Diary: A turn for the worse

Relief worker Farhan Safdar writes about the difficulties in Pakistan's northwest.

    The UN has launched an appeal for millions of dollars to help those affected [AFP]

    Pakistan is suffering disastrous floodingwith about 14 million people being affected.

    Yousef Raza Gilani, the prime minister, has said that the flooding is beyond the control of the government and has called for international aid.

    Farhan Safdar is a volunteer working for Doctors Worldwide,the British medical relief organisation, in the affected province of Nowshera.

    His diary for Al Jazeera is posted below.

    Tuesday August 17, 2010

    I met up with Iqra, the little girl who was severely dehydrated and close to death a few days ago. Iqra looked tired and subdued as she sat in her father's lap. Her parents brought her back to see us as they were concerned about her health.

    Iqra had been discharged from the government hospital. But after checking her, we discovered that she was still dehydrated and in need of further medical treatment, so we transferred Iqra to one of the main hospital in Peshawar.

    Even though our hospital is up and running, we still lack funds to buy basic equipment such as hospital beds and drip stands, so we are only able to offer emergency medical care to our patients. We have a good number of staff working with us, which is fantastic. A mix of international and Pakistani nurses and medical staff are working around the clock to try and scale up our work.

    The fields surrounding our hospital are water logged and it's not easy for people to make their way to a hospital. If they are able to go and seek treatment, they are forced to walk long distances as they can’t afford to hire a car.

    Cholera fears

    We got word that cholera has been found in Sindh province, and in the Nowshera area of Khyber-Pakhtunkhwa. This news has caused great concern, and we are on the lookout for signs and symptoms of the disease. We don’t have the facilities here to treat cholera, and neither do any of the larger international medical organisations.


    At the moment, all suspected cases are being sent to the main hospital in Peshawar. There are no facilities to test or check for cholera in Nowshera and I imagine that the hospital is finding it hard to cope with an influx of patients since the disaster, never mind those with cases of potentially fatal cholera.

    We are working all day, every day and we snatch some sleep when we can. New members of our team have arrived from Turkey and from the UK. Our team is divided into small groups, focusing on mobile clinics, food delivery and medical care. As our team expands and people come and go, the workload is increasing, as those of us who have been here from the first few days of this disaster are expected to brief the newcomers.

    My colleague called me today to say that he has indentified a village close by that has not received any aid since the floods started over three weeks ago. The community’s homes have been washed away and they are desperate. We now need to accommodate the 50-100 new families, ensuring that these homeless and exhausted survivors receive at least two hot meals a day and medical care. 

    We are preparing to provide 400 families with food and cooking utensils so that they can prepare their own meals. People do not want to be dependent on charity, so we provide raw ingredients that they can turn into a meal, and they can cook and eat in privacy and with dignity.

    Doctors Worldwide will also provide a small amount of cash to families in the form of Zakat money so families can but new clothes or whatever else they need. 

    Friday August 13, 2010

    I've been in Pakistan three weeks and have been working with the Doctors Worldwide team from a few days in to this humanitarian disaster.

    If you ask me if anything has changed on the ground, I have to respond with honesty and say that things are taking a turn for the worse. The rain keeps on falling and the true magnitude of this disaster is becoming clearer minute-by-minute.

    Earlier, I was with a doctor from an international medical organisation. He confirmed that there are cases of cholera in Sindh province and the reality is that if cholera has been found in Sindh then it will of course be found in other parts of this broken and devastated country.

    An area twice the size of my own country, Great Britain, continues to be affected by this disaster.

    Sadly, many of the people that I've met and come across have resigned themselves to thinking that this is as good as it gets.

    International aid is still not reaching massive numbers of people. Nobody can pretend that its easy to get aid to the flooded areas but its also important to be honest and acknowledge the sheer scale of the problem so that the international community can deal with it head on.

    One international organisation told me today that they have yet to carry out a detailed health assessment on the ground, so far they have only carried out an assement by helicopter which means that they have not spoken to any of the desperate flood survivors swamped in their villages below to understand the needs of survivors.

    I must confess I found this simply extraordinary.

