Pakistan: Relief and Health Services for Earthquake Affected Victims

SWAT Earthquake Relief Project First Progress Report

January 09, 2016

On October 26, 2015, at 14.09 hrs, an earthquake of magnitude 7.7 hit the Hindu Kush region of Afghanistan. The epicenter was centered in Badakhsan Province of Afghanistan, 76 km north of the Chitral border of Pakistan. The earthquake has been calculated to have occurred due to reverse faulting at approximately 213 km (132 miles) below the earth’s surface where the Indian tectonic plate collides with the Eurasian plate, this convergence collision having produced the highest mountain peaks in the world including the Himalayan, the Karakoram and the Hindu Kush ranges. The U.S. Geological Survey measured the magnitude at 7.5. Sustained tremors were felt all the way down to Islamabad, Lahore and New Delhi in India.  

Emergency response by the National Disaster Management Emergency Response teams and Pakistani Army Rapid Response units was the initial face of the rescue operations. Mortality and morbidity figures rose to nearly 300 dead and over 2,000 injured in KPK’s key affected areas of Districts Dir, Chitral, Buner, Swat, Shangla and Malakand.

Due to the depth of the earthquake, the damage impact of this otherwise powerful earthquake was controlled, but the main quake was followed by 87 aftershocks, which along with the winter rains, triggered off a series of landslides in the mountainous regions causing weakly structured houses built on hill slopes to collapse. So far 59,000 houses have been destroyed rendering nearly 600,000 people homeless or living in makeshift shelters.  The freezing winter weather has placed the lives of those who are living in the open or temporary shelters at risk.

The response to this earthquake by the nation is one of panic and frenzy, triggered by the memories of the devastating 2005 earthquake where thousands died, and hundreds of thousands were injured and rendered homeless. The Post Traumatic Stress effect has lingered on and surfaced with this incident.

The National Disaster Management Programs led the immediate rescue and relief efforts of the areas of the affected districts that were accessible by road. The Pakistan Army, already based in these areas for their ongoing operation against the Taliban in the KPK province, also assisted in the rescue and relief operations. Together, they have supplied to all districts of KPK, FATA and Pakistan Administered Kashmir. Their relief efforts supply so far consists of nearly 29,000 tents with 15,300 plastic mats for in-tent flooring, 490 tons of food packages, and 32,555 blankets. Along with this food, 14 tons of bottled water and 40 filter plants have been set up to provide clean drinking water. Medical care services are being provided by augmenting the Government health facilities with nearly 5 tons of medical supplies. Volunteers registered with the Government health facilities are assisting in easing the burden on the health facilities.

Although no formal request was made by the Government for international assistance, a fact attributable to the security concerns related to these previously Taliban infested areas, local NGOs and CSOs have taken an active role in providing rescue and immediate relief services to victims. According to OCHA, a total of 4,876 households were served by several local NGOs.  

Detailed data of affected populations in terms of shelter, food and health needs was lacking. So Real Medicine Foundation, Pakistan carried out a needs assessment survey. A team of two RMF staff members visited three affected districts, namely Shangla, Dir and Swat over a period of 5 days from 29th October to 2nd November 2015.

The team selected upon District Swat because local feedback was that remote pockets of villages that had very poor road accessibility were badly affected and hence are not being accessed by the Government and Army response teams. With our experience with the 2005 earthquake, we have seen that whole villages can be destroyed and they remain unidentified, having fallen through the cracks of the relief services by the active players in the field at that time. The other two districts have good road access and hence relief operations are already underway. Following this lead, the RMF team zoned into District Swat.

On the ground, our team based itself at the periphery of a blocked area and went on foot into the surrounding areas to identify the poorest of the poor who had been dealt with the worst hand. A total of 100 households were identified and registered with RMF using the National Identification Card number (NIC) of the head of the household. Their demographics and needs, both short-term and long-term, were collected using survey forms.

We identified 30 households in Mohalla Bhakharawan in Union Council Kabal, Tehsil Matta and 70 households from Mohalla Akhonbaba, Union Council Shagai, Tehsil Saidu Shariff.  The average household size is composed of 7-11 family members with an average income of USD 100 per month. The occupations of these people range from daily laborers, carpenters, farmhands and sweepers. Most of their houses were in weak mud/stone houses, often built with their own hands that collapsed at the first tremors. While all of their houses have been destroyed, some people lost their livestock which was being kept indoors to protect them from the cold. Their hand-to-mouth existence (average income is 100 USD per month for an average of 7-9 member families) meant that their entire existence collapsed with the rubble. The needs assessment report identified the following needs:

Short term relief needs:

  1. Tents and plastic mats – People need winterized tents which they intend to put up in the same place till a more permanent structure is made possible. Matting for the floor of the tent in the face of the impending winter months and protection in the rain.
  2. Food rations – Most families have managed to salvage some of their home furniture, cooking utensils etc. from the rubble, hence are able to cook for themselves using firewood as was their normal practice. They need uncooked food rations for the family.
  3. Health services – Families located in Mohalla Akhonbaba, UC Shagai in Tehsil Saidu Shariff are close to a large teaching hospital and hence have access to medical services. However, families in UC Kabal are at a distance from this facility and need health care services. Beyond Kabal are remote villages which are still not accessible but we expect that people will need help as days go by and they will need healthcare

Long-term Rehabilitation needs

  1. Rebuilding of homes. Currently winter is setting in which lasts for an average of 3 months. By March, the snow thaws out and construction can begin.

