Mother and daughter fleeing from Swat
PAKISTAN’S IDP CRISIS
Pakistan is facing the largest internal displacement of its population since its birth, with a grave humanitarian
crisis unfolding in the North West Frontier Province (NWFP), where the on-going military operation in Swat and adjoining tribal areas (FATA) against the Taliban has forced approximately 3 million people to flee their homes. These internally displaced persons (IDPs) have fled to the relative safety of surrounding areas, where they are being accommodated in humanitarian relief camps and in host communities in the districts of Mardan, Swabi, Nowshera, Charsada, and Peshawar. These host communities are also greatly affected by
the crisis and their resources are limited, resulting in internally affected persons(IAPs) who are also at risk with
regards to potential epdemics and shortages of food, clean water, medicines and other resources. The IDPs
and IAPs of this region are poor people, without the resources to survive on their own under such circumstances. In the absence of a functioning system, they do not have the means to provide for
themselves and their families. The IDPs fled the conflict with nothing but the clothes they were wearing and
arrived in an area much hotter than the mountains they called home. Their lives have come to a halt. Life for the IAPs in host communities has also been greatly affected, as local systems are overwhelmed, host families endure the hardships of taking in many families into their homes for long periods, and schools have been closed to accommodate IDPs.
Today, according to official figures, out of the 3 million people displaced, only approximately 300,000 men,
women and children are living in relief camps set up across the region. The remaining 2.7 million have spread
out across the region accepting and occupying whatever little space has been made available to them (over
2 million are staying in District Mardan alone). Almost every home or built up structure in the region is housing
IDPs, with acute shortages of resources and capacities that are needed to keep all basic life support systems
functioning. Schools, colleges, and in some cases even poultry farms and warehouses in the area have been
converted into makeshift camps to house IDPs.
The Current Situation
The sheer scale and magnitude of the displacement, and the vast geographic area covered for settlements pose a great challenge for humanitarian relief organizations to effectively reach all those in need. There is a serious shortage of doctors, healthcare professionals, and essential medicines across the region.
Health Systems: According to UN figures, there are more than 600 public health facilities operating in the districts hosting the IDPs. However, most of the IDP hosting districts are under-developed with poor health indicators. Existing medical facilities, under-staffed and under-resourced by their own standards, are in no way equipped to handle an influx of this magnitude. They are simply overwhelmed.
The Threat of Disease: Overcrowded host communities and villages are facing serious threats of disease outbreaks as a result of contaminated water, poor sanitation and hygiene conditions, low vaccination coverage, degraded nutritional status and inadequate provision of healthcare. Water and sanitation conditions in IDP camps and across host communities in the region need urgent attention to prevent spread of water-borne diseases. Many among the displaced are suffering from acute respiratory infections, fever, acute diarrhea and various skin diseases such as scabies. Without proper shelter, IDPs could face added risks during the monsoon season from water-borne diseases such as dysentery and diarrhea. Malaria cases are also expected to surface as the monsoon season starts towards the end of June. Vaccination campaigns have been initiated for both measles and Hepatitis B in some camps, however a theater-wide drive is urgently needed. Although some 25 outbreaks have so far been registered and contained through the World Health Organization’s Disease Early Warning System (DEWS), a resource shortfall can seriously undo preventive measures and threaten to dramatically increase infant and child mortality rates among IDPs/IAPs.
Malnutrition: Under the current circumstances and living conditions, IDP families are especially vulnerable to inadequate nutrition, especially with food prices increasing by 22 per cent in the area, and with shortfalls in relief distribution efforts. It is estimated that more than 15 per cent of the children amongst IDPs are suffering from malnutrition.
The Plight of Women: Approximately 60 per cent of IDPs are women and girls of child bearing age. According to UNFPA, there are almost 70,000 pregnant women among the displaced, 6,000 of whom are expected to deliver within the next month. At least 1,000 of these women will require emergency obstetric care to handle pregnancy-related complications. Owing to the conservatism of the Pashtun culture and society, these women will only have access to adequate healthcare services if female doctors and healthcare professionals are made available to them.
