Pakistan’s New IDPs
Ashfaq Yusufazai
Even from a distance, the Sheihk Yasin Camp on the Mardan-Charsadda Road in northern Pakistan looks bleak. The heavily armed guards at the main entrance, where visitors are subjected to a body search, to the rows of greenish-gray tents amidst the hot, dry climate, portend much illness and suffering among its inhabitants, Pakistan's newly displaced population.
Sheihk Yasin is one of 23 makeshift camps established largely by the United Nations following the April 26 military action Pakistan launched against Islamic militants in its North West Frontier Province. An estimated 3 million civilians fled to the adjacent provinces of Mardan, Swabi and Peshawar. Of these, around 80 percent live with host communities and about 500,000 displaced people live in camps.
The strain of displacement has left an indelible mark among many in this population. Dr. Mian Iftikhar Hussain, a psychiatrist at one of the camps, estimates 50 percent of the women suffer from mental disorders after witnessing the deaths of their loved ones and the destruction of their properties. The relative comfort of their old lives lies amidst the rubble they left behind.
"[We] traveled on foot for hours along with other women and children after failing to get a vehicle to transport us to a safer place," says Jamila Bibi, a 39-year-old housewife who now lives in Sheikh Yasin.
Dr. Hussain says Bibi is one of many women suffering from severe depression. Bibi's 11-year-old son, Gul Jamal, was a casualty of the raid. "My son was playing outside the house when a bomb hit him and we found his charred body scattered all over the place," she told the doctor.
Of another woman, Hussain says, "She suffers from post-traumatic stress disorder due to the loss of her son in fighting between the government's forces and Islamic militants. Her condition will deteriorate further due to [continued] fighting in Swat."
Children, likewise, have been affected by the trauma of conflict and displacement. Abdul Hameed, president of the Pakistan Pediatric Association, says there are about 1.3 million refugee children who are at high risk of mental illness, as well as other disease. "These children could turn into monsters in the future if they aren't rehabilitated," he bluntly said. "The government should arrange for children's health, shelter and educational facilities."
In a recent survey of physicians at the various camps, of the 15,000 patients visited, 50 percent suffered from depression, 28 percent from dysentery, 11 percent from scabies, many suffer from acute watery diarrhea, according to Dr. Fazal Mabood, director-general for health services in the North West Frontier Province.
In the Jallozai Camp, "About 51 percent of the camp's (residents) suffer from acute respiratory infections and 19 percent had acute watery diarrhea," said Dr. Saeed Akbar Khan, operation medical officer from the World Health Organization. The camp is home to 87,000 people from volatile districts, who are exposed to a host of diseases because of scorching heat and the lack of electricity.
Lack of food or potable water, inadequate sanitation and close quarters make children particularly susceptible to illness. Children are among the worst-affected, prone to malaria, typhoid and water-borne diseases because of contaminated food and water. Dr. Khan said that along with the provision of diagnostic treatment and facilities, WHO has deployed environmental engineers to test the quality of water and food.
According to UNICEF's estimates, 15 percent of children in the camps are severely malnourished. "The worst affected are those from Nowshera, Lower Dir, Mardan and Charsadda," said Dr. Akbar. In an effort to raise awareness about nutrition, UNICEF has launched a program to train 10 people in each camp in Community-based Management of Acute Malnutrition (CMAM).
Cholera and watery diarrhea are major problems in the camps. In May, more than 5,325 children from the Mardan camp alone were hospitalized because of an outbreak of diarrhea.
A shortage of beds, coupled with the steady influx of IDPs in many of the hospitals, has forced health-care workers to place two children in one bed.
The Pakistan Pediatric Association established two wards dedicated to providing specialized treatment to critically ill IDP children, one at the District Headquarters Hospital in Mardan, another at the Shah Mansoor Medical Complex in Swabi. Within two weeks, 1,424 patients were examined. Of them, 995 had acute watery diarrhea, 147 had an acute respiratory infection, 121 suffered from dysentery, 104 had high temperature, 24 had malaria, three had meningitis. Though most patients were taken care of on an out-patient basis, 360 were admitted.
Hundreds of local health providers working in conflict areas of Pakistan were deployed to clinics and other facilities within the camps and in other communities where refugees are living with host families. This strategy also offers the added benefit of being able to better monitor displaced TB patients on DOTS.
However, lack of coordination among government agencies, multilateral institutions and private-sector partners have severely compromised health resources in the region. The logistical challenges of triaging patients have resulted in several deaths, many of whom are children.
Ashfaq Yusufazai is a Pakistan-based journalist. He has written for the BMJ and the Telegraph, both in the UK, among other publications.
I am in the US from the past years and it’s gladdening to see the Pakistan’s internally displaced persons story in a US magazine.
We need more health issues because the US has millions of Pakistanis who are interested.
— Gul Ghutai on 2009-10-26