The strain on the host families is tremendous - the situation of internally displaced persons from the Swat valley, Pakistan

Can you describe the conditions in a district such as Mardan, where so many IDPs now live?

With temperatures between 40 and 50°C, it is currently very hot. This means that any activity requires more effort – both for aid workers and for those who require their help. The landscape here is largely flat and life is governed by arable and livestock farming. IDP camps set up by the government and the military are, for the most, part empty, as the overwhelming majority of those affected are either staying with friends or relatives or in public buildings such as schools. Many people are still too afraid to return to their homes.

"Therefore, the strain on the host families is enormous &#– for weeks and months now, they have been taking in displaced families, which is pushing many of them to the limit both financially and physically."

How is MSF helping the IDPs and their host families?

"We provide free treatment to anyone who comes to one of our clinics. At the hospital in Mardan, we have set up an accident and emergency department as well as treatment stations for both men and women. There is also a severe diarhoea treatment centre, which is isolated from the main hospital to ensure that hygiene standards are not compromised. We treat an increasing number of suspected cholera patients at the centre in that endemic region.

"WHO performed analysis for further investigation. We are working in six primary health centres in and around Peshawar, the capital of the North-West Frontier Province. We treat approximately 1,000 patients every week, most of whom are suffering from diarrhoea, respiratory diseases or skin conditions.

"We treat many sick children, such as ten-year-old Basit. Accompanied by his mother, he arrived at the primary health centre in Darband in the east of the North-West Frontier Province, where we were already treating his two brothers. His knee was swollen and itchy, and like his brothers he is suffering from a common illness in the region. Although not well known, leishmaniasis is an old disease affecting some two million people every year. The symptoms include a high fever, red skin sores, extreme weight loss, joint pains and an enlarged spleen. In its most dangerous form, the illness is called kala azar and if left untreated leads to certain death. Basit is not suffering from this form of leishmaniasis and therefore has every chance of making a full recovery, even if this means being subjected to a course of treatment involving extremely painful injections."

How do things stand for patients injured in the fighting?

"Whilst the number of acutely injured patients is decreasing, surgical aftercare remains a problem. Furthermore, almost nowhere in Pakistan has sufficient acute care provision for the wounded. People are still dying as a result of attacks. Providing these people with emergency aid is a huge challenge. Injured people who could be saved are dying before they even make it to a hospital. What’s more, emergency care in the hospitals is unacceptable and also requires urgent improvement. This also applies to primary medical care in rural areas, especially in the areas near the border with Afghanistan."

Is sufficient help available and how does the future look for these people?

"This year’s violence in northern Pakistan has clearly led to the most severe humanitarian crisis since the earthquake in Kashmir in 2005. There is just about enough aid for the IDPs from the Swat valley. However, there are other groups of IDPs, such as members of the impoverished Bajaur tribe from a region north-west of the Swat valley. When these people return home, they will have to rebuild their lives from nothing, which is made all the more difficult by the dangerous political climate. They will be dependent on external aid for many years to come."