Pakistani militants declare war on healthcare

An increasing wave of militancy has destroyed the health infrastructure in the Federally Administered Tribal Areas (FATA) and the Malakand division of Khyber Pakhtunkhwa, forcing the population to seek treatment outside its hometowns, even for minor ailments. “About 104 health facilities have been destroyed by militants, requiring $11.7m for reconstruction”, said Dr Mustaqeem Shah, an official at the FATA health directorate. Such massive destruction has deprived about 5m people of healthcare needs, he said. Khyber Pakhtunkhwa’s health department needs about $19m to restore the 55 Swat health facilities damaged by militants between 2008 and 2009. Militants in Malakand division also stole about 45 vehicles used to transport pregnant women to health facilities, executive district officer health Abdul Wali said. “The tribal population happened to suffer the most, as 80% of the health facilities have gone into disuse”, Mustaqeem said. The number of patients visiting the health facilities has dwindled since 2005, said Dr Riaz Shah. Medics examined about 150,000 patients in 2006, 131,000 in 2007, 104,000 in 2008, 80,000 in 2009 and 28,677 this year so far, he said. “Similarly, the number of surgeries dropped to only 12,040 in 2009, compared to 90,000 in 2005”, he added. “Targeting health facilities is an inhuman act and condemnable by all the people because it has deprived patients”, said Shakirullah, 40, who underwent an appendectomy at the Khyber Teaching Hospital Peshawar last week. “In 2005, my younger brother was operated on for a kidney stone in our native Miramshah, but now the doctors have left the hospital after threats by militants”. The FATA has been home to Taliban and al-Qaeda members whom coalition forces expelled from Afghanistan toward the end of 2001. From there, they began targeting Pakistani forces, music shops, and government installations, such as schools and health facilities. Their campaign against health facilities extended to medical personnel. The list of slain or injured medics is long. Three years ago, Dr Bakht Sarwar was critically injured by a missile that slammed into his hospital in Miramshah. He refused to return to work and is on indefinite leave in Peshawar. In February 2008, a roadside bomb killed Bajaur Agency surgeon Dr Abdul Ghani Khan and injured three health department officials. In May 2009, nine health workers conducting a survey were kidnapped in North Waziristan. They were freed after a week. Such intimidation has caused a shortage of medics, paralysing FATA’s 26 hospitals, eight rural health centres and 400-plus community health centres. The government appointed 66 specialists, 435 medical officers, 48 female doctors and 182 nurses to serve in FATA, but now only a few primary care doctors can be seen. “Doctors have either taken long leaves or have transferred to settled areas for security reasons”, said Dr Dilaram Khan, general secretary of the Provincial Doctors’ Association. “I had been working in Bajaur Agency since 2000, but under pressure from my family, I took leave and (opened) my clinic in Peshawar”, said Dr Wakil Ahmed, a medical officer. The entire FATA lacks a single nurse, he said. School teacher Fazal Maula from Mohmand Agency brought his wife to Lady Reading Hospital to deliver a baby June 9. “We had a full-fledged hospital there before the emergence of militancy”, he said. “Now the same hospital has a deserted look, as doctors and health staff have disappeared”. The strain of travel added to their woes. “On transportation, we are spending $150. It’s not the money so much as the journey being full of trouble for the patient”, he said. Basic health indicators like infant and maternal mortality rates have worsened, said Dr Fayyaz Ali, a public health specialist. He questioned the government's commitment to meet the UN’s Millennium Development Goals by 2015. Those goals include bringing down the infant mortality rate to 44 from the present 116 per 1,000 live births and the maternal mortality ratio to 140 from 600 per 100,000 live births in FATA, he said. The health indicators for FATA are worse than the national averages. The infant mortality rate for Pakistan is 103 per 1,000 live births and the maternal mortality ratio is 350 per 100,000 live births, he said.