The situation in the Federally Administered Tribal Areas (FATA) was particularly unstable in 2010 and early 2011. Spikes of violence, isolation, closure of supply routes, and the near-collapse of the health system created obstacles to obtaining medical care. Médecins Sans Frontières (MSF) has been working in Kurram Agency since 2004, supporting the hospitals in Alizai (a Shiite community) and Sadda (a Sunni enclave) since May 2006 and is trying to meet the populations' medical needs. 

Many residents had to flee inter-religious clashes and military operations in the FATA zones. Most still live under unstable security conditions and in highly precarious situations. They find it very difficult to obtain quality medical care. People are afraid to travel on the roads that cross through their villages. To avoid exposing themselves to danger, they take detours, following longer routes, and usually travel on foot. Medical personnel are lacking and vaccination programs are non-existent or operate only partially. In some communities, the number of cases of contagious diseases - such as measles, whooping cough, respiratory infections, diarrhoeal illnesses, and maternal and infant malnutrition – is increasing. Mortality and morbidity rates are high.

Paediatric consultations in Alizai

MSF also offers free paediatric care at Sadda hospital to children under five in its clinic's inpatient and outpatient departments. MSF treats illnesses such as malnutrition, measles, cutaneous leishmaniasis, diarrhoeal illnesses, and respiratory infections. "Patients come from distant, isolated regions," says Dr Gulam Hazrat, an MSF paediatrician in Sadda. "Because of the insecurity and transportation problems, it is difficult for them to reach a healthcare facility. When they do arrive, most are suffering from serious illnesses and multiple complications."

Said has six children. He is from Sherzai and lives with other displaced people in Laddah, more than two hours’ drive from Sadda hospital.  His eight-year-old son was hurt in an accident when he fell from the top of a hill. The child was seriously injured and covered with blood. "Everyone thought that my son was dead, including me," he says. "I asked people to prepare his grave but someone noticed that he still had a pulse, so we brought him here to Sadda hospital and were told that MSF treats children for free. My son was unconscious for a day and a half.We didn't think that he would survive. MSF saved my child and gave him good care for three days. We are very poor and cannot pay for expensive medical care but, luckily, everything is free here."

At Sadda hospital, in addition to providing paediatric care, MSF also help the Ministry of Health to manage the emergency department with its massive inflow of wounded patients, victims of road accidents, and trauma cases. MSF organises transfers from Alizai and Sadda for acute medical, surgical, and OB-GYN emergencies to the Hangu and Peshawar hospitals.

Responding to emergencies

In 2010, during an epidemic of acute watery diarrhoea, a specialised 30-bed treatment centre and mobile clinics were set up in Sadda and the central region of Kurram. Medical kits were distributed to medical organisations, particularly during the latest spikes of inter-communal violence. In 2010, MSF provided assistance to 3,500 displaced families who took refuge in several areas of Kurram Agency. In February 2011, 517 displaced families living in Turimangle, Parachinar, and Sadda received aid kits that contained blankets and personal hygiene and cooking items.