2.1:  Real Medicine Foundation (RMF):  RMF Pakistan will be the implementing partner. Real Medicine Foundation USA was established in 2005 as a non-for-profit organization based in Los Angeles, USA. RMF’s vision is to move beyond traditional humanitarian aid programs by creating long-term solutions to health care and poverty related issues, focusing on development and capacity building. A global management team headed by the CEO operates offices in 15 countries.
RMF Pakistan was established 10 years ago and registered as a Welfare Trust with the Government of Pakistan under the Welfare Trust Act 1882.  RMF Pakistan has two wings of operation, a service delivery wing and a research wing.  The RMF research cell, in collaboration with different universities, conducts qualitative research studies on gender, class, social exclusion and Menstrual Health Management in Punjab and Balochistan. Under the Service Delivery wing, RMF’s experience lies in provision of quality healthcare services to over 200,000 victims of disasters e.g. 2005 earthquake, 2010 floods and 2011-15 IDP crisis via six operations of static/mobile health clinics and outreach through free medical camps in KPK, Kashmir and Sindh.  All our basic healthcare clinics operate on the premise to provide healthcare services until the local health departments take over for stand-alone function.
2.2: Latter-day Saint Charities, Inc. (LDS):  LDS is the funding partner. A non-for-profit organization organized under the laws of Utah, United States of America, LDS Charities is the humanitarian arm of The Church of Jesus Christ of Latter-day Saints. With the main purpose of relief of suffering, fostering self-reliance and providing opportunities for service for people of all nationalities and religions, LDS has sponsored relief and development projects in 179 countries.
LDS gives assistance without regard to race, religious affiliation, or nationality and is based on the core principles of personal responsibility, community support, self-reliance, and sustainability. Largely run with volunteer labor, LDS operates both independently and in cooperation with other charitable organizations and governments. More than one million workdays of labor are contributed each year by volunteers in support of welfare initiatives.
LDS funded projects include emergency relief assistance in times of natural disasters, clean water, neonatal resuscitation training, vision care, wheelchairs, immunizations, food production, and other community projects. The funding is made possible by generous donations of cash and materials from members and friends of the LDS Church.
3.1: Project Goal: To rehabilitate 2015 October earthquake affected victims of District Swat, Province of Khyber Pakhtunkhwa (KPK), Pakistan.

3.2: Project Objectives:

  1. To provide immediate relief shelter
  2. To provide immediate relief food
  3. To provide immediate health care
  4. To assist in rebuilding of destroyed homes

3.3: Project Location and Target population
The project will take place in two areas:

  1. Mohalla Bhakharawan, Union Council Kabal, Tehsil Matta, District Swat
  2. Mohalla Akhonbaba, Union Council Shagai, Tehsil Saidu Shariff, District Swat

The target population is 100 households (1,106 men, women and children), all residents of the above two mohallas (villages)

3.4:  Project Activities:  The project is composed of two phases.

Phase 1: This is the short-term provision of relief services. The time period for this phase will be 3 months and activities of Phase 1 include the following steps:

Distribution of Relief Goods

  • Registration of households genuinely in need of aid. Our initial registration of 100 families will be re-evaluated on ground at time of relief service provision and for food rations; this will be an ongoing evaluation.
  • Procurement and distribution of supplies of winterized tents, plastic mats and blankets. Tents will be large enough for families of an average size of 7 people. For larger families we will issue two tents. An average of 5 blankets per household will be distributed.
  • Procurement and distribution of uncooked, non-perishable, dry rations, following RMF quality control protocols and packaging them into deliverable form. One RMF Food Ration Package will be enough to feed a family of 8 people for one month. This package will include the following supplies:
    • Flour 20 kg
    • Rice 20 kg
    • Cooking oil 5 litres
    • Tea 1 kg
    • Powder milk 2 kg
    • Sugar 5 kg
    • Lentils 10 kg
    • Spices/Salt – I pkt
    • Matchboxes – 1 pkt each

