Pakistan

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Key medical figures:
• 252,500 outpatient consultations
• 3,900 surgical interventions
• 22,700 births assisted
• 8,400 individual and group mental health consultations

Pakistan

Providing comprehensive emergency healthcare to people in remote regions of Pakistan is a priority, yet accessibility and security are a constraint for both Médecins Sans Frontières(MSF) and the patients.

In addition to the general gaps in the healthcare system, people living in remote areas and those displaced or directly affected by conflict suffer from a critical lack of medical services, in particular emergency treatment and maternal and child care. MSF runs programmes to try to address these needs.

Khyber Pakhtunkhwa province
Hangu district borders three  tribal agencies, North Waziristan, Orakzai and Kurram. These areas are among those most exposed to violence since military operations were launched by the government in response to an aggressive campaign by the Pakistani Taliban, which started in 2007. There are also sporadic clashes between the Sunni and Shia communities in the district. MSF teams  manage the emergency and surgical services in the Hangu Tehsil Headquarters hospital. They admitted more than 25,000 patients to the emergency room and performed 1,407  surgical procedures in 2013. Within the hospital’s maternity unit, MSF midwives support Ministry of Health staff, assisting with complicated deliveries, and providing training on  obstetric procedures and hygiene protocols. MSF runs a 32-bed private women’s hospital in Peshawar, which opened in 2011. It offers free, emergency obstetric care, including surgery. A third of the 3,717 admissions this year were displaced or refugee women. A referral network has been developed among the district’s rural health centres, communities and  camps for displaced people or refugees, and is expanding to the neighbouring tribal agencies. A fivebed newborn unit opened, and a further 10 beds will be added in 2014. In Lower  Dir, there was a dramatic increase in patient numbers in the emergency and resuscitation rooms at Timurgara district hospital. More than 100,000 patients came to the emergency room, an increase of 33 per cent over 2012, and more than 22,000 patients were treated in the resuscitation room. MSF provides obstetric care with a focus on complicated deliveries,  and assisted around 7,000 births in 2013. Teams also support the blood bank, improve sterilisation and waste management, and organise health education activities – some 56,000  health and hygiene education sessions were carried out. In addition, MSF conducted more than 5,300 mental health consultations and 26,900 mother and child sessions.

Federally  Administered Tribal Areas (FATA)
Conflict in Kurram Agency has led to the isolation of local communities, closure of supply routes and the near-collapse of the state-sponsored  healthcare system. Measles is very common in Kurram, highlighting gaps in basic health services such as vaccination. The area is hardly accessible to international staff, and local MSF  personnel provide paediatric services at hospitals in the Sunni enclave of Sadda and the Shia community of Alizai. In 2013, a military offensive launched against the Tirah Valley in the neighbouring Khyber Agency led to the displacement of thousands of families to New Durrani camp, and around Sadda. In Bajaur Agency, years of violence have left the  population with limited access to basic healthcare. In March, a team of local MSF personnel began running mobile clinics to facilities in Talai, Kotkay and Derakai, providing basic  healthcare and monitoring for cases of infectious illnesses such as measles and diarrhoeal diseases.

Balochistan
Pakistan’s largest province is remote and rural, and hosts many Afghan  refugees. Healthcare indicators are among the country’s worst, as delays in obtaining medical help are common and are accounted for by geography, insecurity in the region and a low density of medical services. In Quetta, the paediatric inpatient medical care provided by government and private hospitals is insufficient to meet the population’s needs and  many people cannot afford the fees charged. MSF offers medicalcare in Quetta paediatric hospital, and treats malnourished children in ambulatory and inpatient feeding programmes.  Neonatology services, and family and individual counselling sessions are also available. An MSF team runs a mother and child health centre in nearby Kuchlak, offering outpatient treatment, including nutritional support, for children under five. There is a birthing unit, and a system to refer complicated emergency obstetric cases to Quetta. Other  services include psychosocial support and counselling, and screening and treatment for cutaneous leishmaniasis. Comprehensive emergency obstetric, neonatal and emergency care is  provided at the Chaman District Headquarters hospital, where 17 per cent of patients treated in the emergency room in 2013 were victims of conflict. More than 2,500 measles  vaccinations were given, in close collaboration with the Ministry of Health. In the eastern districts of Jaffarabad and Nasirabad, MSF continued to focus on maternal and child health  in programmes in Dera Murad Jamali hospital and four health centres. Conflict-related displacement has exacerbated malnutrition, and vaccination coverage is low. The team conducted a measles vaccination campaign with the Ministry of Health and reached 7,500 children. More than 9,600 children were treated in the therapeutic feeding programme at  the Dera Murad Jamali hospital, and 6,000 antenatal consultations were carried out.

Healthcare in Karachi
On the outskirts of Karachi, the Machar Colony slum is home to many  undocumented migrants who cannot access medical care. MSF runs a basic healthcare clinic with SINA Health Education and Welfare Trust, providing free basic, emergency and  obstetric services around the clock. Mental health support is also available. More than 35,000 basic healthcare consultations were conducted in 2013, 7,600 children were screened for malnutrition and over 80,000 people participated in health education sessions.

Emergency responses
Together with Ministry of Health staff, MSF treated 110 people for bomb blast injuries resulting from election-related violence in Khyber Pahktunkhwa and FATA over four days in May. Non-combatants were the primary victims of the violence. Between August and November, teams responded to outbreaks of both dengue fever and acute watery diarrhoea in Timurgara and Swat, a measles outbreak in Upper Dir in June and July, and an earthquake in the Mashkel district of Balochistan in April. MSF was ready to provide assistance following the Awaran earthquake in September, in the same province, but the Pakistani government did not think it necessary for MSF to intervene. 

Faiz Bibi
Kirani village, west of Quetta My one-month-old baby boy has been sick with pneumonia. He had a high fever for two  days and was wheezing and then became lethargic. My house is far away and when the baby was unwell during the night, in the morning I told my husband I would take the child somewhere – anywhere – for medical treatment. I  asked a tuk-tuk [small taxi] driver and he said that at the MSF Quetta hospital, I could have the best treatment for my  baby.

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