In southern Pakistan’s Sindh province, on the edge of Karachi’s bustling fish harbour, sits Machar Colony. It is an informal settlement where life is harsh, often unkind, and plagued by overcrowding, poor sanitation, and limited access to basic services. The community’s struggles with health and well-being have long been exacerbated by these conditions, leaving residents vulnerable to a range of medical issues. 

Médecins Sans Frontières (MSF) had been providing essential healthcare services in Machar Colony since 2012, offering emergency services, maternal health, and general health consultations. However, as the years progressed, MSF’s team noticed troubling patterns at our health clinic.  

“Many residents started coming in with symptoms such as body aches, fatigue, decreased appetite, fever, or sometimes infection signs that hinted at a serious health issue,” says Dr Khawar Aslam, the project’s medical lead, who has been working with the team since 2014.

“As we investigated further, we found that a significant number of these cases were related to hepatitis C, a viral infection that affects the liver and can lead to severe health complications.” 

“Notably, during that time, Pakistan had the second-highest hepatitis C disease burden globally, and had already initiated its national hepatitis control programme in 2005,” says Dr Aslam. 

Hepatitis C transmission in Pakistan is largely driven by inadequate sterilization of medical equipment and the improper reuse of needles and syringes. Contaminated blood transfusions also pose a significant risk. Common practices like barbering, tattooing, and piercing are contributing to the spread of the virus, as equipment is often not properly sterilized. In addition to these factors, the growing issue of intravenous drug use is also fuelling the transmission of hepatitis C in Pakistan.  

According to the World Health Organization (WHO), as of April 2024, Pakistan has the highest number of viral hepatitis C infections in the world, with around 8.8 million cases. The country accounts for 44 per cent of all new hepatitis C infections attributed to unsafe medical injections. People are usually screened for hepatitis C only when they start showing signs of liver disease, which is often too late. If left untreated for too long, hepatitis C can progress to severe liver disease and even liver cancer. 

“Even those who recognised their condition, either elsewhere or at our clinic, often faced obstacles to treatment, including high costs and the challenge of travelling to distant hospitals.” 

“Residents have limited income sources, primarily relying on fishing, daily wage work, or small-scale businesses, which barely cover their daily needs,” Dr Aslam continues.

“Additionally, upon referrals to other hospitals, identity cards were required for hepatitis C care; however, most of the community in Machar Colony was undocumented, so they were refused treatment.”

Recognising the urgent need for action, in 2015 MSF started a comprehensive programme to provide free testing and treatment directly to residents. The hepatitis C services were integrated into the existing healthcare facility, allowing our teams to reach people who would otherwise remain unaware of their condition. In 2018, we closed our basic healthcare services and shifted our focus solely to the treatment of hepatitis C patients. 

“My wife was diagnosed with hepatitis C about a year ago and received successful treatment at the MSF clinic in Machar Colony,” says Javeed Ali, one of the programme’s patients.

“When I subsequently developed symptoms such as leg and back pain, as well as weakness, I sought medical attention and was referred to the MSF clinic.” 

“Inspired by my wife’s positive experience, I underwent testing and was diagnosed with hepatitis C,” says Ali. “I then completed a three-month treatment course, and fortunately, my follow-up test results were negative. My wife and I are both now in good health.” 

To effectively address the crisis, MSF implemented a proactive strategy focused on community engagement. In a basic healthcare setup, free-of-charge hepatitis C services including screening, diagnosis, treatment, health education, and patient support were provided under one roof.  

Between 2022 and 2024, MSF teams conducted widespread testing, going door-to-door and using mobile vans to offer in-home testing for residents aged 12 and older. This approach, called ‘bending the curve’, ensured that no one was overlooked and that those who tested positive were quickly referred for treatment, helping to bend the curve of hepatitis C prevalence in the community. 

“By offering free services in one location, we made it easier for people to access care,” says Dr Aslam. 

MSF also collaborated with the Ministry of Health to bring hepatitis C care closer to the community. In August 2022, we established a treatment facility at the Baldia town rural health centre, in Kemari district, Karachi. In this initiative, patients referred from Baldia hospitals’ outpatient departments, and those identified by community health workers, were screened for hepatitis C. The community health workers were trained to educate the community about hepatitis C risk factors and prevention.  

Patients diagnosed with chronic hepatitis C received treatment for 12 or 24 weeks, depending on the severity of their liver disease. Additionally, all patients were offered hepatitis B vaccination to prevent future infections. This centre, handed over to the Ministry of Health in August 2023, serves as a crucial hub for hepatitis C treatment in the region. It is equipped with modern diagnostic tools and is now recognised as a key site for hepatitis care in Sindh province. 

In addition to reducing hepatitis C, MSF also played a vital role in Machar Colony during the COVID-19 pandemic. We supported vaccination efforts in Machar Colony and surrounding areas, ensuring residents received vital information about COVID-19 symptoms, prevention, and vaccination. MSF teams also distributed reusable masks and soap to help the community stay safe during the pandemic.

As our hepatitis C programme concludes, the results are clear: thousands of lives have been transformed, and the rate of new infections has significantly declined. While hepatitis C remains a challenge in Machar Colony, the alarming spread has been curtailed, thanks to widespread awareness and early detection.