Nurses treat an injured child at the Lady Reading Hospital in Peshawar. Credit: Ashfaq Yusufzai/IPS.

By Ashfaq Yusufzai
PESHAWAR, Pakistan, Nov 16 2013 (IPS)

Ajab Gul is haunted by bloody scenes. He hears women crying and children screaming. “I can’t sleep,” says the 25-year-old health worker at a well-known Pakistani hospital in the frontier city that tends to terror victims.

He works at Lady Reading Hospital (LRH) in Peshawar which is said to receive 98 percent of all terror attack cases in the restive Khyber Pakhtunkhwa province.

And Gul’s job is particularly difficult. Posted at the hospital’s accident and emergency department  – one of the largest in Pakistan – he has to stitch and bandage wounds.

“I see flashes of bloodied faces and bodies. The cries of women and children who are brought here for treatment ring in my ears every night,” Gul tells IPS.“They asked me who attacked them and why? I had no answer.”

The ferocity and frequency of bombings and suicide attacks in Khyber Pakhtunkhwa and the adjacent Federally Administered Tribal Areas (FATA) have had a chilling impact on the lives of doctors, paramedics and nurses in the region.

Their wounds may not be visible, but run deep. “Most of us develop psychological problems,” says Gul.

Peshawar, the capital of Khyber Pakhtunkhwa, used to be a peaceful city. But after the Taliban government in Afghanistan was toppled in 2001, many of its militiamen crossed over to Pakistan and took refuge in the border areas along FATA.

For years now, the Tehreek Taliban Pakistan (TTP) has been targeting the armed forces, government installations as well as public places like markets and schools.

Police say at least 210 attacks have been carried out by the Taliban in Peshawar since 2005.

Professor Arshad Javaid, chief executive officer of LRH, says, “Healthcare providers treat terror attack victims and see their trauma from a close range. Many use anti-depressants, tranquillisers and sleeping pills to avoid nightmares.”

There are around 12 big hospitals in Khyber Pakhtunkhwa, which is home to 22 million people. But most terror attack victims land up at the 1,650-bed LRH.

The state-owned LRH has treated more than 6,000 victims of violence since 2005, says Javaid.

“It is our mission to reduce mortality from terror attacks,” Javaid tells IPS.

But close encounters with severed limbs, bloodied faces, tears and screams leave their scars on the most dedicated of health workers.

“I keep seeing the charred bodies of children in my dreams,” says Rifat Bibi, a 28-year-old nurse at the hospital. “Many times I wake up.

“It is heart wrenching to see children suffering or dying for no fault of theirs,” she says. “They remind me of my own children, sisters and mother.”

Some are unable to put up with the trauma of their jobs.

“About a dozen of my A&E colleagues have got themselves transferred to other wards because they couldn’t stand the stress,” she says.

The twin suicide bombings at All Saints Church on Sep. 22, in which around 80 people were killed, are still fresh in Bibi’s mind.

“A woman, with a bloodstained face, who lost two young brothers that day, wept so much over their bodies that the memory still haunts me,” Bibi tells IPS.

Jauhar Ali is the president of KP Paramedics, which works with various hospitals in the city. He says its 560 paramedics provide diagnostic services and treatment to all kinds of patients.

“But our priority is those who suffer multiple injuries in bomb attacks. We need to stop the bleeding, and bandage their wounds,” he says.

“Even when we are not working, the scenes keep flooding back to mind,” says Jauhar Ali, who also conducts X-rays.

Two years ago he encountered three severely wounded children who were in Grade I. “They asked me who attacked them and why? I had no answer.”

Now he worries endlessly for his own children.

“My children are the same age, they too could become terror targets some day.”

Dr Amjad Ali, a psychiatrist at LRH, says healthcare providers are also vulnerable to rough treatment at the hands of victims’ families.

Citing the Sep. 22 church attack, he says, “That day we received 233 victims within one hour. All were provided treatment. But the angry relatives of some victims attacked health workers.”

Nurses and paramedics often develop mental health problems, he says.

“They burst into tears when they see people in pain. One in 10 shows symptoms of psychological illness. I have examined dozens of health workers who required anti-depressants and counseling,” Amjad Ali tells IPS.

“When you see bloodied bodies so often, how can you not be affected?”

At an artificial limbs centre in Kabul. Credit: Najibullah Musafer/Killid/IPS.

By Esmatullah Mayar
KABUL, Mar 7 2013 (IPS)

Efforts to clear Afghanistan of landmines have been painfully slow. At least 45 people on average lose their limbs every month to deadly anti-personnel mines, according to the Mine Action Coordination Centre of Afghanistan, formerly a project of the UN Mine Action Service, and now a national entity.

Under the UN’s mine ban treaty, Afghanistan should have been free of landmines by the end of 2013. The country was granted until 2023 to clear all mined areas in Geneva in December last year.

Since 1997, the International Campaign to Ban Landmines, a global network of non-governmental organisations, has been campaigning to make the world free of landmines and cluster ammunition. It has a presence in 90 countries including Afghanistan.

A signatory to the UN Anti-Personnel Mine Ban Convention, or the Ottawa Convention as it is called, Afghanistan is littered with anti-personnel mines that are built to maim.

Demining activities were started in 1979. The work, which is extremely time-consuming, has meant that a million Afghans in an estimated population of 30 million still live in areas with unexploded ordinances.

At the prosthetic centre of the International Committee of the Red Cross (ICRC) in Kabul, 36-year-old Ghulam Siddiq of Khogiani district in Nangarhar province 200 km east of Kabul has come for an artificial leg. “I was cutting some grass in the mountain in the early evening when suddenly an explosion occurred,” he told Killid/IPS.

