Health care in Pakistan crumbles under refugee burden

The crisis has exhausted doctors, used up limited supplies of medicines and buried hospitals in a mountain of red tape as they try to get money and medicine.

She doesn't have a name yet. Born five weeks too early, she came into this world at the end of a painful six-hour drive on a creaky old bus that passed through a battlefield before arriving at the hospital. There was no electricity and not enough fuel for an incubator to feed oxygen into her tiny lungs.

Her mother, Zeenat, lay in a rusted steel bed, covered in a dirty blue blanket, the incision from her Cesarean section now septic.

Pakistan's rundown health care system is near collapse bringing yet more instability to a country already in turmoil. Hospitals have been overwhelmed by more than two million refugees from the mountainous northwest, where the army is battling Taliban insurgents. The crisis has exhausted doctors, used up limited supplies of medicines and buried hospitals in a mountain of red tape as they try to get money and medicine for the crisis.

‘In fact, to tell you honestly, health is not our national priority. It is very unfortunate,’ says Dr Arshad Khan, local doctor from Mardan, which is the epicentre of the refugee onslaught because it borders the battlezone.

And now, with this crisis, every smaller hospital is overloaded with displaced people and our district hospital in Mardan is collapsing.

The outpatient unit at 213-bed district hospital used to see 100 people a day before the anti-Taliban war. Now it is up to an average of 500 a day.

The government has allocated one million rupees for medicine for the refugees. But it will be months before the refugees see any because of bureaucratic hurdles attached to the money.

Pakistan's health care system is loaded with grim statistics, beginning with an annual budget of less than $150 million this year. The government says it plans a 56 per cent increase next year, bringing the budget to $300 million.

By contrast, Pakistan's defence budget last year came to $3.45 billion, and is expected to reach $3.65 billion next year.

More grim statistics: A new doctor to the government service is paid $120 a month, with an additional $16.50 housing allowance. There are only 12 doctors to every 10,000 people in Pakistan and 10 hospital beds to every 10,000 people, according to the World Health Organization (WHO). That compares to 22 doctors and more than 30 hospital beds in the United States.

International charities have provided medicines and field hospitals in refugee camps. But only about 20 per cent of the two million refugees are in camps.

The rest are scattered throughout the frontier province, as well as other provinces in Pakistan.

Even in the camps, there are 10 dog bites a day and no rabies vaccine. And the refugees from the camp still come to the district hospital looking for tests and X-rays, carrying their elderly and their children.

Most hospitals in the surrounding area where fighting still rages have been closed. That puts more strain on the Mardan District Hospital.

There, shadows lie on cement benches, or beneath on the floor, waiting for doctors. The only relief from the stifling heat comes from a half dozen ceiling fans. And even those don't work when the electricity is off, which is most of the day.

In the men's ward, 30 steel beds lie crammed together, with two-inch mattresses and no pillows. Pools of urine spread on the floor, and fresh blood stains the ripped bedding.

Beneath the bed of 10-year-old Abdul Hadi lie vomit and urine. His father stands by helpless.

‘He has had a high temperature for four days. No one has given him anything. They just say, take him to Peshawar,’ he says.

The father has covered the soiled brown plastic sheet on the boy's mattress with a bright red one from home. ‘We have nothing but how could I let him lie on this?’ he asks, picking up a bloodstained sheet.

Abdul Wadood, a refugee from Swat, watches his grandfather lying with his stomach tube unused.

‘They tried to insert it earlier but they couldn't, so they told me too to go to Peshawar,’ says Wadood, who is barely 24.

A technician at the laboratory, Etishan Khan, says the hospital now runs roughly 1,000 tests a day, compared to around 400 before the refugee influx. His department requested another two technicians and two lab assistants more than a year ago.

‘We have received nothing. We know that there is a problem here but what can we do?’

The steel grills between wards are closed in the morning to stop an influx of visitors. 

Early one morning a security guard with a stick beats back a few visitors who try to come through with medicines for family members.

Khan Zameen, wearing a red felt cap, is one of only two cleaning people on duty at the Mardan District Hospital during the 11 a.m. to 8 p.m. shift. He and his partner clean 10 wards, the blood bank and the X-ray department. He gets paid $50 a month, less than Pakistan's minimum wage of $82 a month.

The one bathroom for 30 patients stinks of urine and faeces. The toilets are overflowing, the door to one cement cubicle is falling off and a two-inch river of urine covers the cement floor. In one corner, garbage is piled high.

‘We're not animals. How can they treat us like this?’ he asks.

Things are not much better at Daggar Hospital, about 40 kilometres from Mardan.

Daggar was under siege for four weeks as the army tried to drive the Taliban from Buner, a mountainous district that bumps up against the Swat Valley.

Dr. Maqsood Ahmed, the senior health official for Buner, shut most of the 200-bed hospital because most of his staff fled when fighting broke out four weeks ago. Only 40 remained behind, including two surgeons. Now, the hospital is running just two wards and one operating theatre.

‘We are the only hospital in Malakand division (of which Swat and Buner are a part) that is functioning,’ says Ahmed. ‘It was very difficult for us. We slept here, but our families, they also stayed in Daggar, so we were afraid for them, afraid for our patients and afraid for ourselves.’

They begged for fuel from the military to run the generators. In the early days of the war they received 20 and 30 litres at regular intervals from the army, but the generator requires 90 litres a day on average. They had two ambulances but no fuel to run them.

‘We even buried two bodies in our yard. They died and it was curfew and the families could not get to them,’ Ahmed says.

When Daggar was cleared of Taliban a week ago, the International Committee for the Red Cross moved quickly to bring 1,200 litres of fuel and some medicines and evacuate two war-wounded.

As Ahmed walks the dark hallways, he apologises for the garbage under the beds and shoved into the corners. He says the cleaning staff left early in the war. In the one operating theatre, bloodied bandages stuff plastic garbage cans and an empty bottle is stuck beneath the two operating tables.

In what seemed like a small gesture to normalcy, Ahmed takes rubber slippers from a blackened wooden shelf and insisted they be worn instead of street shoes into the operating theatre. Yet the floor is littered with old bottles, needles and plastic wrappings.

It was at Daggar Hospital that Zeenat and her baby arrived. But Ahmed couldn't even vaccinate the baby because he had no vaccines. He had to ship them all to Mardan because he lost electricity for most of the day.

Ahmed has now put the mother on antibiotics. And so far, the baby was alive.