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Pakistan: doctors on the frontline

15-01-2008 Feature

Life remains difficult in many parts of the world, and Pakistan is no exception, having experienced its fair share of war and conflict in its short history. The ICRC's Sitara Jabeen reports on how medical professionals cope with the heightened stress of living in areas affected by armed violence.

Armed clashes between Pakistani forces and armed groups in western areas of the country are increasing. The worst affected areas in the second part of 2007 were the Federally Administered Tribal Areas (FATA) and the North Western Frontier Province (NWFP), especially the area around Swat.

Doctors participating at the ICRC war surgery seminar    
    The fighting has forced those who can to leave their homes; those unable to do so sta y put and hope for the best. For those involved in the medical profession, it is a doubly challenging situation: not only do they suffer the consequences of the violence themselves; they must also treat others caught up in it.

Training sessions on war surgery techniques organized by the ICRC in Peshawar and Quetta in December 2007 gave medical staff the chance to talk about their experiences of working and coping in such circumstances.

 Life before the violence  

" Life in Swat used to be very calm and peaceful some months back, even though it isn't the most developed region. The scenic valley was a delightful place for a doctor to work. The usual diseases used to affect people but those living in the mountains are physically strong and healthy. "
These are the words of Dr Yasir who is based in a public hospital in Swat and also lives in the area.
Now Swat is far from peaceful and the some local residents cherish the memory of a more peaceful past when even street crime was rare and no one was afraid to go out.
For the people of the Federally Administered Tribal Areas, the fighting is not new but still the violence and tragedies are never easy to get used to. The doctors from Swat are now facing the same problems that medics in FATA have lived with for several years.

One FATA doctor copes with the present by blocking out distant memories.
" I don't recall the past anymore. It simply adds to the pain of the present and that which we are likely to have in the future. "

 The ongoing challenges  

Since the increased intensity of the fighting, these doctors are routinely treating emergencies related to the v iolence but see fewer patients suffering from every-day illnesses.
" We no longer receive the normal influx of patients. Not because they no longer fall ill but because they are simply no longer able to reach hospital due to restricted movement, " explains Dr Waseem from Swat. Dr Yasir said that he was unable to see his family for six months as he couldn't reach his village due to heavy fighting – he also felt for those patients he couldn't see that may be in need of medical treatment.
" It isn't very different in Miranshah, the capital city of Waziristan. Bombs and rockets land in people's homes sometimes and if they're lucky they don't explode. Otherwise, it just adds to everyone's pain, " says Dr Mubarak Khan.

One doctor from Swat laughs, " I am grateful for the ICRC for this training although it means that I will be given all the patients injured by weapons now! "
For some of the doctors, a great tragedy is that they now have to conduct more post-mortems than regular examinations.

 Psychological damage  

According to the ICRC programme manager, Salad-ud-Din, the human damage is not only physical. He says that the population, especially the children, are being psychologically affected by the frightening environment marked by blasts and explosions.
The consequences have also spilled over to the more peaceful areas of the province, including the capital city Peshawar. According to a female doctor recently transferred from Swat to Peshawar, the situation is even worse for women.
" When the men are scared to go out, the women are one step further back and I am afraid that many women are losing the opportunity for essential visits to the doctor. "
Participants at the ICRC workshops were all asked if they would like to leave these troubled areas. The unanimous reply was negative. Professionally they can't because they have to be posted elsewhere but in any case, they have an emotional connection they want to maintain.
However, they would all like to return to a time when they received fewer emergency cases and more patients with routine complaints.