Intended for healthcare professionals


UN tries to secure safe corridors for humanitarian aid in Pakistan

BMJ 2009; 338 doi: (Published 20 May 2009) Cite this as: BMJ 2009;338:b2042
  1. John Zarocostas1,
  2. Peter Moszynski2
  1. 1Geneva
  2. 2London

    United Nations relief officials have called for international aid to help nearly one million displaced people and to help large numbers of civilians trapped in the escalating conflict between Pakistan’s armed forces and Taliban militants in the country’s north west.

    “Circumstances in these areas are very, very difficult. Supplies of electricity have been cut, which means often water systems are not functioning,” said Martin Mogwanja, the UN’s acting coordinator for Pakistan.

    “The monetary system is not functioning because the banks have been closed, and the food supply is very limited because there is no means of distribution with many road blocks in all directions.

    “We’re also concerned that a major hospital near Mingora, the capital town of Swat district, has had to be closed, and the doctors have evacuated themselves due to insecurity,” the UN official told reporters in Geneva in a teleconference.

    “This means that there’s very limited medical capacity in those areas to respond to urgent medical needs of those who may be wounded in the fighting.”

    Mr Mogwanja said that the humanitarian community is considering the establishment of safe corridors in the region, but noted, “It is very difficult to make the necessary contacts and to obtain the necessary guarantees of safety and security to allow humanitarian workers to enter the area.

    “We hope all the stakeholders will respect such requests as they are made and provide humanitarian workers with the possibility to access all the affected civilian population.”

    Fighting in the Swat, Dir, and Buner districts has resulted in the latest influx of nearly one million displaced people. Camps have been established to accommodate displaced people in Lower Dir, Mardan, Malakand, Swabi, and Nowshera districts. But many are staying outside the camps with host families or in rented accommodation in these districts and also in Charsadda, Kohat, and Peshawar.

    Dorothea Krimitsas, spokeswoman for the International Committee of the Red Cross, said that the agency had been able to deliver hospital supplies in some of the conflict areas, such as Buner on 13 May, but had not been able to get in the Swat valley “because the heavy fighting prevents us.”

    The Pakistan Red Crescent society was able, however, to deliver humanitarian assistance on Friday 15 May in the conflict hit areas of Malakand and lower Dir.

    William Spindler, a spokesman for the UN High Commissioner for Refugees, said that the number of displaced people registered since 2 May has reached 987 000, of which 80 000 are in camps and the rest with host families or in rented accommodation.

    The new influx, along with the 550 000 who fled their homes in earlier fighting in the same region last August, means more than 1.5 million people are in need of humanitarian aid.

    The World Health Organization and other relief agencies are trying to increase medical supplies, food, and other essentials.

    Paul Garwood, WHO spokesman, told reporters that the agency had sent 20 emergency health kits, sufficient to treat 20 000 people for one month, and said that 400 disease surveillance points had been set up to monitor for possible outbreaks of respiratory infections, malaria, and other diseases in the towns and in the camps housing displaced people.

    Mr Garwood said that in the last week clinics in the North-West Frontier Province had reported 5571 cases of acute diarrhoea; 903 cases of bloody diarrhoea; 9020 cases of acute respiratory infection; 2366 cases of scabies; 431 cases of suspected malaria; and 16 cases of acute jaundice.

    Larger hospitals in the region, he said, were “overburdened” by the case load with the influx of people fleeing the conflict and noted there was also a need to increase the number of ambulances.

    In the camps, there was a need to increase obstetrics services and the number of female health workers, Mr Garwood said.

    The world food programme said that it was providing food to 780 000 displaced people.

    Amnesty International’s Asia director, Sam Zafiri, told the BMJ that despite local people’s hatred of the Taliban, they were not fleeing the insurgents but the military bombardments. “The chief concern has to be the wellbeing of the civilians. You don’t fight a successful counterinsurgency campaign by terrorising the people. If the military don’t do it right they will create a resentful population and the Taliban will return, in which case the humanitarian and human rights outcomes could be horrific.”

    Maria Luiza Galer, country director for the UK medical charity Merlin, which is working with newly displaced people, told the BMJ, “People arrive having travelled long, arduous distances, many on foot. They are physically and emotionally exhausted. Most fled with just their clothes on their back and have had limited access to safe water, sanitation, and shelter on their journey.

    “They are now living in environments with limited access to basic services such as shelter, water, sanitation, health care, or food. Conditions will be further stressed when the monsoons arrive.”

    Dr Galer said, “An outbreak of acute watery diarrhoea is of real concern as people have limited clean water, sanitation, or the facilities to practise safe hygiene. It can easily spread and can kill in 24 hours. The cramped living conditions and poor shelter also increase the incidence of respiratory infections.

    “We also remain vigilant to the potential of the outbreaks of other key communicable diseases such as measles. Malaria is also of particular concern since many people have fled from cooler climates, where malaria is not as prevalent into endemic, high risk areas. As such, they do not have any natural resistance to the disease or any bed nets needed to protect themselves from mosquitoes.”

    “It is only through the rapid and sustainable provision of shelters, food, clean water, sanitation, hygiene, effective health care, and other basic services that the incidence of these diseases can be minimised.

    “It is critical for us and other agencies working in the area to receive support through the donation of funds. These donations will allow us to maintain and to increase our activities by supporting health workers who, operating against the odds and working around the clock, are responding to this crisis.”


    Cite this as: BMJ 2009;338:b2042