I won't pretend that this is a genuine letter 'from the field', as I have been back from Pakistan for a while now, following 15 months in the country as Head of Mission. So this piece may not be 'hot off the press', but it does benefit from having a period of reflection. As I'm sure you can imagine, there are a vast amount of things that I could write about. We experienced and responded to floods, an earthquake, and the biggest displacement of people in Pakistan since partition from India in 1947, all on top of our planned activities – mainly focused around providing medical services to mothers and children, an area of medicine that is vastly neglected within the local health systems. Pakistan, it seems, especially when you have a vested interest, is always on the news. Western troops in Afghanistan; huge donations by western governments for development and stability goals, a huge and thoroughly international Pakistani Diaspora, all contribute to the international interest in the country. Indeed, when you are there, it seems like the world revolves around Pakistan. We hear a lot in the news about the politics, the economy, the fighting, but not much about the people themselves. During my time there I saw whole villages that had been destroyed overnight by natural disasters and thousands of people who had fled their homelands due to being surrounded by some of the fiercest fighting seen in the country for decades. One of the moments I remember most distinctly was sitting in a displaced persons camp in Mardan, just outside the provincial capital of Peshawar, with some men who had fled from Bajaur Agency on the border with Afghanistan. While sitting together their mobile phones started to ring. "What's happening?" I asked as the meeting started to fall apart. "There are helicopters over our houses again, there is fighting all around our village..." In my naivety I thought that everyone had left the village, but some family members had stayed behind to look after others and their property and in the chaos the men I was with were trying to guide and talk their family members to safety. You hear stories of people making last calls to close family in times of crisis, not knowing if they are going to survive. Thankfully I have never experienced such a call, but I was suddenly surrounded by dozens of people going through that very horror. And there were many other such stories. Families trying to run for shelter with babies in their arms, families having to run as fighting erupted on the road or from the air around them or people trying to flee, but simply not able to because of the dangers en route... Too dangerous to stay, even more dangerous to go. I find even imagining that situation horrific. Yet these are just examples of the many thousands of stories behind the headlines that are so easy to miss and ignore, but are happening every day. This is why MSF included Pakistan in its annual 'Top Ten Humanitarian Crises of 2008'. There are clearly direct needs for a medical humanitarian intervention in Pakistan, whether in terms of supporting rural healthcare [including severely neglected maternal and child healthcare], responding to the abundance of natural disasters or treating the wounded after fighting between governments and militants [leading to the displacement of hundreds of thousands of people]. However, delivering aid in Pakistan is not easy. In one of the most politically and militarily charged areas in the world, it is more common than not that aid is linked to political objectives and following the headlines, rather than for an impartial reason that puts people first. This compounds the mistrust and disillusionment felt amongst local people - "Why are they bombing us over there, but bringing us medicines over here?" - assistance that people need and deserve is dragged into a greater political agenda. I'm very pleased at the way MSF remained neutral in this hugely complex situation and tried at least to reach those who needed our assistance the most. We provide care in a way that very few other organisations can. Our independence is hugely important both in principle, but also in practice, as agencies without it run the risk of being drawn into local and international politics. MSF stands in a unique position in Pakistan, and it is thanks to this conviction and our dedicated and talented teams that we are in a position to help the people who are most affected by the ever-changing and highly charged situation in Pakistan.