Since August 2008, several waves of displaced people have sought refuge in Lower Dir district in Pakistan’s North West Frontier Province. Most of the displaced have come from neighbouring Bajaur Agency and Maidan district where conflict between armed opposition groups and the Pakistani army has been raging. During summer 2009, MSF logistics teams helped set up camps for displaced people in Sumer Bagh and Sadbar Kalley, including provision of latrines, showers and other water and sanitation facilities. MSF medical teams also offered free medical care to 1,500 families who sought refuge in three camps in Sumer Bagh, Sadbar Kalley and in Munda. The three camps closed at the end of October, however the camp in Munda reopened soon after to accommodate 400 new families fleeing the ongoing fighting in Bajaur. MSF has also supported Timurgara hospital, in the same area of Lower Dir, since February 2009. Driving along the main road that connects the small town of Munda to Timurgara, in Pakistan’s troubled Northwest Frontier Province, it seems to be business as usual in the shops that line the street. But just behind the crowded shop fronts and bustling sidewalk trade lies 506 tents - their white canvas roofs glistening in the early morning sun. In these tents some 290 women, 270 men and more than 2,000 children have been living for months. They wait hoping that the sporadic attacks and counter offensives between Pakistani troops and fighters from armed opposition groups that drove thousands from their homes in the Bajaur and Maidan Agencies into neighbouring Lower Dir will cease. Due to the pressing needs of the thousands of displaced, emergency medical aid organization Médecins Sans Frontières (MSF) initiated free medical care and water and sanitation services in the displacement camps at Sumer Bagh, Sadbar Kaleh and in Munda as part of an emergency response to the consequences of the conflict. MSF is independent and remains one of the few organizations offering assistance as the conflict in Bajaur continues and the humanitarian needs of the people displaced by violence grow. The Munda camp's youngest resident, 14 day-old Kauser, lies safely cradled in her mother’s arms. Khubana Lal Rachman sits in her tent, surrounded by her meagre possessions while the improvised cooking hearth outside the door smoulders. She was able to make it to the Timurgara district hospital, a bumpy 45-minute drive from Munda, before Kauser was born. But as with most other medical procedures it came with a hefty price. Khubana paid PKR 9,000 ($112) for the delivery – money which she had to borrow from friends and relatives. “It’s a lot of money and I will have to repay it slowly. But at least my baby was born in a hospital and my only hope is that she does not grow up in these tents and that she does not go hungry,” Khubana says. Her husband struggles to make ends meet while trying to find work as a labourer. Although conditions in the Munda camp are cramped, with tents only 40cm apart, it is neat and clean thanks to the efforts of MSF hygiene promoters and medical staff. At the health centre Dr. Naseeb Gull is carefully monitoring his patient’s blood pressure and heart rate in the MSF-run outpatient department. He describes how the fighting has affected his patients. “The conflict has had an intense impact on these people’s lives. It is a war and many of them do not know what happened to their relatives, whom they last saw when they fled. They suffer from anxiety and depression,” Gull says. Of the 53 patients who came to the outpatient department during the course of the day, 12 complained of headaches and general body pain, which is associated with post traumatic stress. Wahid Mukhitar still suffers the anguish and trauma of the aftermath of the fighting he fled in Bajaur agency. “At one of the checkpoints outside my village, Manyal, a soldier shot at me, several times. I ran away into the mountains. I lost my mind. I was wandering in the hills for ten days. Ever since then I have been depressed. I feel like a walking corpse. I cannot understand why the soldier shot at me. I used to be a civil servant like him. I was a driver for the education ministry. Now I have lost my house, my animals, my family and my mind,” he says. At the Summer Bagh camp, about an hour’s drive from Timurgara, 19 year-old Ruhudullah Didanpuru describes how he trekked 30 km on foot through the mountains to reach the camp - once home to about 5,000 displaced people - while fleeing the conflict in Maidan in March of this year. “People were caught in the crossfire and they have suffered mental trauma. I can see the effect on the women, and the young men like me. The children are scared and they cry when they hear those guns,” Ruhudullah says as another salvo of artillery fire erupts from the Toor Ghundai military base close to the camp. While the trauma is a primary concern, Abdurrahman, a 50 year-old farmer and father of 10 children, says that before the arrival of MSF, medical care was too expensive for most people been living in the camp. “Doctors in the area charge patients consultation fees of between PKR 300 ($3.75) and PKR 1,500 ($19) for a general health check-up. That means it takes us, working as casual labourers, up to five days wages to pay for a wife or children to be seen by a doctor. I’m really happy MSF is here and we can get to see doctors free of charge,” Abdurrahman says.

During the cholera season in September and October this year, MSF operated three cholera treatment centres in Timurgara, Munda and Summer Bagh, treating a total of 2,500 patients. MSF also provides support to the emergency room, operating theatre and post-operative unit at the District Head Quarter hospital in Timurgara, where MSF treats about 40 percent of the 4,000 emergency room patients each month and is setting up a sterilization and a waste management system for the hospital. MSF is also setting up an operating theatre in this district hospital that should be ready by mid-December.

MSF does not accept funding from any government for its work in Pakistan and chooses to rely solely on private donations. MSF has been working in Pakistan since 1998.

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