Ton Koene/MSF
MSF was about to start a maternal health project in Lamnian, a small village in the mountains, when the earthquake struck. Despite considerable damage to the health structures the MSF team were fortunate enough to survive the quake and immediately changed their intervention into emergency relief.
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The first day after the earthquake MSF started to deliver emergency aid and rapidly organized more assistance. At the peak of the intervention, from mid-October to mid-November 2005, just over 150 international and over 450 national staff were providing emergency care in 18 permanent sites in Pakistan and three in India. By the end of March 2006, the bulk of assistance had been delivered and MSF intervention reduced. MSF has currently just over 60 international staff and 250 national staff working in its projects.
In Pakistan, MSF concentrated its relief efforts in the districts of Mansehra (North West Frontier Province), Bagh and Muzaffarabad (both in Azad Kashmir). In India MSF worked in the districts of Srinagar, Baramullah and Kupwara of Indian administered Kashmir
Azad Kashmir (Pakistan administered Kashmir)
According to the federal authorities over 40,000 people died in this part of Pakistan with over 70,000 injured. It was by far the worst hit area, with much of the capital Muzaffarabad destroyed. Also Bagh, a town nearby, was severely damaged. Remote villages in the mountains took the hardest toll, many of them completely destroyed or for weeks cut off from the outside world.
MSF intervention
MSF was about to start a maternal health project in Lamnian, a small village in the mountains, when the earthquake struck. Despite considerable damage to the health structures the MSF team were fortunate enough to survive the quake and immediately changed their intervention into emergency relief.
Within one day of the earthquake, MSF started relief efforts in Muzaffarabad, the capital of the region, and set up several clinics throughout the heavily damaged city. Within a week, 74 international staff had arrived in Muzzafarabad. MSF started an intervention in the hospital of Muzaffarabad, which also became the main hub for the distribution of medical and relief supplies into the Kashmir mountains.
Four days after the quake additional resources were flown into Lamnian and nearby Hattian villages by helicopter. From Muzaffarabad more assessments were carried out in the region, including the town of Bagh where another programme was opened.
Numerous official and makeshift camps for the homeless started appearing in and around Bagh and Muzzafarabad, as the majority of the population of Muzzafarabad and Bagh had become homeless and thousands of homeless people from the mountains started arriving. MSF concentrated mainly on the makeshift camps giving special attention to the water and sanitation needs by constructing latrines, water points and providing water on a daily basis as well as focusing on hygiene promotion.
Throughout the following months, more roads became accessible, significantly improving access to smaller villages. Following the initial emergency response to treat the wounded and to distribute relief items, attention was given to reconstructing health facilities. MSF built a permanent hospital in Hattian, which was handed over to the Pakistani health authorities in April 2006. In Bagh, MSF set up a temporary hospital to replace the destroyed hospital in Bagh until the main hospital is reconstructed.
Ton Koene/MSF
Initially, the bulk of MSF activities focused on providing relief to the population living in mountainous areas which were inaccesible by road. Distribution of relief items, medical consultations and measles vaccination campaigns were carried out primarily in Kaghan Valley, and on a punctual basis in Syrian and Allai Valley.
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Locations where MSF worked:
Muzaffarabad; Bagh; Saidpur; Kai Manja; Hattian; Lamnian; Leepa Valley; Chamukam; Paniali; Chikhar; Mallot; Bir Pani
Activities:
Medical: Basic health care; mental health; maternal health; surgery; vaccinations; distribution of hygiene kits
Non medical: Distribution of tents; blankets; heaters; plastic sheeting; construction kits; kitchen sets; water and sanitation activities; building and renovating health structures.
North-West Frontier Province
Although less affected than the region of Kashmir, the earthquake had also devastating consequences in this province. Provincial authorities estimated 38,000 deaths, although federal estimations have been lower. The main affected towns were Balakot, Batagram and Mansehra, as well as numerous villages in the mountains where access was extremely difficult.
