Account of a project visit in northern Pakistan seven month after the floods
“You are visiting the Swat valley? Are you sure you wanna do this?” I was confronted with this question several times before my project visit to Pakistan in March 2011. So I started to explain: That I’ve been working as a communications assistant with Malteser International for one year – this is the relief agency of the Order of Malta for humanitarian aid. That I get to visit one of our project areas for some weeks, to see and experience directly the projects of which I had, up to now, only theoretical knowledge and second-hand experiences. That I will take photos and collect stories to show the many people that have donated for our relief in Pakistan that their money reaches the needy there and is still needed. That I have respect for the tasks awaiting me but that I am generally looking forward to it. And that I will not be alone, but in good hands with our team in the field that will show me the projects. Fortunately, I was able to convince most people: “This will be fascinating, but come back safely”!
The monsoon flood in Pakistan started in July 2010. At that point in time, I had only been working for Malteser International for a short time. These floods therefore were the first big disaster that I experienced while being part of the humanitarian relief. For Malteser International, on the contrary, Pakistan is no virgin territory: Already since the huge earthquake in Kashmir in 2005, the organisation has been working there in relief and reconstruction – many times responding to disasters that hardly get media attention in Europe.
Spring 2009: The Swat valley in northern Pakistan is in focus of the world public. Islamic militants had gained control of the area and were then fought by the Pakistani army. Almost all civilians were forced out of their homes.
Summer 2010: Many of those affected by the devastating monsoon floods have just repaired the damages caused by the 2009 fighting and started to cope with their losses.
In effect, Malteser International in summer 2010 just wants to complete its medical relief for these internally displaced people and returnees and wants to go over to longer-term projects in the fields of reconstruction and disaster risk reduction. But these have to wait now as the acute need of the people in Swat is more important. Quickly, Malteser International redeploys its medical teams and organises the first distributions of relief items. At the beginning, there are not many donations, but this changes fast as the extent of the flooding gets clearer and the relief organisations can show that the donated money is directly turned into help for the affected. At this moment, I come into play again, sitting in front of my computer in Cologne, Germany. Together with my colleagues, I inform the public about what we do to relieve people’s distress and to keep them from dangers like the outbreak of cholera. Now, some nine months later, I get the chance to meet these people that needed our support.
In a sense, Pakistan is not a very poor country. In the western world, the dominating image is one of a country that can afford nuclear weapons, which is important because of its proximity to Afghanistan and which is, in some ways, volatile. But Pakistan is also a country regularly stricken by disasters that bring many people in distress. In the end, this justifies our commitment for the affected. “Mismanagement and corruption” – this is how our local staff puts their country’s most serious problems in a nutshell. “We cannot prevent the natural disasters”, explains Irshad Ali, engineer at the office in Islamabad, to me.
Therefore, Malteser International does not limit its relief to the acute emergency situations but wants to go further – and I have come now at the right moment to observe this transition. When the country’s poorest are in distress because the flood takes the little they possess materially from them and threatens their health, they need help immediately. With substantial emergency relief, Malteser International has reacted to these needs. The task is now to help people with the reconstruction without creating dependency. We want to empower them to recognise their needs and voice them vis-à-vis the authorities. In the future, one focus of Malteser International will therefore be in the field of community-based disaster preparedness. Malteser International guides the communities in the process of discussing and analysing the risks for their homes and lives, and preparing for the next earthquake, flood or landslide. This means that, for example, volunteers are trained in First Aid to attend to the wounded in case of disaster. This is how sustainable help can grow out of emergency relief.
Health is a focus of Malteser International in Pakistan. In the Swat Valley, I accompany our medical teams that are working in the Union Council Islampur. In the emergency relief phase, Malteser International sent its medical teams to the places where the need was acute after the floods: in “mobile clinics” held in schools or mosques they treated patients, informed the villagers about good hygiene behaviour and thereby prevented the spread of infectious diseases.