The Plight of the Elderly and the Disabled: There is a lack of specialized healthcare services for vulnerable and disabled persons among the IDPs. These people have special needs that need to be addressed urgently. There are also huge numbers of elderly IDPs suffering from exhaustion, severe stress and heatstroke, and illnesses such as diabetes, high blood pressure and heart related conditions. Theses people have special medical and dietary needs, however no special arrangements have been made.
Mental Health Services: A minimum of 30,000 of the IDPs are estimated to have severe mental disorders as a result of the stress they have undergone, and this number could triple as the fighting stretches on. No mental health and psychosocial support services are being provided thus far. The capacity to identify and manage mental health and psychosocial problems must be built up urgently. Primary health care facilities require psychological and pharmacological interventions, as well as psychotropic medicines on a regular basis.
The Threat of Polio: There is a crises looming, and if immediate action is not taken, Pakistan could be plagued with a polio epidemic. Along with Afghanistan, India and Nigeria, Pakistan is one of the four countries where polio continues to thrive. The residents of the Malakand division are extremely vulnerable to a polio outbreak. As early as September 2007, threats to health workers disrupted vaccination campaigns in about half the valley. The trouble began when Swat-based extremist cleric Maulana Fazlullah denounced polio vaccinations and declared them un-Islamic. He argued that polio drops were part of a western conspiracy to render Muslims infertile.
More recently, since October 2008, none of the target population of over 377,000 children under the age of five in Swat has been vaccinated owing to the deteriorating security situation and military offensives. The mass exodus resulting from the ongoing military operation thus presents Mother and five children; father is feared dead
opportunities as well as serious challenges in terms of averting a polio epidemic. Much needs to be done. Even if one child is affected, children across Pakistan remain at risk because polio spreads rapidly in populations that have not been immunized. Also, haphazard displacement trends and crowded camps present monumental challenges in attempting to every child under the age of five receives the vaccine.
Moreover, given the lapse in regular vaccination in recent years, it is possible that undiagnosed children already carrying the polio virus are now exposing dozens more to the disease in IDP camps. Since many IDPs have scattered across the region to avail of the hospitality of host families, children throughout the province and the country are now at a higher risk of infection. If properly managed, attempts to raise awareness and eradicate polio risk among the IDP population could, in turn, benefit the country as a whole. It may seem premature to be worrying about a polio epidemic when IDPs barely have access to basic primary healthcare, food, clean drinking water and shelter. But Pakistan has a bad habit of worrying about the benefits of foresight only in hindsight. Now is the time to take the right steps in the right direction towards a comprehensive polio vaccination drive. That way, we may save ourselves another major crisis in the coming years. According to official figures, up to 1.3 million children in the Frontier Province are expected to miss vaccination owing to the mass displacement. This does not have to happen.
Crisis Response Assessment
CDRS’ on-ground assessments and direct contact and communication with large numbers of IDPs, and close coordination with the World Health Organization (WHO), National Rural Support Program (NRSP), other field partners and local health sector responders (UM Trust, Edhi Foundation, Ayub Medical College, Disaster Management Center of Abbottabad, Human Development Foundation, Mountain and Glacier Protection Organization, Railway Hospital, Islamic International Medical and Dental College of Riphah University, Islamic Relief) has provided us with a clear picture of the current situation. The response is poorly coordinated, late to crank up and woefully inadequate to meet the needs of the people living on and off camp in the affected districts.
A massive-scale and long-term mobilization effort by Pakistan and the world community is required to face the challenges posed by the current crisis. Unfortunately, an adequate theater-wide response has not been enacted as of yet. The government of NWFP is under-prepared, under-equipped and Comprehensive Disaster Response Services, Pakistan Camp completely inexperienced in managing a crisis of this magnitude and coordination is poor between responding organizations. Meetings are held
Camp for Swat IDPs
Father and his malnourished child, Swabi Camp