"It was sometimes quite bizarre," recalls Jose Hulsenbek, a former MSF project coordinator of the Chaman project. "Although Spin Boldak (in Afghanistan) and Chaman (in Pakistan) were only six kilometers apart, it had an international border in between - meaning different rules and regulations, different counterparts, different supply lines, different currency, moving from left to right on the road and, when Pakistan introduced daylight saving time, we were even confronted with a time difference of 1.5 hours between both locations'.

For the past three years Medecins Sans Frontieres (MSF) had been working on a cross border project between Afghanistan and south west Pakistan, in camps around the towns of Spin Boldak, on the Afghan side, and Chaman, on the Pakistan side. In this period MSF provided medical assistance for desperate Afghans fleeing the aftermath of the 2001 war as well as the recent devastating drought, in one of the roughest and most insecure places along the border of both countries.

In October 2004 the intervention has come to an end.

On the Pakistan side, the closure has come because the government of Pakistan, and the UNHCR, have agreed to stop assistance and relocate the refugees either to other locations inside Pakistan or back into Afghanistan.

On the Afghan side, the closure comes as a result of the withdrawal from MSF from Afghanistan following the deadly attack on five of its aid workers in June.

In October 2001, the latest influx of refugees from Afghanistan started to arrive at this border, following the two million Afghans that already left for Pakistan since 1980. These new refugees were fleeing the bombs of the Coalition Forces targeting the Taleban regime following the events of September 11, 2001, and from a three year long drought that affected southern Afghanistan, making it impossible for them to sustain themselves.

Coming over the Khojak pass from Quetta, the capital of Baluchistan province in Pakistan, Afghanistan lies shimmering in the heat on the horizon. Descending from the pass you dive into the dusty, chaotic town of Chaman, a frontier town on the Pakistan-Afghanistan border. The town's name means roughly 'green fields', referring to a long, lost past.

In October 2001, the latest influx of refugees from Afghanistan started to arrive at this border, following the two million Afghans that already left for Pakistan since 1980. These new refugees were fleeing the bombs of the Coalition Forces targeting the Taleban regime following the events of September 11, 2001, and from a three year long drought that affected southern Afghanistan, making it impossible for them to sustain themselves.

Some months later, more refugees came, all of Pashtun ethnicity, fleeing from the northwest of Afghanistan wherre they were being targeted by Uzbek and Tajik communities, accusing them of supporting the ousted Taleban regime.

On the eve of the bombings in October 2001, Pakistan officially closed its border with Afghanistan. The numbers of people trying to cross over to Pakistan were initially stopped and began to build up. Sometimes people were being held for several days, and then suddenly admitted into Pakistan overnight, despite the official closing of the border.

The first refugee camp set up in Pakistan in October 2001 was 'Killi Faizo', functioning as a transit area. From there, the predominantly Pashtun refugees were transferred to other camp locations around Chaman. After some months there were five camps in total on the Pakistan side: United Arab Emirates camp, run by the UAE Red Crescent Society; and Lande Karez Rhogani, Dara 1 and Dara 2 camps, run by the UNHCR.

At its peak in 2002, almost 75,000 people lived in these official camps.

On the Afghanistan side of the border, around the town of Spin Boldak, there were already some settlements of displaced Afghans fleeing the drought.

On the eve of the bombings in October 2001, Pakistan officially closed its border with Afghanistan. The numbers of people trying to cross over to Pakistan were initially stopped and began to build up. Sometimes people were being held for several days, and then suddenly admitted into Pakistan overnight, despite the official closing of the border.

Shortly after the fighting started in 2001, these make shift camps quickly expanded to a estimated total of 60,000 people. Five different camps arose over time: Old and new Wamy (World Assembly Muslim Youth), Al Medina, IIRO (International Islamic Relief Organisation) and Al Akhter. They received initial support from several islamic NGOs. All were in Afghanistan.

From the outset, MSF was active in the area both in Pakistan and Afghanistan.

Anticipating an influx of Afghan refugees following the start of the war on October 7, 2001, additional MSF resources were posted around the country. Teams were sent to Baluchistan Province following reports of the influx around Chaman. The first Basic Health Care Unit (BHU) was set up in the transit area of Killi Faizo late October 2001.

It was the beginning of a massive project that would last for almost three years. MSF set up more basic health care facilities in Rhogani and Lande Karez in Pakistan and was continuing with the BHU in Killi Faizo. MSF, and a variety of other national and international NGOs like IRC, Mercy Corps and Concern, were working in and around Chaman in support of both the refugee and host population.

