U.S. AIRSTRIKES ON PAKISTAN BORDER DESTROY ONCE-EFFECTIVE MEDICAL SYSTEM

by Ashfaq Yusufzai

(IPS) PESHAWAR -- Aerial attacks have crippled the once well-organized health delivery network along Pakistan's border with Afghanistan.

Pakistan's Federally Administered Tribal Area extends 27,220 square kilometers along the Afghanistan border and has been the target of a series of debilitating U.S. missile attacks since 2005. U.S. leaders believe several top al-Qaeda officials may be hiding among the region's 3.5 million Pashtuns. The U.S. and its allies likely flushed the al-Qaeda operatives out of Afghanistan along with the country's former Taliban rulers.

Government-run hospitals in the area are exposed to U.S. air attacks from across the border in Afghanistan, as well as to retaliatory fire by Taliban and pro-Taliban groups.

The seriously ill are taken by road to overcrowded hospitals in the neighboring North West Frontier Province. According to very rough estimates, 20 percent of hospital beds in the frontier province's capital city, Peshawar, are occupied by patients from the Federally Administered Tribal Area.

"We live very close to the agency headquarters hospital, in Miramshah, North Waziristan Agency, but due to the nonavailability of doctors and staff, we brought our brother here," said Wajid Khan outside the Khyber Teaching Hospital in Peshawar. His brother, Sajid Khan, was operated upon for appendicitis.

"We had a full-fledged government hospital in Bajaur Agency. But we transported our mother to Peshawar because of the nonavailability of a specialist there," Gul Khan said. He added that he paid 1,000 rupees ($16) for the three-hour taxi ride from Bajaur to Peshawar. With a worried expression, he confided that the stress of travel had worsened his mother's persistent hypertension.

Since 2002, the number of admissions in hospital and outpatient departments in the tribal area had decreased. The tribal areas comprise seven agencies.

"We saw only 50,000 patients in 2006. There were 200,000 or more patients before the Ôwar on terror,'" said Dr Ajmad Ali, who works as a government medical officer in the tribal area. The number of surgeries has also dropped from 32,000 in 2001 to only 13,000 in 2006, he added.

Medical staff are not willing to work in the tribal area. "Several doctors and health professionals have got themselves transferred from [the area] because of the looming danger there," said a health official in Peshawar, who did not want to be named.

Two years ago, Dr. Bakth Sarwar, 48, was critically injured when his hospital in Miramshah was hit by a missile. The doctor has refused to go back to work and is on indefinite leave in Peshawar.

On Feb. 15, Bajaur agency surgeon Dr. Abdul Ghani Khan was killed and three health department officials were injured in a bomb attack by pro-Taliban militants on a meeting to promote an anti-polio campaign.

In May, nine health workers who were part of a survey were kidnapped in North Waziristan Agency. They were released after a week on May 25.

Governed directly by the federal government, the tribal area has well-equipped facilities. But an acute shortage of medical professionals has paralyzed the roughly 26 hospitals and eight rural health centers, as well as more than 400 community health centers.

Dr. Zubair Khan, director-general of health for the Federally Administered Tribal Area, said he had directed all surgeons to increase admission and outpatient departments. According to him, the North West Frontier Province governor Ali Mohammad Jan Aurakzai was "angry" that health facilities were not being used in the tribal area.

Prior to the launch of the U.S.-led "war on terror," Afghan patients would come to hospitals in the tribal area for treatment. The tribal area had 66 government-appointed specialists, 435 medical officers, 48 female doctors and 182 nurses apart from nontechnical staff, according to official records.

"Most of them prefer to stay away from their duty places for fear of lack of security there," said a doctor, who insisted on remaining anonymous. "Lady health workers, nurses and doctors in North and South Waziristan, Bajaur and Khyber Agencies have been approaching us to get themselves transferred to the North West Frontier Province. Some of them have either taken long leave of absence or were staying home," he said.

Health authorities admitted that basic health indicators such as infant and maternal mortality rates have worsened in the Federally Administered Tribal Area. They have questioned the Pakistan government's commitment to meet the United Nations' Millennium Development Goals by 2015.

For instance, the government was required to bring down the infant mortality rate from the present 116 to 44 in a population of 1,000 and maternal mortality ratio from 600 per 100,000 live births to 140 in the tribal area.

"Compared to the rest of the country, the health indicators for [the tribal area] are poor," the senior doctor said. The infant mortality rate for Pakistan was 103 per 1,000 live births and the maternal mortality ratio 350 per 100,000 live births.

Director-general Dr. Khan blamed the heightened threat of militancy for the poor health services. "Health workers face problems in North and South Waziristan and Khyber agencies. They are told not to wear pants and shirts, not to carry cell phones or shave their beards," he said. He said he had appealed to the authorities to provide security to his staff.