Tucked into the dark and dirty corners of Quetta - the capital of Pakistan's poorest province, Balochistan - are hints of a refugee tragedy that has received little notice and even less assistance: The plight of the urban Afghan refugee.
Most of Quetta's refugees live in katchi abadis, a destitute and spontaneous neighborhood that receives no government services or support, basically a slum. These katchi abadis are scattered throughout Quetta. Few katchi abadis have access to water, electricity or gas. And, for most, the sanitary conditions are poor, access to basic health services is scarce, and the risk of disease is high.
The residents are among the poorest in Quetta, with few opportunities for economic or social advancement. They are almost entirely dependent on unreliable daily wages from manual labor. The women refugees, often house-bound by cultural norms, have few income-generating options. They typically engage in home-based carpet weaving--labor intensive work that yields very little profit.
Mah Bibi, a refugee woman who has been living in Pashtunbagh for the past 16 years, spins yarn that is used for carpet weaving. "I only get a few rupees per ball, but I don't have any other skills and I have seven children I must look after," she says.
In response to these deplorable conditions, Mercy Corp initiated a health and capacity building program, funded by the Bureau of Population, Refugees and Migration (PRM). The program focuses on the health needs of women and children in five urban Afghan refugee communities in Quetta. Mercy Corps Basic Health Units (BHUs) provide treatment in the communities, including free vaccination programs and referral hospital services.
Community health is further supported through hygiene and sanitation improvements and education programs, including mother-child health training. In addition, increased economic opportunities are created through a micro-financing program.
Training for Community Healthcare Workers (CHWs) is an important component of this project. Refugee women in the communities are trained in pre-natal care, family planning, pediatric monitoring and basic outpatient care. Quidisia, a Master Trainer working at the Killi Sabzal BHU near Pashtunbagh is currently running a six-week course. She has 20 female students, including one who is breast-feeding.
"These women have volunteered to come. When they finish the course they will go back to their neighborhoods and help other women by teaching them about pre- and post-natal care, as well as basic health and hygiene, and referring them to the BHU," says Quidisia. "They don't get paid for their services, but they typically are given a new suit of clothes by a family when they deliver a baby."
Marjan, a refugee who came to Pashtunbagh a year ago after fleeing the fighting in northern Afghanistan, is attending the CHW course. "I am a traditional midwife and I deliver 15 babies a month. I came so I could be more help. Before I attended this training, if the baby did not come after three days of labor, I would organize the prayers. Now, I know more about how to help, and I can refer them to the BHU if necessary."