Four million people displaced by fighting between Pakistani forces and the Taleban in the North West Frontier are being told to return home. The first hundred thousand have left, and are facing harsh conditions. Their homes, shops, and livestock are destroyed, and there is an acute shortage of food. Most remain in host communities where other problems grow. The locals, themselves poverty stricken, are supporting on average 25 people in their households. During this transition, CWS partners through ACT International will follow the homeless home, and at the same time continue to assist the displaced people living in camps and host communities.
Urgent needs remain for shelter, food, health services, sanitation, safe water, trauma counselling and livelihood opportunities. Donate now or call 0800 74 73 72.
Forty year-old Said Daulat expresses many of the concerns prospective returnees have. “Although we are very happy to go back, we have many concerns as to what will happen. Before we came here, I owned a rickshaw and was earning about five to six thousand rupees on a monthly basis. When we left in such a panic, my rickshaw was left behind. Now, I wonder how I will save money to buy a new one. Currently, my children have a playground. At least we are safe and secure, and as parents we do not need to ponder more on their safety.”
Saadia Haq, a 13 year old boy says, “My father’s shop was destroyed in the shelling; now, I feel sad as we are going home. How will my three siblings and I be able to go to school? Where will we get our school books and uniforms? Now I am scared that we will not go to our school on foot as we used to do before the war started; Mum is not going to allow us to go on foot and public transport is ten rupees one way.”
From ACT International/Church World Service Pakistan/Afghanistan
About the Crisis
The humanitarian crisis in the North West Frontier Province (NWFP) and Federally Administered Tribal Areas (FATA) of Pakistan is escalating. Tens of thousands of civilians are fleeing to escape fighting between the state army and the Taleban militants.
Of the 3.3 million people in Swat, Buner, and Lower Dir districts 1.2 million people have been displaced by the armed conflict.
This new situation compounds the pre-existing situation in NWFP where hundreds of thousands have been displaced by earlier battles. The UN refugee agency (UNHCR) has registered more than 550,000 IDPs in NWFP since October 2008, more than 80% of whom live in rented accommodation or with host families, while the remainder are living in 11 camps (UNHCR report, 21 April).
There is an urgent need for
- health services
- sanitation and hygiene services
CWS is supporting the relief efforts of partner Church World Service-Pakistan/Afghanistan. Directors of this relief agency have been in New Zealand and are calling for greater assistance. Church World Service teams moved into the area on 8 May to meet the needs of those who are in makeshift camps–thousands in small refuges where no sustainable food, shelter, water or hygiene is available.
The situation remains violent and unpredictable. The monsoon season is worsening the situation.
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The rainy season is about to start in Pakistan. The annual monsoon rains will increase uncertainty, health issues, and hindrance to resettlement to the already existing problems for the IDPs.
One of the major concerns IDPs expressed over the past couple of months is the uncertainty of how long they can be accommodated by the government, humanitarian organizations, and host communities. Particularly for those living in tents, the heavy rains will make life more difficult. Despite efforts to prepare camps for the rainy season, undoubtedly rain water will seep into tents where IDPs sleep on the ground and keep their few possessions. The ground will remain muddy for days and weeks at a time. IDPs were right in assuming the assistance cannot last very long. Due to lack of funds, humanitarian organizations find it difficult to continue providing relief items even as the number of IDPs increases from the fighting in Waziristan. Previously, the concern was over socialservices including education, protection, and livelihood, but now, food, health, and shelter are again areas of uncertainty for the IDPs. The approaching monsoon adds to the uncertainty.
Under normal circumstances, the monsoon season increases health risks; however, for the IDPs who are already facing major health issues, the heavy rains will cause significant increases in diseases especially cholera and malaria. The WHO recently announced that essential medicines supplies will be depleted within the next couple of weeks. Without essential medicine, IDP deaths could rapidly increase. The most vulnerable are women and children because a severe shortage of female doctors continues to plague the IDP population. Women remain in tents and host homes unwilling to be treated by male doctors.
