More than one million people fled the recent fighting between Pakistani military forces and armed opponents in the Swat Valley. They found refuge in the districts of Mardan, Charsadda and Peshawar. Toward the end of May, Médecins Sans Frontières (MSF) sent medical teams to support the Mardan University Medical Complex and the Takht Bhai rural health centre as both faced a massive influx of displaced people.

Concern for refugees

Almost three months later, the population flow is gradually reversing. Temporary camps have shut down and a third of the displaced people have returned home with material and financial support from UNHCR and the government. Their departure has lessened the burden on local residents.
At the same time, there are serious concerns for the safety of the returnees. Security has improved in urban centres in the Swat Valley, Lower Dir and Buner. However, information reaching MSF suggests that more isolated areas are still threatened by persistent violence, pushing families to flee once again.

Many cases of acute diarrhoea

Beyond these concerns, and despite the partial return of those displaced by the conflict, pressure has not let up at the Mardan medical complex staffed by MSF aid workers. More and more displaced people and local residents are coming in for treatment. In the past three weeks our medical teams have witnessed a sharp rise in cases of severe acute diarrhoea, in this region where cholera is endemic.

The World Health Organization has undertaken diagnostic tests but has yet to release its findings.
In the meantime, MSF has rapidly opened a temporary health structure that will soon have a capacity of 100 beds. Identical structures on a smaller scale have opened in Timurgara and Summerbagh hospitals in Lower Dir district.

“Within one month we have gone from 30 admissions in the first week, to 127 patients admitted last week,” said a concerned Fabien Schneider, MSF’s head of mission in Pakistan.

Aggravating factors

Overcrowding increases the risk of an epidemic and worsens sanitation. Making matters worse, torrential rains beginning in mid-August caused flooding, displacing tens of thousands in Mardan and Swabi districts. MSF teams responded quickly to help 150 families in the most isolated areas who had been deprived of other assistance.

Mardan is not the only region affected by acute diarrhoea. The illness has also struck areas bordering Nowshera, with one village where there have been a number of deaths reported.

Another medical organisation already working there responded, and the Nowshera hospital now refers patients to the Mardan medical complex. By August 18, MSF had treated 553 patients in various health centres and isolation units.