Pakistan

Background
Pakistan—a country of 161 million bordered by Afghanistan and Iran in the west, India in the east, China in the northeast, and the Arabian Sea in the south—was established in 1947 by the partition of the Indian sub-continent. Since that time, it has experienced both periods of significant military and economic growth, and of instability, whether from domestic political upheavals or regional confrontations. While its economy is relatively healthy, the World Bank puts Pakistan’s poverty rate at 33 percent.

Due to conflict and instability in neighboring Afghanistan, Pakistan now hosts as many as three million refugees within its borders. The first wave arrived during the Soviet occupation of Afghanistan in the 1980s; the second, during a civil war in the 1990s; and the third, prior to the fall of the Taliban in late 2001. Of those refugees populations, approximately 1.2 million live in camps consisting of mud-walled huts surrounded by rubbish-strewn dirt streets. Harsh winters, with heavy rain and snowfall, only exacerbate the squalid living conditions.

In fall 2005, a magnitude 7.6 earthquake devastated the mountainous Pakistan-administered Kashmir region in the country’s north, along its border with India. The earthquake, coupled with subsequent landslides, killed more than 73,000 people in Pakistan and displaced another 3.3 million. Entire towns and villages were destroyed and bad weather, mountainous terrain, and blocked roads made it difficult for relief workers to reach survivors. Recovery has been slow, but the international community remains in Pakistan, providing health care and economic and technical assistance to crisis-affected communities.

What IMC Is Doing
IMC began working in Pakistan in 1984, shortly after IMC was founded. Until the 2005 earthquake, programming focused on two major directives: building the capacity of the national health care system and providing primary and secondary health care services to the burgeoning Afghan refugee population in the Northwest Frontier Province (NWFP).

Integral to IMC’s community-based approach to relief and development is its emphasis on building local capacity by strengthening institutions. Working with nongovernmental and government partners, IMC conducted a variety of training and development programs for both Afghan refugee and Pakistani health professionals, with a special focus on female doctors and health care workers. Staff and volunteers held initial and refresher training classes for traditional birth attendants, community health workers and supervisors, physicians, pharmacists, nurses, vaccinators, and laboratory technicians. Courses varied in subject matter, but included reproductive health, primary health care, health education, training methodology, and diagnosis and treatment of common diseases. These programs help promote self-reliance and are providing health workers with the skills necessary to rebuild national health care capacity, whether in Pakistan or Afghanistan, when they repatriate.
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MC has also provided extensive health care services to hundreds of thousands of Afghan refugees over the past two decades. IMC has provided curative out-patient care, immunization, reproductive health, maternal and child health, wound care, dental care, pharmacy, health education, food demonstrations and growth monitoring, laboratory services, and 24-hour emergency care. IMC has established five primary health clinics, a maternal and child health clinic, and two emergency obstetric care centers (both of which offer care to refugee and Pakistani women), which deliver services throughout the Afghan refugee camps in the NWFP. In addition, IMC provides assistance to three health care centers run by local nongovernmental organizations.

Following the October 2005 earthquake, IMC significantly expanded its programs in Pakistan, dispatching medical and relief teams to remote and nearly inaccessible locations within twelve hours to administer emergency medical care and establish basic health units to meet the long-term needs of affected communities. As many survivors were forced to leave their villages and take refuge in makeshift camps, IMC supplied them with hygiene kits, blankets, and materials to protect them against harsh winter conditions. IMC provided emergency water and sanitation services to prevent widespread epidemics of infectious diseases. Through its fixed and mobile clinics, IMC provided health care to thousands of people. Moreover, IMC’s cash-for-work programs provided much-needed economic assistance to vulnerable people and give survivors the opportunity to help rebuild their homes and villages.

To this day, much work has yet to be done to ensure stability for earthquake survivors. IMC continues to rebuild and re-staff hospitals, providing a full range of primary health services, including prevention and treatment of infectious diseases, measles and tetanus vaccinations, and reproductive health services. IMC is addressing the mental health needs of survivors, as well, not only by offering therapy to help them cope with trauma, but by training local health professionals and community volunteers to identify and treat anxiety, depression, and stress disorders.