the ground were able to provide assistance to victims immediately after the flooding, supporting hospitals as well as setting up mobiles clinics.

The areas affected, however, are difficult to access.

Since the flooding began, Médecins Sans Frontières doctors have provided approximately 10,000 medical consultations, the most common complaints being diarhhoea as well as skin and respiratory infections caused by the overcrowded living conditions.

Dr BAKHT BILAND
« He says it started raining again when he started to work again in to rebuild his home again. Then he started to face problems like skin itching. »

A lack of hygiene and water, combined with overcrowded living conditions are perfect ground for water-related illnesses such as dysentery or cholera, which is endemic in the country.

Médecins Sans Frontières is monitoring closely any changes in the health of the population and is trying to prevent epidemics emerging.

Olga Em, Médecins Sans Frontières doctor (in English)
We’ll see if it’s possible to use this room for the stock, just in case of cholera cases. We’re just arranging with logistics in case a new flood comes -  this is the ground floor, so we’re seeing how we’ll manage.

Medical care is for the most part provided by local healthcare services. Médecins Sans Frontières is focusing its activities on the population’s other needs. Teams have so far distributed more than 7000 kits consisting of essential non-food items.

650 Afghan families have settled in this refugee camp in the Peshawar district. Each family has received a tent, a set of blankets, cooking utensils and a hygiene kit.

This man fled Afghanistan 3 years ago because of the war. His home has been destroyed by the floods:

SHIR MOHAMMAD
"We needed all these things, because when the floods came, we tried to save our belongings but everything got soaked  in water. Everything’s dirty and smelly. The  doctor told us not use our things, that maybe we’d catch diseases…"

The flood waters that invaded the towns swept away everything and left water sources polluted.

To improve access to clean water, Médecins Sans Frontières has set up water tanks in the most populated zones.

More isolated groups, like these people living on the side of a motorway, are regularly supplied with water by trucks.

The organisation is distributing a total of 310,000 litres of water a day.

The overcast morning sky in Nazirabad, Peshawar, where Médecins Sans Frontières is conducting another round of relief items distribution, hints that more rainfall is probably on the way. Farida’s five year old boy tugs at her long dress impatiently “He wants to know why we can’t go home, I don’t know what to say, so I just tell him that we’re going somewhere new” she explains.

The floods that overwhelmed Pakistan more than two weeks ago have forced people to leave their homes with such urgency that they were able to salvage very little, some have even lost members of their family. “The water came into our home at night and we had to swim out as quickly as possible. I carried my baby boy on my shoulders. This flood has taken everything away from me, including one of my girls. She breathed in too much water and couldn’t make it” says Nizam Ali. He hoists the tent, kitchen set and hygiene material above his shoulders.  The packages are tailored to fit a variety of needs, and a typical Médecins Sans Frontières relief kit could include clothes, soap, toothbrush, towels, buckets, a jerry can, plastic sheeting, cotton mattresses as well as water purification tablets. Until now, Médecins Sans Frontières had distributed kits to more than 8,000 families in Khyber Pakhtunkhwa and Balochistan provinces.

In addition to providing people with guidance on how to set up the tents, the distributions are also now being augmented by health promotion activities that raise awareness about health risks, and in particular the proper usage of water purification tablets (Aqua tabs). Each kit includes 20 tablets, which when used properly, means that a family of seven can have safe drinking water for a period of two weeks.

“For two weeks now, my family has been sleeping under the open sky, I’m happy that I will be able to put a plastic sheet over their heads. I keep going back to what is left of our house, to clean it, or to find anything that is useable, but the rain keeps restarting” he continues.

In the aftermath of this disaster, millions are now left without safe water, food, shelter or medicine. Despite the growing risk of diarrheal diseases like Cholera, which is endemic in some parts of the country like Khyber Pakhtunkhwa province - help is still not arriving  fast enough - particularly clean drinking water.

However, it is not only international aid that will meet these needs. Solidarity amongst affected communities and from local organisations has meant that a huge amount of assistance has already been provided to meet some of the most acute needs. Still much more needs to be done.

Even two weeks after the onset of the heavy and violent rainfall, Médecins Sans Frontières teams working in Pakistan to alleviate the impact of the floods on people, still face a variety of logistical challenges.  In Swat district the water has demolished 16 bridges leaving Médecins Sans Frontières teams on either side of the valley, and forcing them to find innovative ways of sending supplies via boats and even horses.  In Balochistan, teams from the provincial capital, Quetta, are currently struggling to supply the Médecins Sans Frontières mobile clinics with fuel and medical materials they need to be able to provide people with essential healthcare.

When it comes to Kit distributions, the priority is finding a safe and secure site.

“We could not find a single space that was not ravaged by water in Jala Bela, so we were unable to conduct the distribution for the people in their own village,” explains Waqar Ahmad an Assistant project coordinator working with Médecins Sans Frontières in Pakistan since the Kashmir earthquake in 2005. “This is the third distribution we are holding in the courtyard of this house in Nazirabad for people from nearby villages like Agra. This man, the owner of the house, has generously allowed us to use his private space to help people from nearby villages. We are doing our best to help people, but above all they are helping each other.”

For the relief goods to reach the people who need it most, community involvement is key; meetings with elders and Imams help identify the most vulnerable families and the people’s most pressings needs. From the minarets of mosques and through megaphones, the site and time of the distribution are broadcasted, to ensure that people know where to go to get what they need.

“Each distribution gets a little more organized; people have their tokens ready and stand patiently in line until their number is called. Our aim here today is to distribute to 585 families, but Inshallah we will surpass our target, and even include unregistered people like these women of Gul Bela. We have enough kits.” continues Waqar.

Two hours into the distribution, and Farida is still standing patiently in line. For the people in Pakistan today, patience is not just a virtue it is vital if they are to recover from what has happened to them. “There is good water and bad water” explains Farida, “the good water is the one we need today, the one that does not make us sick. The bad water took everything away from us. I’m not going back empty handed, even if I have to wait here the whole day”.

In addition to the scale up of medical activities, Médecins Sans Frontières teams continue to focus on providing affected families with basic items and safe drinking water in order to help them attain a minimal standard of living conditions and prevent the spread of diseases.

Since 1988, Médecins Sans Frontières has been providing medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care and natural disasters in KPK, FATA, Balochistan and Kashmir.

Médecins Sans Frontières does not accept funding from any government for its work in Pakistan and chooses to rely solely on private donations.