After Kurram Agency, medical charity MSF told to leave Bajaur

Emergency department of the District Headquarter (DHQ) Hospital in Timergara. To improve day-to-day patient care in the emergency department, MSF has implemented a routine triage system. Upon arrival, every patient receives an initial screening, where staff measure blood pressure, heart rate, and clinical conditions, to help prioritise patientsmedical needs. MSF has been working the DHQ Hospital in Timergara, Lower Dir district of Khyber Pakhtunkhwa (KPK) province, in northwestern part of Pakistan since 2009. MSF provides emergency care, emergency surgeries, post-operative care, as well as mother-and-child health care in the hospital.
  • MSF’s representative says ‘extremely disappointed’ by authorities’ decision

PESHAWAR: After Kurram Agency, the government has directed the Médecins Sans Frontières (MSF), also known as Doctors Without Borders—to close its medical activities in Bajaur Agency of Federally Administrative Tribal Areas (FATA) of north-western Pakistan.

MSF’s Nasar Ghafoor through a press statement confirmed closure of its services in Bajaur Agency. He added that host government has refused to renew the no-objection certificate (NOC) already issued to MSF.

The closure will leave thousands of people in Bajaur Agency without vital healthcare, and comes just seven weeks after MSF was forced to close its project in Kurram Agency, also in the Federally Administered Tribal Areas (FATA). With the closure of its project in Bajaur, MSF will now have no presence in the FATA—one of the areas of the country where the need for emergency, maternal and child healthcare is most acute.

“We are extremely disappointed by the authorities’ decision to refuse permission for MSF to continue providing urgently needed medical care in Bajaur Agency,” said Azad Alessandro Alocco, MSF’s Country Representative in Pakistan. “Healthcare services are very limited in the area, and most of our patients cannot afford to pay even for basic medical care. As the only major hospital providing free, quality healthcare in the area, the closure of MSF’s activities will leave a major gap and have serious negative implications for the health of people living in Bajaur and the surrounding areas such as Mohmand Agency.”

MSF has been informed by the Pakistani authorities that the NOC required for carrying out medical activities in Bajaur will not be renewed, although no explanation has been given. Without a valid NOC, MSF is not permitted to continue providing medical services. MSF has informed its team and the local community in Bajaur Agency about the decision and will complete the closure process within two weeks.

In Bajaur, MSF has been supporting the Ministry of Health at the Tehsil Headquarters Hospital at Nawagai since 2013, providing medical care in the outpatient, emergency room, and mother and child health departments. As the authorities have not permitted MSF international staff members to access Bajaur Agency, the project is run by 120 Pakistani staff with support from international staff based in Timergara in Khyber Pakhtunkhwa province and in Islamabad.

“The number of people seeking healthcare at Nawagai hospital has continued to increase, illustrating the enormous need for medical care in the area,” Alocco added. “Since extending the emergency services at the hospital in February 2017 to be open 24 hours, 7 days a week, we have seen the number of patients treated in the stabilisation room more than double. The end of MSF’s support will likely mean that people in need of life-saving emergency, maternal and paediatric care will face challenges accessing it, especially at night time when travelling is more difficult.”

In first nine months of 2017, MSF teams provided care to 41,029 patients in the hospital, compared to 38,865 in all of 2016. More than 14,400 patients were seen in the stabilisation room between January and September 2017, compared to around 8,200 in all of 2016. Moreover, 1152 deliveries were assisted by skilled MSF medical staff between January and September 2017, compared to 1,291 in all of 2016.

In 2016, MSF teams at Nawagai hospital conducted more than 31,000 outpatient consultations and treated 167 children for malnutrition. The team also treated more than 800 patients infected with leishmaniasis, which is an endemic disease in Bajaur. MSF also manages support services in the hospital such as the laundry and infection control. It has also provided support, including medical supplies and training, to the Ministry of Health Khar Agency Headquarters Hospital for responding to mass casualty events. For severely ill patients in need of more intensive medical care than what can be provided at Nawagai hospital, MSF ensured their referral to Khar Agency Headquarters Hospital or to the MSF-supported district hospital in Timergara, Khyber Pakhtunkhwa province.

It is pertinent to mention here that after 14 years of working in Kurram district, MSF’s chapter there was asked to shut down in September.

The organisation has been working with Pakistani communities affected by natural disaster, conflict or lack of access to healthcare since 1986.


    • MSF has had a stellar track record of proving health care in many war-torn countries of the world, including Pakistan. MSF’s hospitals have been bombed in Afghanistan, Yemen and Syria, and yet they continue trying to provide health care to people. Instead of defending a pathetic decision by blaming media, read about MSF before commenting. And you are not ‘James’.

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