Health Clinic: Phase 1 will also include a healthcare service clinic to be in UC Kabal, Tehsil Matta. The clinic is an OPD day-only quality primary healthcare services based on RMF’s Comprehensive Integrated Primary Health Care (CIPHC) Model of service. The clinic will be operative for 3 months to begin with, subject to renewal based on need beyond the time period and availability of budget. The steps in establishing the clinic will be:

  1. Securing a place/location in a central place accessible to those who have no access to any other medical facility. Duplication of activity to be avoided at all costs.
  2. Employing the services of a local male doctor, a female LHV and a medical Technician.
  3. Procuring medicines and surgical supplies, following the model that RMF adopted in the 2005 earthquake and following RMF quality control protocols. The most commonly needed medical/surgical supplies needed in emergency clinics include painkillers, antibiotics, IV fluids, oral rehydration, disinfectants, gauze, gloves, masks, sterile consumables etc.

Phase 2: This is the long-term rehabilitation of the destroyed homes. At this point, 100 destroyed homes are registered with RMF.  Phase 2 will be carried out when the snow thaws at the end of winter.
4.1: Meeting between LDS and RMF

The MOU was signed between LDS and RMF USA on 22nd November 2015.  A meeting with the members of LDS visiting Pakistan was held on 21st November 2015 in the RMF Pakistan office in Islamabad. Persons attending the meeting were:

LDS Representatives RMF Representatives
1. Elder Ronald Rasband,  Apostle 1. Dr. Rubina Mumtaz, Country Director
2. Elder Gerrit Gong, Asia Area President 2. Ms. Afshan Bhatti, Research Manager
  3. Mr. Mujeeb Rehman, Field Supervisor
  4. Ms. Fozia Hussain, Admin/HR Manager

The agenda of the meeting was introduction of the respective organizations and personnel. Details of RMF Pakistan’s projects were discussed and administrative protocols were shared. Folders with organization projects history and published reports of our research studies were given to the LDS delegates. The meeting concluded at a mutually satisfactory note and joint hope to work together towards the alleviation of suffering of the underserved and deserving.

The Swat Earthquake Relief Project was officially launched on 1st December 2015. Activities undertaken till the 10th of December are as follows:

4.2:  Activity 1:  Procurement, Permissions and Re-verifications

Permission for the project was sought from the National Disaster Management Authority (NDMA) of KPK and the military based in District Swat. The purpose of the permission was not only for security reasons since Swat was the hotbed for Taliban militant activity but to ensure that there is no duplication of services and the target population is genuinely in need and has not received similar aid from another source. A meeting with the NDMA head office in Islamabad was held on 25th November with the member in-charge of operations. Details of our needs survey and the organizational profile were shared. They recommended District Shangla for intervention with aid of different types such as jackets and hats etc. but left the decision to our choice. We then decided to have a meeting with the Army Commander in District Swat for their opinion and recommendations. This meeting was held on 27th November 2015 in Islamabad. The recommendations received from the Army were that they would first run the NIC numbers of our list of registered families from our needs assessment report in their database and identify how many of these families are in genuine need. It was decided that we stay with the original plan of distributing tents and blankets instead of jackets/hats/shawls simply because the logistics of the latter would create chaotic disorder.

Re-verification of our list of registered families from our needs assessment was shared with the Army and they ran the NIC numbers in their data base. Twenty eight families had already received relief aid from other sources. Among the remaining 72 families, 54 families were contacted and informed to reach a distribution point in the center of Mingora City. The remaining families were untraceable. The Army brigade of that area offered to help in the distribution process to maintain discipline, an aspect that often dissipates quickly when dealing with a large crowd.

Procurement of supplies was initiated following the RMF operating protocols of seeking at least three quotations. 100 winterized tents, plastic mats and 500 quilts/blankets were purchased from Peshawar City and transported via two trucks to Swat on 3rd December and kept in a storage facility. We had underestimated the bulk of the supplies; two trucks were needed instead of one. Regarding food supplies, we received quotations from several vendors but considering that a third truck would be needed, thus increasing the transport budget considerably, it was decided that the most cost effective option would be to purchase food supplies from Mingora City in Swat District. A vendor close to the distribution point set up by the Army was selected and orders were placed. This vendor will remain our source for food ration supplies for the next three months.

4.3:  Activity II:  Data Validation and Quality Assurance

The date for distribution of relief supplies was set for 5th December 2015. On 4th December, the RMF team from Islamabad drove down to Swat to carry out three main exercises prior to the actual distribution. These included:

  • Data validation: The RMF team made a random selection of three households from the Army verified list of families in Mohalla Akhonbaba and visited them on ground, meeting with the families. The purpose was to validate the data collected from our needs assessment survey and ensure that we are reaching out to the genuinely poor and vulnerable. All three houses were in need of food and warm blankets. Two needed tents but one house had already received compensation money from the government and was ready to re-construct the house. This exercise revealed that families with some social capital managed to get their names on lists of the government offices making them eligible for government funded compensation allowance, a one-time amount of PKR 200,000/-(USD 2,000). Marginalized and socially excluded families with little or no social capital like Mr. Tariq-ur-Rehman and Mr. Wazir Khan had no access to any aid for the sheer virtue of having no contacts in the right places.

