Médecins Sans Frontières Suspends Work in Detention Centres in Misrata
Pibor, South Sudan, 23 January 2012
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Médecins Sans Frontières has been present in Pakistan since 1988, when our teams set up a base to support medical activities in Afghanistan. In 1998 Médecins Sans Frontières started to provide medical care in Pakistan to Afghan refugees in Jalozai and Shamshatoo camps near Peshawar. On an ongoing basis since that time, Médecins Sans Frontières volunteers continue to provide medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care and natural disasters.
Pakistan suffers from one of the highest infant and maternal mortality rates in the region. There is poor access to good quality and 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.
Over the past two years, difficult living conditions of communities 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 (FATA). Insecurity and travel restrictions are limiting access to and provision of medical services to communities hit hardest by the fighting. Most recently, this has impeded Médecins Sans Frontières teams from providing medical support to communities displaced towards Tank and Dera Ismael Khan Districts by the fighting in South Waziristan. An independent Médecins Sans Frontières assessment found acute needs in the hospitals’ emergency rooms and in the women’s hospital operating theatre. Médecins Sans Frontières is in contact with all authorities to obtain authorization to implement 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. Médecins Sans Frontières completely disassociates itself from these policies, and our teams strive to clarify that Médecins Sans Frontières is a private medical organisation, independent of political, religious and economic objectives. In Pakistan, Médecins Sans Frontières 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, Médecins Sans Frontières volunteers currently provide free emergency medical and relief services in over a dozen sites in the North West Frontier Province (NWFP), in the Federally Administered Tribal Areas (FATA) and in Balochistan Province. Médecins Sans Frontières is prepared to respond to emergencies with 750 national and international staff.
Since August 2008, several waves of displaced people have sought refuge from violence and arrived in Lower Dir district in Pakistan’s North West Frontier Province. Most of the displaced have come from neighbouring Bajaur Agency and Maidan district where conflict between armed opposition groups and the Pakistani army has been raging.
In May 2009, one million people fled fighting in Swat valley and Buner district to Mardan, a district in Pakistan’s North West Frontier Province. More than 80 percent of the displaced stayed with host families. Médecins Sans Frontières 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 Mardan Medical Complex, Médecins Sans Frontières ran a 40-bed inpatient department, and managed activities in the emergency room. Médecins Sans Frontières also set up a cholera treatment ward. Up until November 2009, more than 3000 consultations were carried out in the emergency room, 817 patients hospitalised and 1672 patients treated for cholera.
Médecins Sans Frontières volunteers also assisted displaced families living in schools and public buildings by providing mobile medical clinics, non-food items and water and sanitation support.
From July 2009 onwards, families started to return to Swat and Buner. As a result, Médecins Sans Frontières projects in Mardan were closed down in November.
Besides, during summer 2009, Médecins Sans Frontières logistics teams helped set up three camps for displaced people in Sumer Bagh and Sadbar Kalley and Munda, including provision of latrines, showers and other water and sanitation facilities. Médecins Sans Frontières medical teams also offered free medical care to 1500 displaced families in these camps as well as in a rural health centre in Munda and a hospital in Sumer Bagh. 2,500 cholera patients were treated in three cholera treatment units set up by Médecins Sans Frontières in the area.
By the last week of October, as the vast majority of displaced population had returned home, the three camps were closed.
For the third time in the past 18 months another wave of displaced people arrived in early November 2009 from Bajaur agency, once again fleeing from fighting between the Pakistani army and armed opposition groups. In response, Médecins Sans Frontières 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. Médecins Sans Frontières 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.
As with other parts of North West Frontier Province, Lower Dir remains insecure and providing medical care for both the resident population and displaced people is still an uphill battle.
In Lower Dir, Médecins Sans Frontières also supports the hospital at Timurgara which is the district referral hospital situated 20 km from Munda. 1100 patients are treated each week at the hospital’s emergency room, both by Ministry of Health medical teams and by Médecins Sans Frontières teams who take care of the patients most at risk. Médecins Sans Frontières is also developing a new operating theatre and setting up a sterilisation and waste management system for the entire hospital.
In neighbouring Malakand district, in NWFP, the hospital emergency room in Dargai is functional with Médecins Sans Frontières medical staff and Ministry of Health teams working 24 hours a day, seven days a week.
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; ten of them died. The constant stream of patients with violent trauma bears testimony to the ongoing violence in Malakand. Médecins Sans Frontières also supports an obstetrics service, an operating theatre notably for caesarean procedures, and an in-patient department with 40 beds in the Dargai hospital.
On average, 150 women come to the hospital each month to give birth. 700 patients are treated on a weekly basis in the emergency room, with Médecins Sans Frontières taking care of the most difficult cases.
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 Médecins Sans Frontières international staff in Dargai.
In Peshawar and neighbouring Charsadda, Médecins Sans Frontières has been supporting since February 2009 internally displaced people living in host communities. These displaced families come from a variety of areas such as Bajaur, Swat, Dir, Buner, Kurram and Khyber Agencies. In addition to providing basic items such as hygiene kits, blankets and winterised tents last year, Médecins Sans Frontières is also 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 Médecins Sans Frontières has also been providing support to the emergency services of Lady Reading Hospital, the main referral hospital of NFWP, rehabilitating a post operation ward and a sterilization room, and constructing a new trauma operating theatre. A post operative structure has also been set up in addition to the refurbishing of male and female wards.
