Health care under pressure in Muzaffarabad

Carried on foot by his brother for three days from Batnara, a tiny village located in quake-affected Neelum valley, it’s unclear whether Ali Riza, two, will get the medical assistance he needs in Muzaffarabad, capital of Pakistan-administered Kashmir. Suffering from a severe form of diarrhoea, he may well die unless he gets immediate medical attention. “We have no facilities and our village has been destroyed,” his older brother said, visibly exhausted by their journey. “I was hoping they could help him here.” Hope, however, is all he has, as health facilities in the city struggle to cope with more and more earthquake survivors arriving from remote mountain areas in search of medical care. As critically injured patients in surrounding villages and hamlets arrive, many still without shelter remain outside - exposed to the elements as temperatures continue to drop. Many are in dire need of medical assistance. According to the UN Children’s Fund (UNICEF), the lack of treatment for many of the estimated 79,000 injured, combined with a shortage of water and sanitation facilities, will undoubtedly increase fatalities in the coming days. Between 1.6 and 2.2 million people throughout the quake-affected region are severely affected (homeless) by the tragedy and are at risk, facing a deadly combination of cold, malnutrition and disease, the UN children’s agency warned, noting more than 120,000 quake survivors had yet to be reached.

Ali Riza may or may not receive the medical attention he needs in Muzaffarabad

In short, with many roads still blocked to the valleys, coming down from the mountains by foot is not a choice - it’s a vital necessity. What they find, however, is not good. While most patients arriving at the field hospital of the Pakistan Islamic Medical Association (PIMA) come from Muzaffarabad and its immediate peripheries, an increasing number are now coming from the remoter areas of the Neelum and Jelum valleys - two of the worst quake-affected areas. “They’re in a disastrous state there. These valleys have been shattered by the quake,” Dr Reyaz Shaikh, responsible for the PIMA facility, said. “These people have no shelter, no food and certainly no access to healthcare,” he said. Poorly resourced, the field hospital receives over 1,300 people a day, suffering from a broad range of complaints, but particularly acute respiratory infections (ARI), scabies and diarrhoea. “We’re still receiving trauma cases, fractures, infected wounds and gangrene, but those numbers are decreasing,” Shaikh noted. Like much of the region’s health infrastructure, Muzaffarabad’s was devastated by the 8 October quake, which killed over 58,000 in Pakistan’s North West Frontier Province (NWFP) and Pakistan-administered Kashmir. Of the city’s primary hospitals at the time of the disaster, Muzaffarabad’s Combined Military Hospital (CMH) was all but obliterated by the quake. Once the largest health facility in the region, with a bed capacity of 400, it was largely a civilian hospital, despite its name.

One of six toilets donated by Oxfam, but not properly installed according to PIMA officials

“This hospital was totally destroyed,” Col Iqbal Hanif, commanding officer and head of CMH, said outside the destroyed remains of his office and residence. “We are now working with the French military in providing field hospital services.” Of the 265 patients at the time of the quake, 76 were killed, as were 37 staff members and their families mostly in the hospital’s family and children’s wing. Those who survived were shifted to the Abbas Institute for Medical Sciences (AIMS), a 200-bed facility which was not fully operational at the time of the quake but whose building escaped largely unscathed. “We have shifted many of our staff members there now,” Hanif said. “That facility is now fully operational.” According to Dr Hussein Zahid at the AIMS facility, theirs was the only hospital with any infrastructure left intact, adding: “Still they (patients) are coming, but now they are coming from more remote areas as roads reopen.” Despite their efforts, given the sheer scale of the disaster and an increasing number of people arriving daily, their facility is clearly not enough – putting increasing pressure on field hospitals like PIMA’s and others outside. Arriving from the village of Chokti near the Line of Control dividing Pakistan and Indian-administered Kashmir, six-year-old Sabir lies in a half body cast in the open air as a young nurse waves away flies from his face. Suffering from a shattered pelvis and fractured right leg, he has yet to be told he is the sole survivor of his family. “I have received children whose parents have carried them for 20 hours,” PIMA’s Shaikh explained. “And they continue to come.” As many roads into the affected area were blocked, in collaboration with the Pakistani military, PIMA has dispatched medical teams to the affected region bringing medical relief to where it’s needed most. “So far we have sent more than 41 missions to the two valleys,” he said, adding a number of gynecological cases have been received and three babies have been also born.

Outside the AIMS hospital in Muzaffarabad, an elderly man carries his grandchild

But this facility is hardly any place for a child, much less a newborn baby. Sanitation conditions at the field hospital are particularly dire, providing fertile ground for disease and infectious diseases. “We need help from the government, from anyone, in cleaning this mess up,” he said, referring to the mountain of rubbish and refuse located directly behind the PIMA facility. “This will undoubtedly aggravate health conditions in the hospital and the risk of a disease outbreak would be catastrophic,” he said, clearly agitated. Not prone to exaggerating, he refers to six toilets donated by the international NGO Oxfam following the quake that he claims have yet to be properly installed. “There is no water arrangement for them. No sanitation,” he complained. “What kind of toilets are these?” he demanded, warning of further disease and infections. A quick inspection inside reveals just that. Flies abound and empty water bottles litter the inside as the stench of human faeces permeates the air. These are the only toilets available to patients at the field hospital. “If there is an outbreak, we will be helpless,” he repeated, describing the toilets as a serious health risk. But this Muzaffarabad doctor has little time to dwell on such problems. With more and more patients arriving as he speaks, he has more urgent matters to attend to. Inside the tented facility, a haggard looking woman cries openly, as doctors attempt to stop the bleeding from an open gash on her daughter Sarian’s head. “A house fell on her head today,” a doctor from the Islamic Medical Association of North America (IMANA), shouted out loud, prompting Dr Shaikh’s immediate attention. Asked how he was coping or whether he needed more resources, he concluded with one simple response:“Just clean this mess up,” he said. “We’re doing our best, but this is simply not right. This is not the way hospitals should be run.”