Following this rapid influx of refugees, and with no sign of the flow abating, in February 2002 the Pakistani authorities resealed the border with Afghanistan. A tripartite repatriation agreement was being prepared, committing Pakistan, Afghanistan and the UNHCR, to a voluntary return process for the over two million Afghan refugees now in Pakistan. With this agreement imminent, a parallel process, allowing new refugees TO CROSS the Pakistan border, appeared to contradict the return process, in the eyes of the Pakistan authorities.

This closure of the border left tens of thousands of Afghans literally stranded in a no-mans-land. Officially - but only just - they were on Pakistani soil, yet were unable to reach the official refugee camps where they hoped to find sanctuary.

Meanwhile more Afghans, in particular Pashtuns, continued to arrive at the border, fleeing persecution and discrimination in the north following the collapse of the Taleban regime. And as their numbers grew, so did their needs.

"The more people there were, the more pressure was exerted on the small area of land known as the 'Waiting Area', where they had taken up residence", said Vickie Hawkins, the project coordinator for MSF at that time.

Yet the Pakistani authorities, extremely disturbed to see this make shift 'Waiting Area' camp spring up almost literally on the border with Afghanistan, and with the hope of discouraging its establishment, refused to allow NGOs access to the area. This came despite the people being a particular vulnerable population, some of whom had traveled a number of months before reaching the border area, and who required protection as refugees but were denied any legal status, whether on individual or 'prima facie' basis.

For some months during 2002, the MSF basic health unit at Killi Faizo was the only form of assistance this population had access to. As the summer approached, the situation for the population in this 'Waiting Area', with no regular food distribution, no water and sanitation provision and only make shift shelter from the scorching heat, grew increasingly desperate.

It was only when MSF opened a therapeutic feeding centre to cope with increasing numbers of severely malnourished children, and made preparations for the cholera outbreak that was foreseen in such unsanitary and crowded conditions, that the Pakistan authorities realised they had an impending public health crisis right on the doorstep. They relented and other NGOs and international actors were allowed in and levels of assistance increased.

MSF, along with other assistance actors in Chaman, applied consistent pressure to the Pakistani authorities to be allowed to do more for them. But it was only when MSF opened a therapeutic feeding centre to cope with increasing numbers of severely malnourished children, and made preparations for the cholera outbreak that was foreseen in such unsanitary and crowded conditions, that the authorities realised they had an impending public health crisis right on the doorstep. They relented and other NGOs and international actors were allowed in and levels of assistance increased.

"Assistance was never allowed to reach the standards that are expected for a refugee setting and the status quo remained pretty much the same for over a year," according to Vickie Hawkins.

During this period, MSF concentrated on delivering basic health care services; mother and child health care services; immunization programs; dehydration treatments; supplementary and therapeutic feeding; health education; outreach activities; tuberculosis treatment as well as chlorination and sanitation services to Rhogani and Lande Karez camps on the other side of Chaman.

With joint American and Pakistani military teams increasing their operations in the North West Frontier and Balochistan provinces in the hunt for Al Qaida and Taliban operatives, having a large group of refugees on the border, in such a volatile area, clearly complicated matters.

There was increasing pressure to break up the 'Waiting Area' camp, stating they were too close to the border and in an area that was too volatile. Despite the provisions in the Tripartite Agreement, committing to voluntary return only, the refugee population of the 'Waiting Area' were put under enormous pressure to return to their places of origin in Afghanistan, despite many being Pashtuns, fearful of discrimination, or worse, should they return to north and west of Afghanistan.

Despite the pressures, many of the refugees at the Waiting Area refused to move. Finally, the UNHCR and the Pakistani authorities were forced to offer an alternative. If they could not return to their place of origin, they would be relocated to a camp for internally displaced at a remote location inside Afghanistan. Only those deemed to have special protection needs would be granted access to Pakistan. They were not going to be accommodated in the official camps around Chaman, as was preferred by the displaced, but in a more remote setting.

MSF stated, both to UNHCR and to the refugees themselves, that medical assistance would not be withdrawn from Chaman as long as the refugees had need. Faced with the choice of repatriation or relocation, in August 2002 more than 10,000 Afghans were moved to Zhare Dasht - returning them to Afghanistan- a newly established camp for internally displaced, one hour west of Kandahar in southern Afghanistan.