CWS-P/A’s health team reports that a majority of treated patients suffer from acute respiratory infections, diarrhoea, skin diseases, and urinary tract infections. Other organizations providing health services report similar findings. Within a few weeks time, malaria and cholera will join the list. Combined with a lack of overall funding and limited resources and medications, the health of IDPs will be jeopardized by the onset of the rainy season. Aside from the physical health concerns, mental health of the IDPs will also continue to suffer during the monsoon because of the increased restriction of large families to tents and small living quarters. The aforementioned uncertainty linked with the rainy season along with depression will increase the difficulty of living as an IDP.
Recently, the government announced success in particular areas of NWFP and has started encouraging IDPs to return to some areas. At one point, July 10 was announced as the date IDPs could begin to return to Malakand Division in Swat, but that date has been extended. The Emergency Response Unit of the NWFP Government also addressed preliminary plans for assisting IDPs in Swabi to start returning to Buner. The government announced rupees 25,000 per family and one month’s food ration for the IDPs. Despite the government’s assistance plans, IDPs remain reluctant to return to their homes due to uncertainty of whether the government has taken control over the areas. Other concerns over the damage to property, lack of food and water, and destruction of health facilities are prevalent among the IDPs. The expected rains will further decrease the likelihood of many IDPs returning to their homes in the next couple of months. Thousands of IDPs came by foot and many will probably return the same way. The torrential rains will make it impossible to make the long journey by foot or in open vehicles.
IDPs consistently express the desire to return to their homes, but the monsoon is a new hindrance. Unable to return, life as an IDP will become more difficult in the coming weeks. Of the aforementioned concerns, health risks pose the most danger for the IDP population. Medicines and sufficient service, particularly from female doctors, are desperately needed for camps and host communities. If IDPs begin returning to their homes, the same health concerns will exist due to damage of health facilities and lack of food, medicines, and doctors.
CWS-P/A is dedicated to continuing to provide health services through its mobile health unit as long as resources are available. So far, the team treated 1,285 patients for various diseases and provided free medication. A female doctor is regularly available to treat women and children. Additionally, the team provided antenatal care to thirty-three pregnant women and also provided immunizations to children less than five years of age. Representatives of the health program regularly attend the UN health cluster meetings. CWS-P/A hopes to expand its services and service area.
CWS-P/A is also preparing for continued distribution of food packages and non-food items to IDPs in Mardan and Swabi; some distribution will take place this weekend. Representatives regularly attend UN Coordination and cluster meetings. Most significant in the past couple of weeks is CWS-P/A’s role in advocacy and emphasis on gender issues. CWS-P/A was part of the strategy and framework initiative to include gender in all segments of the response. CWS-P/A as part of PHF also advocates for improved registration for female-headed households as well as other support for women such as women friendly spaces. CWS-P/A’s Rabia Wasid was also nominated as the gender focal person in the WFP Food cluster; her role is to ensure that women’s needs are highlighted in all related response activities.Church World Service Pakistan/Afghanistan, 8 July 2009 CWS is supporting the relief work of CWS P/A.
Disease Outbreaks Averted, Despite Delayed Funds
ISLAMABAD – Dr. Kashif Islam knows what it costs to respond to the massive medical needs of overlooked Pakistani families displaced by the military conflict in Swat earlier this year.
It was free.
The doctor, a health project officer from ACT International, was one of the many humanitarian workers who spent weeks developing and sending proposals to international donors to support the millions of people caught up in the world’s fastest and largest human displacement in a decade.
Yet as proposals were sent to overseas government donor agencies – with some making large financial pledges – much of the money became delayed in bureaucratic processes abroad and within Pakistan.
As needs increased on the ground, volunteer health workers from ACT member Church World Service – Pakistan/Afghanistan mounted a shoestring-budget medical response from cash reserves that assisted more than 3,000 displaced people, while the funding delays continued up to three months in some cases.
