After 14 years of aiding the ill in the north-western tribal areas of Pakistan, Doctors Without Borders or Médecins Sans Frontières (MSF) has been forced to halt its operations by the Pakistani government.

This comes as a shock as MSF has been serving the community from two of its health facilities in the Kurram district of the Federally Administered Tribal Areas (FATA) region in Pakistan since 2004.

No reason or explanation was offered by the government with regards to the pull-out.

A possible explanation could be that Kurram, which borders Afghanistan, has been the subject of military attacks in the last decade. The volatile area has been a target against the Shi’ite population and militant leaders.

Recently in June, a twin blast took at least 70 lives in Kurram’s most populous city, Parachinar. Prior to that, Parachinar was also bombed in January, causing 20 fatalities.

‘No Objection Certificate’ not issued, forcing MSF to pull out

MSF and other foreign citizens and organisations have been operating in Kurram under the No Objection Certificate (NoC) from the Pakistani government. It was this NoC that the authorities had refused to issue to MSF recently. Without this, MSF cannot provide medical services to the Kurram tribal area, forcing them to pull out from the area.

In recent years, the government and Ministry of Interior – which is responsible for issuing the NoC to non-government organisations (NGOs) – has been shutting down NGOs without a valid NoC. The Ministry also monitors activities of privately funded organisations in tribal areas such as MSF.

“MSF is saddened by the decision from the authorities responsible for NGOs working in Kurram Agency,” said Catherine Moody, the MSF country representative in Pakistan. “The closure brings to an end to 14 years of MSF working with the FATA Health Services in Kurram Agency.”

MSF is following through with the necessary measures to end their tenure in the area, with completion before the end of the month.

Decision could affect region’s state of health

MSF provided essential medical care to the area, which housed some of Pakistan’s poorest medical services and lowest literacy rates. The decision not to issue a NoC could affect many patients in the region.

MSF carried out its operations in Kurram with 70 personnel deployed to two regional hospitals – Sadda and Alizai hospitals. In Sadda hospital, MSF cared for children under five in the outpatient department and severely ill children under 12 in the inpatient department, as well as premature babies and babies with birth complications in the neonatal unit. In Alizai hospital, MSF cared for children under 12 years old at the outpatient department and observation room.

Last year alone, MSF carried out 36,498 outpatient consultations in Sadda and 6,416 consultations in Alizai. Also in 2016, Sadda hospital admitted 1,946 patients and treated 414 patients for cutaneous leishmaniasis, with 736 newborns being admitted to the neonatal unit.

In addition, MSF provided ambulance transfers and medical support during emergencies to maternity facilities. MSF also has made a mark in treating leishmaniasis and children’s immunisation, as well as being quick to respond to disease outbreaks and mass casualties.

Despite its future absence in Kurram, MSF will continue to provide medical care in Bajaur Agency in FATA, as well as in Khyber Pakhtunkhwa, Sindh and Balochistan provinces. MIMS

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