    Crowds of people are pouring into hospital every hour [Doctors Worldwide]

    I spoke to one man from a village north of Peshawar, he is not waiting for aid, or for the government of Pakistan to step in and help rebuild his life.

    He was poor before the floods and finds that he has even less now. He told me he had contacted his brother in Peshawar and told him to sell anything of value including the small amounts of gold his wife and female members of the family possessed. All their belongings have been sold so that they can start rebuilding their homes.

    There are countless other families who are doing the same thing. People want to hold on to their dignity and will not have their daughters, sisters and wives sitting in tents. Pakistanis are very proud people and very dignified people.

    I've noticed an increase calm among people as they resign themselves to the reality that they must face.

    Today is the second day of Ramadan in Pakistan and yesterday we witnessed a Ramadan miracle.

    A very sick, fragile 18-month-old child was brought to our hospital in Nowshera. Her frail body was fighting to stay alive and with each exhausted breath she was taking it was clear that this child had almost run out of time.

    Iqra was severely dehydrated and had been for days. Our team managed to treat her – we were in the right place at the right time and her family were fortunate enough to find us.

    We managed to stabilise her and transported her to the government hospital in Nowshera district.

    Crowds of people are pouring to our hospital on an hourly basis.

    Yesterday a heavily pregnant woman arrived. We don't have the facilities to provide antinatal care so we transported her to one of the military hospitals in the area.

    After being checked out by a doctor, her family were told they would have to take her to a government hospital one hour away. Our team arranged transport for her to get to the hospital safely. She delivered her baby who was sick and we don't know if the baby survived.

    According to some data collected by the UN that was shared with health workers an estimated 45,000 women are due to give birth across the flood affected areas between now and September.

    The UN estimates that at least 25,000 of those babies won't survive because of the lack of healthcare facilities in the area and some due to the impact of the floods.

    As well as providing medical care, Doctors Worldwide, is distributing foods to some villages in the Nowshera District.

    From next week we plan to provide two hot meals a day that are much needed. Our handful of doctors is making a real difference and we are pleased with how our team is working. Our work is a small drop in an ocean but it's a necessary drop.

    Wednesday August 11, 2010

    The heavy rain continues to fall in Islamabad, even though it did not rain for too long, I wonder what kind of misery this extra rainfall will bring to people in Nowshera.

    I attended the World Health Organisation (WHO) meeting in Islamabad earlier today.

    The WHO meeting was an opportunity for aid workers and doctors, working on the crisis in Pakistan, to gather information about how the UN plans to respond to one of the biggest humanitarian disasters in modern times.

    Bigger than the tsunami, Kashmir and Haiti earthquakes combined. An area twice the size of Great Britain is either submerged in floodwater or affected by the floods.

    The UN says that it could take weeks to reach people. Day by day it is becoming clearer why this is the case.

    Conditions are extremely difficult but our aid efforts are being stepped up.

    Doctors Worldwide have carried out a detailed assessment of the health needs of the local population so we are best placed to increase our work, we must first know what people need.

    We hear that a public health specialist will be flying from London to work with us. There is great concern about the potential for the spread of disease such as malaria as the floodwater smells like an open sewer and pools of water have collected with huge flies floating on top. The public health specialist is very much needed.

    WHO warns of waterborne diseases in flood ravaged Pakistan [Reuters]

    I contacted our team leader in Pir Sabaq and he said that he had seen 60 patients before sunrise. The word is spreading far and wide that Doctors Worldwide has set up a hospital and are running a medical service.

    We are working all the time to meet the needs of people. Other members of the team are busy cleaning the building that we are working from. Local people have been extremely helpful too, they have provided us with not only help in setting up the hospital but also with the security required for both the building and our staff members.

    This is a hospital for the people of Pir Sabaq and its important that they take pride in their hospital and are part of what we are trying to do here. We are here to listen to the people and serve them as best we can.

    We are still trying to arrange appropriate accommodation for our team members and with the news of additional Doctors Wordlwide volunteers arriving by the weekend and early next week from Dubai, Turkey and the UK, we must ensure we have everything prepared for their arrival.