Today, our teams support the staff of three public “Basic Health Units”. These are the first place sick people go to, as the most frequent and common diseases are treated there – just like a family doctor, but each for a population of about 20,000 people. In the last months, more and more patients come to the Basic Health Units as they learned that the treatment quality is good and medicines are given out for free. To get there, they take long hours of walk, as Nisar Gul tells me. He travelled by foot for five hours with his wife, two of his seven children and two of the neighbours’ children to be examined by Dr. Yousaf Rehmen at the Islampur Basic Health Unit. The older children are suffering from respiratory infections while the youngest, which is just 14 days old, is examined for the first time.
I am asking myself, how the system can function on its own in the future. The answer of my colleagues is detailed: Malteser International will change its focus to better qualify the public health staff and to prepare it for future disasters. They are learning, for example, which quantity of which medicine they should always store for the case of a disaster and how they have to proceed step by step when an infectious disease spreads in the area they serve. So that I can imagine this, my colleagues take me to one of the trainings. There, the participants study the diagnosis of infectious diseases before solemnly receiving a certificate in the end.
A second focus of Malteser International’s long-term work will be the health of mothers and their small children. Already at the moment, the majority of the patients are women and children – but they have neither own toilets, nor, as it would be traditionally appropriate, an own waiting area and a separate treatment section at the Basic Health Units. Next to the actual buildings, the construction activities are already under way to assure that in future there will be enough space to examine the women, but also to train the Lady Health Workers. These are connecting the Basic Health Units with the villages that are often far away and advise the other women when they are pregnant or ill. The basic rules of hygiene are also part of the education. The demand is huge, as Dr. Shumaila Akbar, Malteser International’s female doctor, explains to me: “The maternal mortality and morbidity are very high in this region.”
Compared with these long-term activities, the so-called early recovery measures appear rather short-term. Lasoona, a local partner organisation of Malteser International, implements these in several villages, where distribution of relief items during the flood had alleviated the most pressing distress. The Lasoona staff members gladly showed me the projects that rehabilitate infrastructure destroyed by the flooding: With a simple bridge over the river, villages will not be cut off from the other side of the valley in the spring, when the melting snow will bring more water. Walls shall keep the river in its bed so that it does not wash away villages and fertile farmland on the hillsides with its next flood. Irrigation canals that were blocked with mud by the flood in 2010 can now function again. The most affected by the flood in 2010 carry out these works under the supervision of Lasoona and are happy about their income during the time of construction.
In a second step, small farmers will soon receive seeds, fertilisers and agricultural tools to cultivate the rehabilitated farmland. Is that just a short-term measure? No, as the impact will surely be long-term, protecting villages and farmland and strengthening the local food supply.
"Education is the key to development" – I can observe the truth of this old saying also in Pakistan. During the fighting in 2009 and the flooding in 2010, many schools in Swat were damaged – schools that, especially in the rural areas, had not enough classrooms and sanitation facilities even before the flood. That’s why Malteser International is expanding four primary schools in Swat -- three girl’s schools and one with coeducation. Up to 2,000 children will benefit: they do not need to sit outside the building anymore or crowd in the classroom. Some even can leave the waiting list now and be admitted to school. Education as it should be becomes possible – a relief also for the teachers: “We are not old, but school makes us old”, says Mumlikat (35) with a sigh. “That’s why we are very happy about the help of Malteser International.”
Back in Cologne, I am enriched by many experiences and full of impressions of our projects in the Swat valley, the discussions with the local colleagues and the tastes I got of the daily life in Pakistan. I received much gratitude for the work of Malteser International in the field. Meeting the people in Swat for whom we make our projects touched me, their curiosity, their openness and their willingness to answer all my questions. May they be spared from future harm!
Dr. Shumaila Akhbar, medical doctor in the Swat Distrikt with a focus on maternal and child health.
More information on our projects in Pakistan!