Access to good-quality healthcare, including treatment for communicable diseases and lifesaving obstetric and neonatal services, remains a significant challenge for many people in Pakistan.
Living in isolated communities in the mountains between Pakistan and Afghanistan and in areas affected by conflict, Afghan refugees and residents of urban slums are some of the vulnerable groups in desperate need of medical assistance. Healthcare for women and children is a particular concern: women regularly die from preventable complications during pregnancy, neonatal care is inaccessible for many, and one in ten children dies before their fifth birthday. MSF continues to support provincial and district health authorities in responding to some of the most urgent needs. MSF activities in Pakistan are funded solely by donations from individuals, with no institutional or government contributions.
Mother and child health in Balochistan
Government-funded inpatient paediatric care in Balochistan’s capital, Quetta, is insufficient to meet the population’s needs and many people cannot afford private clinic fees. In 2011, MSF opened the 67-bed Quetta paediatric hospital, housing a neonatal ward, an inpatient therapeutic feeding centre for children with complicated malnutrition, and general and isolation wards. Some 1,300 patients were admitted in 2015 and more than 1,900 severely malnourished children received treatment. Over 4,000 individual and group mental health consultations were held in 2015.
In Kuchlak, 20 kilometres north of Quetta, MSF runs a mother and child health centre offering outpatient treatment, 24-hour emergency obstetrics, and nutritional support for children under the age of five. More than 9,100 children were vaccinated against childhood diseases in 2015. In Kuchlak and Benazir Bhutto hospital in old Marriabad town, MSF also treated over 1,700 patients for cutaneous leishmaniasis, a disfiguring and debilitating parasitic disease transmitted by sandflies.
On the Afghan border, at Qila Abdullah district headquarters hospital in Chaman, MSF works with the health authorities, offering free healthcare to local residents, Afghan refugees and people who cross the border seeking medical assistance. Services focusing on women and children include reproductive, neonatal and paediatric healthcare. Teams carried out 10,900 antenatal consultations and assisted 4,400 births in 2015. There is also an emergency room for trauma cases, where staff attended to over 5,800 patients this year. More than 1,500 severely malnourished children under the age of five were treated in the nutrition programme and 8,200 children received essential vaccinations. Through health education sessions, MSF teams highlight the need to seek timely medical assistance, especially during pregnancy. MSF also supervises the women’s outpatient department, which is managed by government staff.
In Dera Murad Jamali, in eastern Balochistan, MSF continues to support the inpatient therapeutic feeding centre for children with complicated malnutrition, and the general paediatric and neonatal wards at the district headquarters hospital. More than 8,000 severely malnourished children received treatment in the feeding programme in 2015.
Federally Administered Tribal Areas (FATA)
MSF provides medical care to vulnerable communities in Bajaur Agency, the northernmost tribal agency. International staff do not currently have access to Bajaur, so a team of national staff manage the project. At Nawagai civil hospital, 43,000 outpatient and 30,000 emergency consultations were conducted, and support was provided to the mother and child health department. Paediatric services include vaccinations in support of the National Expanded Programme on Immunisation, and therapeutic feeding for malnourished children – over 12,500 children were screened for malnutrition this year. MSF also supported outpatient and antenatal services at two basic healthcare centres in Talai and Bilot by donating drugs and medical equipment.
At Sadda Tehsil headquarters hospital in Kurram Agency, MSF provided inpatient care for children under the age of 12 and carried out an average of 600 consultations per week. In 2015, there were 300 children admitted for measles and post-measles complications. MSF also provided treatment for cutaneous leishmaniasis, and managed the hospital’s obstetric and general emergency referrals. At the smaller Alizai hospital, around 100 paediatric consultations were carried out each week for children under the age of 12.
Emergency and maternal care in Khyber Pakhtunkhwa
MSF offers comprehensive emergency obstetric services at Peshawar women’s hospital for patients with a history of complicated pregnancies and/or difficult deliveries. These women come from FATA, Peshawar and the surrounding districts, and the hospital also admits female refugees and displaced people living in Peshawar district. There are 33 obstetric beds and 18 beds in the neonatal unit. More than 5,200 patients were admitted and 4,700 babies delivered in 2015. The team also provided training on high-risk obstetrics and maternity care to staff working in the basic healthcare facilities within the hospital’s referral network.
Approximately 200 kilometres north of Peshawar, MSF supports the district headquarters hospital in Timurgara with medical expertise in the emergency, resuscitation and observation rooms and the neonatal unit. Staff provide treatment for complicated obstetric cases, including surgery, and 8,395 births were assisted in 2015. In March, MSF set up a ‘cardiac corner unit’ to treat patients suffering from acute coronary syndrome, and 560 patients were admitted over the course of the year. In addition, 4,500 mental health consultations were carried out. The team also ran awareness activities to inform communities about dengue fever. More than 6,600 health promotion sessions were conducted overall.
The team at the Hangu emergency surgical project carried out over 15,000 emergency room consultations, performed 800 surgical interventions and assisted 3,202 births before handing over activities to the health authorities in September.
Healthcare for Machar Colony
A clinic in Machar Colony slum, run jointly by MSF and SINA Health Education & Welfare Trust, provided over 102,000 consultations in 2015. Machar is a densely populated community of around 115,000 people living in polluted, unsanitary conditions on the edge of Karachi’s Fish Harbour. The programme includes basic, emergency, obstetric and postnatal healthcare, as well as mental health services. Health promotion teams run educational health and hygiene sessions for parents and children aimed at preventing illness. The team vaccinated 31,000 children against measles during a 15-day campaign in April, and also began a treatment programme for people with hepatitis C that meant patients could access free diagnosis and high-quality treatment without having to travel long distances to a hospital.
An earthquake measuring 7.5 on the Richter scale struck northeastern Afghanistan and northwestern Pakistan on 26 October. MSF responded quickly to an influx of 250 patients at Timurgara district hospital and Khar hospital in Bajaur Agency, and also supported health ministry staff by providing aftercare to the more seriously injured patients. More than 2,100 kits containing items such as soap, washing powder, buckets and cooking pots were distributed in Timurgara and the surrounding districts and to several villages in Chitral district.