    Our co-ordinator has been working on this task in addition to everything else which includes looking after his own family whom he had to evacuate due to the floods. He is from Nowshera and his home was destroyed by the floods.

    Despite this he is working day and night to help the people of Nowshera and shows incredible dignity, strength and professionalism that is remarkable as it is humbling.

    Tuesday August 10, 2010

    I am currently in Islamabad, frustrated and somewhat annoyed.

    I have left behind my colleagues from Doctors Worldwide in Nowshera to continue with their efforts in helping many people in the region.

    I feel uncomfortable leaving them, but I knew I had to return. There is much to co-ordinate from Islamabad in order for us to work effectively and be of assistance to the flood survivors.

    Pakistan's flooding has killed around 1,600 people nationwide [Doctors Worldwide]

    Whilst my colleague's swelter in the heat, cleaning and preparing the hospital we are setting up in Nowshera, I have been frantically trying to gather resources, which we are in dire need of. 

    The hospital we have taken over is a compound behind walls consisting of a number of buildings, each building with large spacious rooms.

    Until Doctors Worldwide rediscovered it, it was an abandoned area, full of mud, water and whatever else the floods had brought into the compound.

    We are working to restore it and further improve the medical services that were once provided to over 100,000 people in the villages around Nowshera. Local people are anxiously waiting for the doors to the hospital to open and medical care to begin.

    In this massive disaster, we have come to realise that we must provide more than just medical relief to communities.

    Food, water and shelter have all become a priority alongside the medical need. We are distributing two cooked meals a day with clean drinking water to one village around Nowshera, but we are struggling due to lack of funds and resources.

    As the exhaustion kicks in, I receive a call from someone in Peshawar who has been told that I am a doctor and a relief worker.  He tells me he has found someone who is willing to supply Doctors Worldwide with drinking water. 

    "My contact owns his own water plant and is willing to provide Doctors Worldwide with water and says he will allow you to refill empty jerry cans as much as we require," he shouts down the phone. 

    I simply cannot believe what I am hearing...

    I take a deep breath and allow myself to break into a smile.

    Clinic opening

    A few hours later, our team leader contacts me, informing me that we have finally commenced providing medical care to the people.

    "For the village of Nowshera, the situation remains unstable and on high alert"

    "The clinic is open!" he said. "I have already seen 15 patients. It is very hot but I'm trying to remain hydrated. There is still a huge amount of cleaning in progress and we will officially open the doors tomorrow."

    Amidst the happiness this news brings to me, I feel sad that I will not to be there when the doors open, but I know I must continue working on the ground here in Islamabad.

    My colleague informs me that the teams are operating in "tough conditions and rough terrain, but we are hopeful that with each small step the situation will improve".

    These are encouraging signs; heartfelt words lift my spirits and I hold on to this news to give me comfort and focus.

    I am humbled and moved to see what a difference a handful of dedicated people can make.

    Bolstered ranks

    They say good news comes in three's.

    Our field co-ordinator informs me that we have a local Pakistani doctor joining our team.

    Since he is a local, he will not face some of the challenges that foreigners face in the area.

    Language and cultural barriers are a massive stumbling block for volunteers and international organisations working in the flood zone.

    The UN has described the flooding as the worst natural disaster in years [Doctors Worldwide]

    Although our number of volunteers have increased and continue to increase, we still lack sufficient amounts of medical expertise on the ground. I am hopeful someone, somewhere, will read these words and help us.

    One of the doctors in our team tells me he has seen a two-year-old child with a skin condition, it is something he has never seen before. 

    All around us we face massive challenges when responding to the needs of people. Especially when we do not, as yet, possess the appropriate equipment to ensure our hospital is adequately stocked.

    I am hopeful someone ... somewhere will read these words and help us.

    The weather has been dry and very hot today. In any other situation I would have found myself complaining about the heat, but as I travel through the streets of Islamabad in the sweltering heat today, I know that I am very privileged.

    I have a family, a home, a job, hundreds and thousands of people in Pakistan have had their lives ripped apart.

