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Hope for the Best, Plan for the Worst

Afghanistan, May 28, 2002

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    Mercy Corps is providing health assistance to Afghan refugees living in the Dara refugee camp in Pakistan. Photo: Cassandra Nelson/Mercy Corps Photo:

CHAMAN, Pakistan - Not a tree, bush or green living thing can be seen for miles. Dust-devils spot the arid landscape near the Pakistani town of Chaman, on the Afghan border. It is this hot, inhospitable place that over 33,000 Afghan refugees call home, for now.

“There is a shortage of just about everything here,” says refugee Abdul Qasim. “It is a miserable place but what choice do we have?”

Refugees are now facing challenges presented by lack of water (less than 10 liters per person in Dara camps), inappropriate sanitation infrastructure and seasonal endemic threats such as leishmaniasis, typhoid and malaria.

“Water is a resource that is in extremely short supply—it has to be trucked in as the wells are dry—and makes for a potentially explosive health situation,” says Philip Wegner, Mercy Corps’ Assistant Health Program Manager.

He has been tracking the incidence of diarrhea and other health concerns and has found a strong correlation between the amount of potable water available and the number of health cases.

“With summer approaching and the water supply still inadequate, we are seeing a dramatic increase in the number of cases of watery diarrhea, and this trend is likely to continue,” he says.

To address these and other health issues, Mercy Corps has established two Basic Health Units (BHUs) at the Dara 1 and Dara 2 refugee camps, funded by the United Nations High Commissioner for Refugees (UNHCR).

“The services we offer have been tailored to meet the specific needs of the community. We offer a special female’s outpatient department, staffed with female doctors and health practitioners. We also have a male outpatient department, emergency room, dispensary, Oral Rehydration Salt (ORS) tents, and an Intravenous (IV) tent to treat the most severe dehydration cases. Currently, as the heat of summer begins to take its toll, the ORS and IV services are in high demand,” says Dr. Sidiq, Mercy Corps’ Medical Coordinator.

In the coming months, Mercy Corps proposes to increase services at the BHUs to introduce an Expanded Program of Immunization (EPI), provide on-site laboratory diagnostic services, establish control over growing cases of diarrhea, implement cholera preparedness plans, strengthen the nutritional surveillance system and improve service for emergency medical cases.

The challenges of working in a remote and inhospitable environment are countless, but one real challenge is hiring qualified female doctors. Because of cultural issues here, female patients can only meet with female doctors. Unfortunately, the number of female doctors in the region is small. Most of the qualified female staff reside in Quetta, a city over 4-hours drive away, and many women cannot travel away from home without a male family member to escort them.

Mercy Corps has been fortunate to find Dr. Siddiqua Achakzai. She resides in Quetta with her husband and two children, but during the week she stays in Chaman and treats patients at Dara 1 BHU. Working in the hot tent of the BHU from 8:00 till 4:00, she often treats over 70 patients a day. After a long day she goes to her temporary home in Chaman and sees her two children. On weekends she goes back to Quetta.

“It is a hard schedule to keep,” notes Dr. Siddiqua, “but I am in this profession so I can help people and here I know that my help is needed.”