Médecins Sans Frontières is currently running a programme in the Mansehra District to respond to an epidemic of cutaneous leishmaniasis in the Kala Dhaka valley, a provincial tribal area (PATA). Médecins Sans Frontières teams estimate that in certain villages 60-70 % of children are infected. The treatment of these patients is based outside the valley, in the town of Darband, where Médecins Sans Frontières provides support to the rural hospital to ensure a functional referral system. Between mid-February and November 2009, 292 cases of cutaneous Leishmaniasis have been screened. Médecins Sans Frontières medical staff also work in the 30-bed ward of the hospital, where a total of 40 to 90 patients are admitted each month. Since June 2009, Médecins Sans Frontières medical teams have also been providing around 100 antenatal consultations per month and, depending on access and security, medical volunteers also provide healthcare support to basic health units inside the Kala Dhaka valley, with an average of 150 consultations per day of activity.
In Kurram Agency in the Federally Administered Tribal Areas (FATA), Médecins Sans Frontières has been providing assistance since 2006. 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. Isolated but not forgotten, the people of Kurram seek medical care for their children and families in Médecins Sans Frontières-supported clinics in Sadda and Alizai. While services dropped dramatically during peaks in the violence, today Médecins Sans Frontières sees over 2000 paediatric cases monthly and provides antenatal care. Médecins Sans Frontières has also responded to flooding, cholera, malnutrition and organophosphate poisoning in the area.
In June this year, an outbreak of sectarian violence resulted in more than 200 war-wounded. Médecins Sans Frontières offered material support for surgical care to the hospitals in Sadda and Parachinar. Clash response kits to help treat the wounded have also been provided to Alizai hospital. Since October 2009, fighting has intensified between the government forces and armed opposition groups in central Kurram, resulting in a regional curfew and a temporary closure of activities in Sadda hospital.
In Balochistan, Pakistan's largest and least developed province, most people get very little healthcare. Médecins Sans Frontières provides free health care in Kuchlak, a largely Afghan refugee settlement just north of Quetta, the capital of Balochistan Province. Médecins Sans Frontières medical teams carry out more than 10,000 consultations every month, mostly for women and children coming from Kuchlak and surrounding towns and villages. The clinic is part of a maternal health programme set up by Médecins Sans Frontières to improve the extremely poor maternal and neonatal survival rates in the region. Every month, 300 antenatal care consultations are performed in the clinic. Since Médecins Sans Frontières opened its project in 2005, the number of live births in the clinic per month has climbed from 10 to an average of 150 to 170. In an area where home births are the norm and women’s movement is very restricted, this improvement is a sign of the trust and confidence the Kuchlak community has in Médecins Sans Frontières.
Besides these activities, mental health counsellors give 400 to 600 individual counselling sessions monthly for psychosocial support for men and women. In September 2008, Médecins Sans Frontières started treating cutaneous leishmaniasis with 15 to 30 patients treated per month. Médecins Sans Frontières also runs a programme to treat malnutrition which not only receives patients from Kuchlak but some of the surrounding remote districts where poverty, poor land and conflict severely affect living conditions.
In the town of Chaman, situated in the Qila Abdullah District bordering Afghanistan, Médecins Sans Frontières medical staff are doing their best to provide care for the residents of the city, in addition to the refugees and patients coming from neighbouring Afghanistan. In May 2007, Médecins Sans Frontières 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 400 kilometres to access caesarian section and emergency gynaecological surgery services free of charge.The nutritional programme also admits around 50 malnourished children per month, some of whom cross the border from Afghanistan to attend.
In the eastern part of Balochistan, a survey conducted by Médecins Sans Frontières team in July 2008 found concerning levels of malnutrition in Jafarabad and Nasirabad eastern districts. An emergency feeding programme for children under-five was opened in the towns of Dera Murad Jamali and Usta Muhammad. By mid 2009, the feeding programme had been extended to the towns of Sobatpur and Mir Hassan. In October, more than 630 children severely malnourished were admitted to our therapeutic feeding centres. The ‘hunger’ season preceding the harvests, difficult access to food and pervasive general poverty due to the feudal landholding system are the underlying reasons for high admission to the feeding centres. Among certain displaced population, this situation is exacerbated by poor access to healthcare and marginalisation from society.
In Usta Muhammad, Médecins Sans Frontières supports mother and child healthcare, particularly safe delivery in the district hospital. Between 100 and 150 babies are delivered each month in the Médecins Sans Frontières maternity ward.
Médecins Sans Frontières also responds to natural emergencies which frequently hit Pakistan. In 2009, Médecins Sans Frontières teams responded to floods in North West Frontier Province (Mardan/Nowshera), in 2008 to an earthquake in Ziarat, and in 2007 to a series of natural disasters in Balochistan, including post-cyclone flooding, not to mention response to the massive earthquake in Kashmir in 2005.