Pakistan: Nowshera Health Centre

Photo: Women and children IDP's gathered at RMF's Nowshera Clinic to recieve food donations

FIRST REPORT

30^th June 2015

By Dr Rubina Mumtaz

The background to Internally Displaced People:

An estimated five million people have been displaced by conflict, sectarian violence and wide-spread human rights abuses in Pakistan since 2004. The IDP crisis is further aggravated by natural calamities and disasters. In 2005, following a massive earthquake, around 3.5 million people became homeless while 15 million people were displaced across the country by three years of monsoon flooding between 2010 and 2012.

Conflict-related displacement reached a peak in 2009, when 3 million people were displaced in the north-west, 2.3 million of them from the Malakand region of Khyber Pakhtunkwa (KP) Province. By the end of 2010, the number of IDPs had fallen to around one million, but again the figure rose due to new conflicts. Today, Pakistan faces what can easily be termed as a chronic IDP problem as the Pakistan Army continues its conflict with militants that have infested different areas of the county.

Photo: Organizing bags of food for the IDP's to carry out

The worst affected areas are the Khyber and Khurram Agencies, a fact that can be attributed to military operations aimed to protect Peshawar and NATO supply lines. Main hosting areas for IDPs in KPK are the districts of Peshawar, Nowshera, Kohat, Hangu, Tank and Dera Ismail Khan.

Displacement leads to a range of serious protection challenges, including threats to life and freedom of movement. Although many IDPs take refuge in government designated camps, the vast majority, that often come as cohesive groups, are absorbed by surrounding host communities either by relatives or rented accommodations, an aspect driven by a range of factors such as camp conditions, lack of privacy and tribal dynamics. Nearly two thirds of IDPs outside of camps live below the poverty line and do not have adequate access to food, housing and basic services. The average IDP family lives below poverty line with an income of 2500-5000/- (USD 25/- to 50/-) per month. National and international responses have been substantial, but they have not consistently been rights-based. In the vast majority of cases, only IDPs who meet government criteria for registration are eligible for food assistance.

Photo: Preperation and serving of a hot meal at the RMF clinic

Since the key focus of the government is safe and voluntary repatriation of IDPs, the government responses are mainly provision of emergency relief such as food, healthcare, sanitation and clean water rather than long term solutions as the host regions face increased pressure on infrastructure by the chronically burgeoning populations. This added pressure, in the arena of healthcare, has been eased by a cluster of NGOs , of which RMF is a part.

Our MCH center in Union Council of Tarru Jabba in District Nowshera has been serving the women and children of the IDP population for the past 19 months. During this period we have generated a great deal of goodwill amongst this vulnerable and needy population. Being the only center providing basic primary level of MCH care that is gender sensitive whereby we respect and observe the ‘purdah’ system of this fiercely tribal and patriarchal society, we have also earned the two additional titles of being the only center that provides free routine pathology investigation and free ultrasound services in this region.

The trust and goodwill we have earned also means that this population leans heavily in our direction for all their problems, in addition to health-related issues. During the month of Ramadhan, especially this year when it is in the peak of summer with average temperatures above 40 degrees Celsius, the burden of life for this poor and vulnerable people becomes heavier. So we seek help from philanthropic friends, who donate generously to our organization, to provide relief to these people to ease their burden of food insecurity.

RMF has been providing cooked food for Iftari (time when Muslims break their day-long fast from sunrise to sunset) to the families of the women and children who frequent our center. At the start of the month, we issued tokens to families totaling to approximately 100 persons. To cut costs and ensure quality of the food being served, we have hired a cook who makes the food on the compound site every day with fresh recipe items that are directly purchased by our staff.

Since our compound has the ‘women only’ purdah system, this means that women and children come directly to collect the food daily. In our last year’s experience, we learned that men would come to collect the food but often would prefer to stay on site, open their fast and have their meal before taking food back to their families. This conforms to the local tradition but our sense of gender rights bristled as the women and children waited patiently for an additional hour of hunger before they could eat. So after one week of this, we changed our tactic by not offering food on site but encouraging a take-away practice which was successful. This year, we developed a better method where the women who were in greatest need and who have specifically requested for this assistance were issued tokens before the program started and hence they came first in line. To keep track of the days of the program, we change the sign board according to the day.

In the first week of our program we have provided food packages to about 700 people (an average of 100 people per day). We aim to continue this program as long as the funding lasts.

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