MSF facility in Dera Murad Jamali Balochistan, Pakistan, November 2018.
In Pakistan, Doctors Without Borders (MSF) focused on supporting the national response to COVID-19, while ensuring continuity of care in essential paediatric, maternity, and trauma services.

MSF launched a range of COVID-19 activities, including infection prevention and control, screening, and treatment in some of the worst-hit areas of the country.

In April, we installed a COVID-19 screening system at Timergara District Headquarters hospital in Lower Dir, to help protect against the virus and prevent it from spreading inside the facility to healthcare workers, patients and their caregivers and, by extension, outside in the community.

For six months, we also ran an isolation ward that, at the peak of the first wave of the outbreak in June 2020, had 30 beds for patients with suspected and confirmed COVID-19. Those requiring ventilator support were referred to specialist care facilities in Peshawar.

The spread of COVID-19 among staff at our women’s hospital in Peshawar forced us to suspend activities for six weeks. The services resumed after structural changes in the hospital, the establishment of an isolation area, and the implementation of strict infection prevention and control measures, including a COVID-19 screening system for patients and their caregivers.

In August, in Chaman, a town in Balochistan located on the border with Afghanistan, MSF supported the establishment of a 32-bed isolation ward in Killa Abdullah New District Headquarters hospital, providing electricity and waste management, as well as personal protection equipment (PPE) for healthcare workers.

Our teams also screened people entering the hospital. In Karachi, Pakistan’s worst-affected city, MSF worked with the Ministry of Health to distribute around 160,000 reusable cloth masks and 70,000 bars of soap to over 20,000 households in Machar Colony, a densely populated slum, where physical distancing was hard to maintain.

Through teams on the ground and a media campaign, we conducted extensive awareness-raising activities on ways for people to protect themselves and prevent the spread of the virus. MSF also donated drugs and PPE to the provincial authorities of Sindh and Khyber Pakhtunkhwa.

Emergency responses

COVID-19 was not the only emergency that struck Pakistan in 2020. Torrential rains during the monsoon season led to flooding in more than 350 villages in Sindh’s Dadu district. MSF set up mobile clinics as part of a post-emergency response and treated more than 4,000 people in a month.

We also distributed relief items including cooking, hygiene, and shelter kits to around 2,500 families, rehabilitated the main water supply sources, and distributed water purification tablets. We donated mosquito nets in Sindh and Khyber Pakhtunkhwa and worked with the health authorities in both provinces to disseminate transmission prevention and vector control messages on dengue fever when health facilities started to report cases.

MSF staff distributing relief packages in the Dadu district, Pakistan
MSF in Pakistan in 2020

Post-emergency response in Dadu

As part of the post-emergency response in Dadu district, MSF distributed relief items including kitchen, hygiene, and shelter kits to 2,500 families affected by the floods in five union councils of Tehsil Johi.

Continuation of regular activities

COVID-19 posed further barriers to healthcare for women and children in Pakistan, where the availability of free, high-quality services is already limited, especially in rural settings.

Many public and private facilities closed temporarily due to fear of infection. In spite of several challenges, such as staffing issues and a shortage of drugs and PPE caused by high demand and restrictions on exporting items from Europe, our teams continued to provide essential reproductive, neonatal, and paediatric care at five different locations in Balochistan and Khyber Pakhtunkhwa provinces.

Local communities, Afghan refugees, and people from the border areas benefited from MSF’s comprehensive 24-hour emergency obstetric services, which include surgery and referrals for complicated cases. We also operate a nutrition programme for severely malnourished children in Balochistan.

In addition, MSF runs the only emergency room in Chaman for the management and referral of critical trauma cases.

Our hepatitis C programme in Machar Colony, Karachi, includes screening, diagnosis, treatment and counselling, as well as health promotion activities. From March to June, to avoid possible exposure to COVID-19, we reduced our timetable at the clinic to two days per week and patients scheduled for monthly visits were given enough medication for three months.

Cutaneous leishmaniasis

Cutaneous leishmaniasis is a skin infection caused by a parasite transmitted by the bite of a phlebotomine sandfly and is endemic in Pakistan. In March, MSF opened a new diagnostic and treatment centre at the District Headquarters Hospital in Bannu, Khyber Pakhtunkhwa, for patients with the disease.

We run four other treatment centres in Quetta and Peshawar. However, following the authorities’ decision to close outpatient services because of COVID-19, we had to suspend these activities between March and July. 

MSF staff and health promotor on a tuk-tuk distributing masks
MSF in Pakistan in 2020

Mask distribution in Machar Colony

Health promotor Munir Hussain leaving on a tuk-tuk from a stock point to hand over facemasks and soaps to community health workers who will be distributing them door-to-door in Machar Colony, Karachi. MSF is handing out 218,000 facemasks and 75,000 soaps in the community to provide people with tools to help prevent the spread of COVID-19.

Handover of activities in Timergara

In March, we began the gradual closure of our Lower Dir project with the handover of the emergency room to the Department of Health. Our teams had provided over a million emergency care consultations to patients since opening the project in 2008.

The second step was the handover of the neonatal unit, which had admitted more than 9,000 babies between May 2014 and August 2020. The handover process was finalised in January 2021.

Misuse of labour-inducing drugs

We continued our advocacy and awareness-raising activities regarding the safe use of labour-inducing drugs such as oxytocin, which are often administered unnecessarily and outside of health facilities. Misuse of such drugs is linked to maternal and neonatal health complications.

In Pakistan, oxytocin is available in many pharmacies without a prescription and is a favoured means of speeding up labour and relieving pain. We used mass communications tools to promote safe medical practices, and engaged parliamentarians and the Ministry of Health to reinforce existing legislation related to labour-inducing medicines.

No. staff in 2020: 1,508 (FTE) » Expenditure in 2020: €15.8 million MSF first worked in the country: 1986

 
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