In this period, several Islamic organisations that had been giving support to the IDPs in the Spin Boldak camps in Afghanistan started to pull out. Some of them literally left overnight, leaving the population of roughly 50,000 people without any form of support.

MSF had opened one clinic in Al Medina camp already but, in the latter half or 2002, felt the need to open a second clinic serving the population of the so called Old and New Wamy camp - all in Afghanistan. These camps never received official status or proper management, and, for a long time, MSF was the only actor present, running this part of the program out of Chaman, in Pakistan.

The cross border project also created basic practical problems.

"It was sometimes quite bizarre," recalls Jose Hulsenbek, a former project coordinator of the Chaman project. "Although Spin Boldak and Chaman were only six kilometers apart, it had an international border in between - meaning different rules and regulations, different counterparts, different supply lines, different currency, moving from left to right on the road and, when Pakistan introduced daylight saving time, we were even confronted with a time difference of 1.5 hours between both locations'.

As of 2003, thousands of Afghans refugees in the Waiting Area chose a third option: being moved to Muhammed Kheil camp deeper inside Pakistan, in the vicinity of Quetta.

"Ironically, almost a year and a half after their arrival, when people finally had developed their survival strategies and adapted to the place, they were informed that they had to leave the area without delay," Hernan del Valle of MSF said, at the time, to IRIN.

For MSF it was important that the rights of the refugees to the voluntarily character of repatriation was upheld. The organization urged the governments and the UNHCR not to force the refugees to move into situations where they would not be able to develop coping strategies, but would remain dependant on aid that was often not available, whether in conflict ridden Afghanistan or in Pakistan itself.

Although the majority of the refugees were sceptical as the new locations had no job opportunities to provide some means of subsistence, they had no choice. By keeping assistance at a bare minimum, the refugees were pushed into accepting the relocation offers of Zhare Dasht in Afghanistan or Mohammed Kheil in Pakistan.

June 2003 saw the end of the so-called 'Waiting Area'.

At the same time the security situation in the area was quickly deteriorating, regularly forcing MSF to manage its activities in Chaman (Pakistan) and Spin Boldak (Afghanistan) from Quetta, in Pakistan, and by national staff only, leaving them without the back up of international volunteers.

Also, increased border control forced MSF to reroute the medical transfers of Spin Boldak patients (in Afghanistan) who were being sent to Chaman (in Pakistan), now were being sent to Kandahar, in Afghanistan, an addition 2,5 hour drive.

Despite practical problems, security concerns and absence of international volunteers, the medical assistance provided by MSF to the population of the camps of Spin Boldak and Chaman was never interruped.

For MSF, the insecurity was exacerbated by a persistent blurring of the lines between military and humanitarian actors which put our neutrality and independence under pressure.

For example, leaflets were distributed in Spin Boldak by the Coalition forces in Afghanistan that made the provision of aid conditional to the populations' cooperation in providing information on Taleban and Al Qaida fighters. Although MSF's strong reaction compelled the Coalition to apologise and withdraw the leaflet, the local perception of humanitarian aid being independent from political and military goals could not help but be damaged.

MSF's activities in Spin Boldak continued to be regularly interrrupted because of security concerns and incidents, and subsequent temporary staff withdrawals.

At last, MSF made the difficult decision to pull out of Afghanistan following the deadly attack on five of its workers in June 2004, and subsequent threats from the Taleban towards MSF, bringing the activities in Spin Boldak to an end as well.

By mid-September 2004, the UNHCR stopped all assistance to the refugees in and around Chaman. The provision of water, food, shelter and education services was discontinued and the camp structure collapsed.

MSF managed to provide health services for some more weeks but a significant group of Afghans were caught in a trap. They could not return to their old communities in Afghanistan, since the security situation was too volatile or there were no means to build up a livelihood.

To move temporarily into an internally displaced camp in Afghanistan (Zhare Dasht) or further into Pakistan (Mohammed Kheil) was a choice between two evils.

In the end, the majority of the refugees were pushed into either relocation or repatriation. MSF had to close its clinics in the Chaman camps, but continued to provide medical assistance in Mohammed Kheil to those who chose to stay in Pakistan.

Having worked for three years in Chaman and Spin Boldak - from the very beginning of the latest crisis in Afghanistan's recent history, MSF has been in an unique position to reduce suffering of the Afghans in both countries who sought refuge from the dire consequences of drought and the violence of the 'war on terror'.

During these years the camps around Spin Boldak and Chaman have been the most visible face of ordinary Afghans being caught in a conflict that has not yet ended.