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Pakistan has had a troubled history since it was officially founded in 1947. Regional confrontations, chronic insecurity as well as domestic political upheavals have all contributed to a weakened health system that is nearing collapse in some areas.
Health indicators in Pakistan are some of the lowest in the world and around one in ten children dies before the age of five. The border areas are among the worst affected and recent regional conflicts and natural disasters have further heightened the population’s need for health care.
Merlin arrived in Pakistan following the Kashmir earthquake in October 2005 which killed 73,000 people, left thousands homeless and destroyed the health infrastructure. We responded within 24 hours of the earthquake, providing primary health care through mobile and static clinics, field hospitals and a referral service for emergency cases. Our emergency response has now drawn to a close and we have handed over the health facilities we supported in Muzaffarabad district to local authorities.
Our programme now focuses on delivering health care to conflict-affected people in North-West Frontier Province (NWFP) and the Federally Administered Tribal Areas (FATA).
HUMANITARIAN UPDATE
In May 2009, continued fighting in the NWFP and FATA regions of Pakistan forced 2.3 million people from their homes in the largest internal displacement since the Rwandan genocide. Merlin was already taking action, having started to provide health and nutrition services to the first wave of displaced people at the end of 2008. We have since seen massive needs for our service and as a result have significantly increased our health worker capacity in region to nearly 1,000 today.
The main military offensive has now decreased, though some pockets remain, and the government has implemented a phased return of displaced families to their former homes. Merlin is still working in the remaining camps for displaced people, but we have also adapted our response to address the ever changing situation. Our mobile health teams are supporting returnees on their way home, and are now working in areas that were affected by fighting to provide health care and nutrition services and help the authorities to rebuild the health system.
HOW MERLIN IS HELPING:
Emergency response
We are reaching over one million people
Merlin continues to provide assistance to displaced communities, providing emergency 24/7 primary health care and nutrition services through mobile and static clinics in the displacement camps and within the host population.
Since October 2009, the Pakistani Government’s military offensive in South Waziristan and the ensuing conflict there has resulted in a new exodus of more than 300,000 people into neighbouring Dera Ismail Khan (DI Khan) and Tank districts. Merlin was the first international NGO to be granted access to these two districts in order to support the health needs of this vast influx of displaced people fleeing the conflict, as well as the communities sheltering them. Merlin is supporting the majority of health facilities in DI Khan and Tank, running primary health care and reproductive health services, as well as operating mobile health teams, and providing nutrition outreach services.
At the beginning of December 2009, the Governement of Pakistan announced the closure of Kacha Gari Internally Displaced Persons (IDP) camp, where Merlin has been providing health care to 2,000 families. These resident families were moved to Jalozai IDP camp by the end of December 2009 and Merlin responded to this dynamic situation accordingly: relocating the two 24/7 health facilities it had been running in Kacha Gari to the new extensions of Jalozai camp, where we already provide health care and nutrition services in six 24-hour health facilities to a population of more than 100,000 IDPs.
Rebuilding shattered health services in conflict-affected areas
We are delivering health care to over 200,000 people
Swat and Buner districts were those most affected by the conflict beginning in 2008. Around 1.1 million people fled Swat district alone, while many others stayed behind, remaining in their homes throughout the fighting. Now that the situation is more stable, many families who fled these provinces are returning home. However, health services in these regions have all but collapsed, with many facilities abandoned and others suffering severe damage, inadequate medical equipment, supplies and staff. Services for the most vulnerable, such as women, children and the elderly, are especially affected.
At the request of and in collaboration with the regional authorities and the NWFP Department of Health, Merlin is helping to rebuild the shattered health services of these provinces. We are currently supporting 10 health facilities in Buner and seven in Swat, providing comprehensive primary health care to around 200,000 people, as well as emergency nutrition services.
Addressing the needs of the elderly population
While access to health services is severely limited in conflict-affected Buner and Swat districts, services addressing the specific needs of elderly people are almost nonexistent. In collaboration with HelpAge International, Merlin is taking steps to ensure that health facilities are accessible for those with limited mobility by installing entrance ramps and hand rails, and providing wheelchairs and walking aids. Merlin is also developing and running health care services which cater for the specific needs of the elderly and those with disabilities, such as eye camps providing free of charge eye screening and treatment.
Targeting malaria
In order to tackle high rates of malaria, Merlin is working with the Global Fund and the Directorate of Malaria Control in 19 districts of Pakistan, supplying bed nets, rapid diagnostic tests and microscopes to serve a combined population of over 12 million people. Merlin is also implementing a project to reduce malaria, focusing on improving diagnosis and prevention in eight districts by the disease in Balochistan, NWFP and FATA.
Key achievements
- Over 597,000 curative consultations have been provided to the conflict affected communities in 2009, around 53,000 consultations per month
- Over 100,000 people have been vaccinated for polio, measles and tetanus amongst others at Merlin supported facilities
- Merlin has provided over 17,000 pregnant women with antenatal care consultations. In addition 99 per cent of these women have received a three-months supply of iron and folic acid
- 101,181 health and nutrition promotion sessions were held in 2009, which include individual and group sessions. A total of 815,597 people attended these sessions
- 129,356 people were screened for malnutrition in 2009
- In April 2009, Merlin distributed 400,000 mosquito nets, 64 microscopes for new labs, and 6,830 rapid diagnostic malaria test kits (enough to test 170,750 people for malaria)
- Merlin was one of only two NGOs to receive an award from the Pakistan government’s Earthquake Reconstruction and Rehabilitation Authority for our excellent work in the region. Our Country Director and Country Health Director received personal recognition
Donors supporting Merlin's work
WHO, UNICEF, Norwegian funds, DFID, ECHO, OFDA, Global Fund for Malaria, independent private donors
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