Women and children in particular suffer from the lack of access to healthcare in Pakistan and there is an overwhelming need for neonatal care. Mother and child health remains a focus for Médecins Sans Frontières (MSF).
Teams also respond to the medical needs of vulnerable communities largely excluded from medical care, including people displaced by conflict, and marginalised, low-income groups.
Government restrictions, bureaucratic processes and a climate of insecurity and sporadic violence pose operational challenges in Pakistan. The presence of armed militant groups and ongoing counter-terrorism operations hamper humanitarian access and there is a general distrust of aid workers. MSF’s activities in Pakistan are funded solely by donations from individuals, with no institutional or government contributions.
MSF continued to provide basic healthcare with a focus on women and children in Quetta and Kuchlak, Balochistan – Pakistan’s most underdeveloped province and home to thousands of Afghan refugees. Staff regularly see malnourished patients and provide nutritional support to severely underweight infants, young children, pregnant women and lactating mothers. A total of 3,361 individual and group psychosocial sessions were undertaken with both women and men in 2014 and additional psychosocial support services, such as children’s play groups, were available.
Teams also admitted 697 people suffering from cutaneous leishmaniasis, a parasitic disease prevalent in this region, and provided treatment and supportive care. The disease is transmitted by the bite of a sandfly and can cause debilitating skin lesions.
Overall, MSF conducted almost 59,690 consultations and assisted 3,598 births in Quetta and Kuchlak.
North of Quetta, at Chaman district hospital, MSF supports medical services for women and children, including reproductive healthcare and specialist neonatal and paediatric care. There are also inpatient and outpatient feeding programmes, and treatment and support services for trauma patients. Teams carried out 6,978 outpatient consultations and assisted 4,048 births. Over 5,795 women attended a prenatal consultation. MSF also supervises the women’s outpatient department, which is mainly run by health ministry staff using MSF protocols.
In eastern Balochistan, MSF works closely with the health ministry and focuses on malnutrition and on providing specialist care to newborns, infants and children suffering from acute medical complications at the District Headquarters Hospital in Dera Murad Jamali district. There are high rates of malnutrition throughout this region, which worsen during the May to October ‘hunger gap’ between harvests. An outpatient feeding programme, which runs all year, was increased during these months to cover eight locations in Jaffarabad and Nasirabad districts, in which more than 8,800 people received nutritional support.
The obstetric and maternity components in Nasirabad and Jaffarabad were handed back to the Ministry of Health at the end of October. MSF also handed over Sohbat Pur and Mir Hassan Basic Health Units to the ministry at the end of May and the sexual and reproductive health components in October.
Federally Administered Tribal Areas (FATA)
MSF provides medical care to displaced and vulnerable communities in Bajaur Agency, the northernmost tribal agency. Medical staff support two basic health centres in Talai and Bilot, and are improving services in the outpatient departments and antenatal care units. Children are screened for malnutrition and receive vaccinations. MSF teams also work at Nawagai civil hospital, in the outpatient department, emergency room, and mother and child health department. Paediatric services include vaccinations and therapeutic feeding for malnourished children. For complicated cases, MSF ensures timely referral of patients to Khar, Timurgara or Peshawar.
In the Sunni enclave of Sadda, Kurram Agency, MSF runs a paediatric outpatient department for children up to the age of five, inside Tehsil Headquarters Hospital. There is also a therapeutic feeding programme for this age group. Newborns and children under 12 needing hospitalisation are treated on the MSF-supported paediatric ward, and referrrals are organised. MSF staff also assisted the ante- and postnatal departments. In addition, some 160 patients received treatment for cutaneous leishmaniasis at a general health centre established by MSF.
In Alizai, a Shia community in Kurram, MSF operates a paediatric outpatient department for children under 12 years of age. More than half (59 per cent) of patients in 2014 were under the age of five.
In Peshawar, the province’s capital, MSF runs a 35-bed maternity hospital receiving patients from health units, government-run hospitals and other health partners in the district and FATA. Over 3,700 patients were admitted and 3,268 babies were delivered.
Mother and child health is the focus at the government-operated Hangu hospital too, where MSF runs a round-the-clock emergency room, an operating theatre and surgical wards, and provides technical and referral support to the delivery room. MSF also supports the health ministry’s blood bank and X-ray departments.
MSF continues to work in the District Headquarters Hospital in Timurgara, Lower Dir, providing medical expertise in the emergency room (where 114,957 patients were triaged), resuscitation room (where 27,576 patients were seen and treated) and in the observation room. Comprehensive obstetric care is available, including surgery for complicated deliveries, and 7,369 deliveries were assisted in 2014. In May, MSF opened a neonatal unit for premature and low birth weight babies. In addition, MSF supports the hospital’s blood bank, sterilisation and waste management systems.
Isolation wards were established in Timurgara following outbreaks of acute watery diarrhoea and measles. MSF also ran dengue fever prevention and awareness activities in communities and schools in the area. More than 8,000 students and teachers attended health promotion sessions.
The Machar Colony slum is situated on the edge of Karachi’s Fish Harbour; and is crowded and polluted and has no proper sanitation. MSF opened a clinic in 2012 with local partner SINA Health, Education and Welfare Trust, providing basic and emergency healthcare, including outpatient consultations, triage, stabilisation and referrals for emergencies. Labour and delivery support for pregnant women is also available. Health promotion teams run health and hygiene education sessions for parents and children, and staff conduct mental health consultations. Demand continues to increase as the community learns about the clinic’s services from the health promotion teams and MSF’s commitment to provide free, high-quality care.
Gul Bibi* – brought her eight-month-old granddaughter to the MSF-supported hospital in Sadda for treatment. Gul Bibi and her family fled their village after militants took control and destroyed their homes and way of life. They now live in a camp for displaced people.
We lived in peace. We lived good lives … then three years ago everything changed. They came to the area and nothing was the same again … There was fear everywhere. We went from living in a happy and peaceful place where everyone knew everyone to not knowing whom we could trust or who was living among us … I still see our village burning when I close my eyes and try to sleep.
* Name has been changed