MSF intervention
Initially, the bulk of MSF activities focused on providing relief to the population living in mountainous areas which were inaccesible by road. Distribution of relief items, medical consultations and measles vaccination campaigns were carried out primarily in Kaghan Valley, and on a punctual basis in Syrian and Allai Valley.
By the end of the first month, MSF had refocused its activities in Mansehra town, where thousands of wounded were arriving. It is estimated that in Mansehra district alone, 10,000 people were severely wounded.
The Mansehra district referral hospital was partially damaged by the earthquake and was completely overloaded by the number of wounded. The wounded were housed in tents in the hospital courtyard or simply left on mattresses in the open air, as there was no more capacity to accommodate them inside the facility. Under these conditions, the district hospital was unable to provide proper nursing care for the wounded. Nor was it able to fulfill its role as a referral hospital for the rest of the population in the district as all other hospital services were nonfunctional.
MSF set up a nine module, inflatable hospital next to the Mansehra District Hospital. The hospital of 120 beds had four operation theatres, an emergency room and an intensive care unit and provided orthopaedic care for the injured. Many patients had developed complications and needed additional surgery. Psychosocial care and physiotherapy was also provided for the patients.
Medical villages were created in Mansehra town for 100 patients and their families, in order to discharge patients who no longer needed hospitalisation but still required follow up. An additional physiotherapy post was set up in Balakot for follow-up of trauma patients.
The Mansehra District Hospital was able to return to its role as a referral hospital for the district as the other hospital services, (such as pediatrics, and maternity, etc) started functioning again.
By the second month after the earthquake, thousands of people came down from the mountain villages to settle around Batagram, Mansehra and Balakot. MSF decided to focus its relief on the people living in makeshift camps on the Mansehra - Balakot route, by identifying specific needs they had in terms of access to water, sanitation facilities, heating and basic material needs (tents, hygiene kits, blankets, etc.) Distributions were carried out for 18003 families living in mushroom camps.
Locations where MSF worked:
Mansehra; Kaghan; Gangwal; Balakot
Activities:
Medical: Referral hospital; surgery; mental health; physiotherapy; basic health consultations; vaccinations
Non-medical: Distribution of tents; blankets; plastic sheeting; kitchen sets and heaters; water and sanitation activities.
Islamabad
In the capital two tower blocks collapsed, killing 48 people, but the rest of the city was not damaged. Islamabad became quickly the main port of entry for foreign relief as well as the referral site for complicated injuries.
MSF intervention
Some additional assistance was given to hospitals in Islamabad where specialised medical staff joined existing Pakistani medical teams. The airport was the main port for incoming staff and cargo.
Activities:
Medical: Surgery; kidney dialysis
Non-medical: Coordination and forwarding of medical and non-medical staff and relief goods.
Indian-administered Kashmir
Despite its proximity to the epicentre the effects of the earthquake were significantly less on the Indian controlled side of Kashmir.
According to the Indian authorities approximately 1,400 people died and around 5,000 people were injured in the Indian controlled region. Some 140,000 people were believed to be homeless. The worst affected part were the districts of Baramullah and Kupwara, close to the Line of Control with Pakistan-administered Kashmir.
MSF intervention
MSF already worked in this part of Kashmir before the earthquake. The existing mental health project quickly extended its work to carry out distribution of relief items and medical supplies. Some 25,000 people received assistance through the distribution of mattresses, cooking sets, tool kits, tents and blankets. On average MSF teams conducted 60 to 120 consultations a day when the mobile teams visited locations in Kupwara district.
In the provincial capital MSF donated surgical material to the hospital whilst psychosocial counsellors provided support to 400 wounded children who had been evacuated and were in shock due to the loss of family members.
At the end of 2005 MSF integrated the relief efforts into its regular heatlh programme.
Locations where MSF worked:
Srinagar, Uri, Tangdhar
Activities:
Medical: Basic health consultations; mental health consultations
Non-medical: Distribution of relief items; provision of clean drinking water
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