    Tomorrow is another important day in Islamabad.

    There is an emergency World Health Organisation meeting in the city where the different charities focusing on health will discuss plans to respond to the disaster. I will represent Doctors Worldwide at the meeting.

    For the village of Nowshera, the situation remains unstable and on high alert. We can only hope that each day we face will be better than the day before.

    Sunday August 8, 2010

    I receive a phone call from a man pleading for help for the people of his village.

    "No one has been to help us," he cries.

    This is a village of about 40 families with an additional 83 families which have arrived from neighbouring villages that have fallen victim to the floods.

    He tells me: "The women sleep in the tents and the men outside. We have been trying to help them but we don't have food to eat or clean water to drink.

    "At least one of two members from every family in the entire village needs medical attention ... all we've have had so far is two lots of food aid dropped by a helicopter. We need medical help."

    I have heard the same story a numerous times now. It brings me such sadness to know that there is nothing I can do except listen.

    The rains have re-started and the water level has begun to rise again.

    The soil has soaked in so much water that even the slightest amount of rainfall has nowhere to go, so it begins to build up - fast.

    I contact our co-ordinator who has been working endlessly and he informs me that the government has told people to evacuate some areas.

    The question is, where will they go? Just how far can a family travel while drenched in mud, barefooted and needing medical attention, without food or water? What of the old, weak and young?

    As our team leader and co-ordinator make their journey home through Nowshera after another day in the field, he tells me, "Nowshera is in trouble" and that another town 20km away has flooded.

    In a nutshell, nothing here is improving and everything is deteriorating.

    We are a handful of people trying to achieve what seems like a miracle I can't help but feel a deep and overwhelming sadness to see so many people suffering.

    Saturday August 7, 2010

    It's over a week now since the floods in Pakistan began.

    When the monsoon rain first stopped falling people felt a ray of hope that they could try and rebuild their lives, some returned back to inspect what was left of their homes and belongings. Some people even managed to smile. Hope, however, is thin on the ground in Pakistan and smiles are hard to find as the monsoon rains continue to return.

    Exhausted, desperate and vulnerable survivors are shocked and traumatised trying to make sense of what has happened.

    I'm a British-Pakistani medical student in the country of my parent's birth, volunteering with the UK charity Doctors Worldwide. My colleagues and I are working on setting up mobile medical clinics to provide emergency medical care to people around Nowshera.

    Yesterday I was in Peer Sabak, a small village about 20km north-west of Nowshera, one of the hardest-hit areas in the region.

    As Peer Sabak is accessible from neighbouring villages, those who were able to have made the difficult journey here in the hope of receiving some food, water and medication. Other areas nearby such as Charsadda, about 45km west of here, have been less fortunate with road blocks making it difficult for people to get out, and for help to get in.

    Disease is spreading among displaced
    people [Doctors Worldwide]

    Scabies, diarrhoea, typhoid, chest infections and minor injuries, alongside ongoing long-term medical problems, have become widespread. It is a similar story to other areas.

    Many of the houses have collapsed, rendering people homeless. Businesses have been destroyed and people have no food and water except for handouts from groups of local volunteers that randomly arrive on the back of pick-up trucks.

    A tractor passes by, pulling behind it the remains of what one family has managed to save. Like other families who have had the ability to do so, they are leaving to join their relatives in other areas who will accommodate them for as long as they can. Others are not so fortunate and for them there is nowhere to go.

    I pass by a small group of men sitting on the mud outside what used to be one of their homes. He points to a hanging door, urging me to look inside. There is nothing behind the door except a pile of rocks surrounded by mud and water.

    Another man walks by covered head to toe in mud and I try not to stare. In the distance I can see three men trying to draw water from an existing pump. Water which governmental bodies have classified as unsafe to drink.

    The entire village is dark, pools of muddy water left behind everywhere. Others are busy cleaning out their homes and businesses.

    It will be months if not years before this village will be rebuilt. Small children covered in mud roam the streets with empty metal pots they have managed to find. They hope and pray that another team of volunteers will arrive with some food and water.

    SOURCE: Al Jazeera


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