“The doctors and staff who started working for us voluntarily knew that they wouldn’t be paid for their additional work,” Dr. Kashif said. “They took their own decision to volunteer themselves because they knew that they needed to help these families–with or without a salary.”
He shared how one husband and wife – both doctors – worked tirelessly and for free to support the ongoing medical needs of displaced women, men and children. Humanitarian organizations are sometimes able to use their own resources to cover initial expenses, which are then reimbursed when the international funds begin to flow. However, in the case of CWS-P/A, incoming government donor funds were restricted to cover medical response activities that occurred after July 15, some two months after people were fleeing the conflict.
Despite the delays in humanitarian funding, communities and aid workers were fortunately able to avoid significant disease outbreaks, which Dr. Kashif attributes to both the efforts of volunteers and effective coordination by aid groups.
“In the beginning of the displacement, there was great fear of massive epidemics,” Dr. Kashif said. “But because of the collective efforts and very good planning by non-governmental organizations and the UN agencies, we were able to avoid a far worse disaster.”
“While international donors do not bear responsibility for this massive conflict and the displacement of millions, we absolutely count on their commitment to effectively carry out our mandate; to provide life-saving assistance to communities in humanitarian emergencies,” CWS Asia/Pacific regional coordinator Marvin Parvez said. “How can we guarantee accountability and humanitarian quality to the people we seek to serve without key donor commitments that match the needs on the ground?”
In a twist of irony, Dr. Kashif noted, “We actually received our first funds just as some families had already returned back home to Swat.”
“Innocent people suffer”
Other humanitarian groups also experienced significant funding delays for the response to the Swat displacement.
“Donors decided to fund the emergency response through UN agencies and the cluster system*,” one agency noted in a report. “This decision delayed funding and had a serious impact on NGOs with the capacity to deliver, significantly reducing their ability to help those in need.” Parvez stressed that, despite the absence of disease outbreaks, the lack of immediate funding support from some key government donors created significant gaps. “Innocent people suffer when we don’t have the resources we need,” he said.
Dr. Kashif described one particularly difficult case of a diabetic 5-year-old girl in Mansehra, a few hours north of Pakistan’s capital, Islamabad. “When I saw her, I was told by her brother that she was diagnosed as diabetic when she was 2-1/2 years old,” he recalls. “After being displaced, the family did not have enough resources to buy insulin.” The girl’s elder brother somehow managed to get a vial of insulin, yet he did not have any means to refrigerate it, so he kept the vial in a water cooler. After meeting CWS-P/A at one of its health units in May, the brother asked if CWS-P/A could arrange insulin for the girl. “As long as she was in Mansehra, we looked after her as much as we could,” Dr. Kashif said. “But after she left for Buner, we don’t know what has happened to her.”
The funds coming in to the UN agencies and aid groups were mostly being used to assist the millions of displaced families in Mardan and Swabi. “However, in every emergency there are always small groups of highly vulnerable people who evacuate to other areas–who become even further marginalized only because of where they happened to flee to safety,” Parvez said.
Food from ACT
“The number of people who evacuated to Mansehra and Abbottabad may not seem like a lot when compared to the millions,” noted Dr. Kashif. “But we were still counting thousands of families far from home in need of food, water, shelter and medical support.”
Dr. Kashif said that these were the groups prioritized by CWS-P/A’s volunteer-driven medical support program in the early days of the crisis.
As humanitarian groups mount their response to a new wave of displacement from the Pakistani military campaign against the Taliban in South Waziristan, the government has slowly been granting some access to the districts of Dera Ismael Khan and Tank, where some 350,000 displaced people have fled.
CWS-P/A is responding with support from ACT International to the food needs of 660 families. An additional water and sanitation response is planned for some 40,000 people, along with the distribution of basic household items.
“As we look at this current crisis, it’s difficult to measure if donor governments are moving funds faster this time, because the scale of the displacement doesn’t compare to the magnitude of the Swat emergency,” Parvez said.