Residence of Mr. and Mrs. Tariq-ur-Rehman and their 4 children

Residence of Mr. Wazir Khan, his two wives and family of 5 children.

Residence of Mr. Khanzada.

The above house, residence of Mr. Khanzada had received construction compensation money in mid-November and had already begun construction. The validation exercise showed us that we will have to carefully identify the families who have fallen through the cracks of the government and other aid agencies and are in genuine need of our help in the phase II of our project of reconstruction of damaged houses.

The validation exercise was satisfactory and up to mark.

  • Quality Assurance: The RMF team then went to the food rations supplier/vendor. Micro-evaluation of each and every food item was made inclusive of their accurate weight and air-tight sealed packing. The flour and rice sacks and the cooking oil tins were kept separate and remaining smaller items were all packed into one individual carton.  The quality assurance exercise involved randomly picking up three sealed cartons and opening them to count all the items and then separately weighing each item individually wherever applicable. We are lucky to have found an honest vendor as all the items were found up to mark. He also provided free delivery of the food rations to the distribution point in Mingora city.

Weighing the rice sacks.

Randomly picking up a packed carton to count all contents.

Weighing the lentils and sugar pakcs in the randomly selected carton.

  • Coordination with the Army Brigade Headquarters: The team then drove down to the Army Brigade headquarters to finalize the coordination of the distribution of supplies the following day. They were extremely helpful and efficient, making this exercise so much easier.

4.4:  Activity III: Distribution of Relief Supplies
The distribution of relief supplies was carried out on 5th December 2015 at Grassy Ground, Mingora City. The Army Brigade jawans arranged for the target population to reach to the site at 9.00 am. Our supplies were delivered to the site within the same time. At 10.00 am, the distribution began after recitation of the Quran.

A total of 54 families received relief items of which 6 were women headed households. Out of these 19 were given tents as well because the rest had already received tents from the Army Aid. Some of the families were given blankets according to their need e.g. some took just one blanket while some took 5 or 6. The distribution activity took place over 4 hours as each recipient was verified using their NIC cards, cross-checked with the print-out of the army and then, after receiving the parcel, registered with the local administrative office.

A total of 31 tents were left over and handed over to the Army office who, over the next 3 days, distributed them to extremely remote homes that were high up the mountain tops and accessible only by foot. It was only made possible as the military camps are spread across the mountain ridges in remote far flung areas, a fact that would have been impossible for the RMF team to access.

At the end of the exercise, we met up with some local councilors of surrounding union councils who sought our help and wanted us to visit their constituencies to see the damage sustained there with our own eyes.

Media Coverage: The event was covered by the local print and electronic media. The next day, 6 local newspapers gave a detailed news article on our intervention. (Please see Annexure 1). A local TV channel, Kohinoor TV broadcasted a video footage on the event in the evening news on 5th December.

4.5:  Activity IV: Groundwork for Health Clinic

For the remainder of the afternoon of 5th December 2015, Mohalla Akhonbaba was evaluated for health care intervention. We found that the Akhonbaba BHU was closely situated to the mohalla (village). A local NGO had established a primary healthcare facility in the same area and a teaching hospital affiliated with a local medical college was with 8 km radius. Our interviews with the women of the area revealed that they were relatively satisfied with the health services and 6 out of 8 of the women interviewed had had hospital based births. So it was decided that we look into the rural outskirts of Matta Tehsil for further evaluation.

The team also interviewed candidates for the doctor, LHV and medical technicians. The call for interviews had been made in the local media on the 1st of December and interviews conducted on a first come first served basis. Short listing for each position has been done to be finalized once we have decided upon a site that is in dire need of health care intervention.


On October 26, 2015, at 14.09 hrs, an earthquake of magnitude 7.7 hit the Hindu Kush region of Afghanistan. The epicenter was centered in Badakhsan Province of Afghanistan, 76 Km north of the Chitral border of Pakistan.

The earthquake luckily spared extreme damage to infrastructure of the affected areas, hence the low rate of mortality and morbidity but remote villages tucked deep in the folds of the mountains composed of mud and wood have succumbed to the quake tremors rendering whole villages shelter less. Also the event triggered off a series of landslides in the mountainous regions that, in the face of the impending winter where it has been raining and snowing in some regions, led to power outages in many places and road blocks, isolating large tracts of areas where people are in need.


1. To provide immediate relief shelter
2. To provide immediate relief food
3. To provide immediate health care
4. To assist in rebuilding of destroyed homes