He said he could not believe he had lost a leg. “When I recovered consciousness I found myself in the hospital. My leg was cut below my knee. It was painful for me. I began to remonstrate with God: one side is poverty and the other side I have trouble with my leg. Then I kept my patience. This might be the will of God.”

Baz Mohammad is a 40-year-old resident of Shakardara district of Kabul who has also come to the ICRC centre to get artificial limbs. The ICRC has limb-fitting centres in Kabul, Herat, Mazar-e-Sharif, Gulbahar, Faizabad and Jalalabad.

He said he lost both legs in a landmine accident. “When I was loading wheat I stepped on a mine. I did not know what happened.”

There appears to be a lack of understanding among people about the slow pace of mine clearing work. There are also complaints that mine clearance is being undertaken in areas where mines do not exist. The areas that are being surveyed for mines are free of mines, some people say.

Dr Mohammad Dayem Kakar, head of the Afghan National Disaster Management Authority (ANDMA), addressed a meeting in Herat in December, before the start of demining operations in parts of Herat’s Karokh, Obi and Chesht Sahrif districts. He said mines were spread over 599 sq km.

“An estimated 3,000 people were killed or injured by mines and unexploded materials each month three years back,” he said. “But now the figure has decreased to 45 people each month.”

Kakar hoped that the contaminated areas in Herat would be cleared by 2018 and the whole country demined by 2023. Kakar praised the perilous work undertaken by demining organisations. “The mine is a danger for human beings, and our duty is to identify the areas and clear it.”

Mines were laid by the communist regime of Dr Najibullah, during the fighting with U.S.-supported mujahideen groups. Further mine-laying took place between 1996 and 2001 during the conflict between the Taliban government and the Northern Alliance led by Ahmad Shah Massoud. Landmines were planted also in residential areas and agricultural land, making Afghanistan one of the most mined countries in the world.

Farid Humayun, head of The HALO Trust, said 54 sq km were cleared over five years in three districts in Herat where the demining charity works. Another 12 districts, including the border districts of Ghorian, Kuhsan, Shindand and Adraskan in Herat will also be cleared, according to the plan. Halo is a demining charity based in Britain, and is the oldest and largest group engaged in demining work.

The HALO Trust, according to its website, has 200 mine clearance teams working in Herat and nine provinces of the northern and central regions. Between 1988 and May 2010, HALO destroyed more than 736,000 mines (195,000 emplaced mines and 541,000 stockpiled mines), 10 million items of large calibre ammunition and 45.6 million bullets.

At the Herat meeting in December, HALO’s director Humayun said their teams do not touch the new roadside bombs, the Improvised Explosive Devices (IEDs), placed by armed opponents of the Hamid Karzai government. These were the cause of 30 percent of civilian fatalities in the second half of 2012, according to the UN. A reported 967 people were killed and 1,590 injured.

Shahab Hakimi, head of the Mine Detection and Dog Centre (MDC), which trains dogs to do the dangerous work, urged donors to continue funding for the humanitarian mine-clearance efforts. He was hopeful the landmines littering the country could be cleared with continued funding and the efforts of non-governmental demining organisations.

Afghanistan will be able to meet its 2023 deadline, said Abigail Hartley, programme manager of the UN Mine Action Services.

*Esmatullah Mayar writes for Killid, an independent Afghan media group in partnership with IPS.

The destroyed Tabu neighbourhood at Gadarfai in southern Libya. Credit: Rebecca Murray/IPS.

By Rebecca Murray
KUFRA, southern Libya, Oct 20 2012 (IPS)

Safia’s six-year-old body is riddled with scars from the rocket that hit her home in February. With her immediate family all killed in the violent attack, this sole survivor smiles shyly as she visits the medics that fought to save her life.

Their makeshift clinic is in Kufra’s impoverished and war-torn Gadarfai neighbourhood, a segregated stretch of flimsy dwellings, piles of rubbish and scorched earth occupied by the indigenous Tabu tribe.

Spent ordnance and a gaping hole left by a mortar round in the clinic’s compound is a reminder of the recent brutal clashes between the Tabu and the town’s majority Arab tribe, the Zwai, over local power sharing and lucrative cross-border smuggling routes.

As fighting got under way, Tabu medical staff at Kufra’s downtown government hospital were threatened.

“I worked there for ten years as a nurse,” says Khadija Hamed Yousef. “The Zwai security guard and ambulance driver came in with Kalashnikovs and warned: ‘This is your last day or we will shoot you’.”

Since the July ceasefire, the Tabu clinics in Gadarfai and Shura are still overcrowded, and lack equipment and medicine. Two North Korean doctors recently assigned to the facilities by the Ministry of Health speak only their native language.

Fearful pregnant Tabu women bring Zwai acquaintances to Kufra’s hospital during childbirth to ensure their safety, and Tabu with serious injuries or illnesses now travel outside for care.

The small oasis town of Kufra lies hundreds of miles south of the Mediterranean, in Libya’s isolated Saharan corner bordering Egypt, Sudan and Chad.

While Kufra’s Zwai tribe benefited from Gaddafi’s favouritism, the semi-nomadic Tabu were deprived of citizenship and ID cards, accused of being ‘foreign’ despite generations born on Libyan soil. They faced state-sanctioned discrimination in jobs, education and housing.

Local roles during the revolution against the Gaddafi reflected this pecking order: the Zwai largely backed the status quo while the Tabu – whose networks stretch west to Sebha, and south into Chad, Niger and Sudan – joined the rebellion to fight for their rights.

Once the revolution was won, Kufra’s tribal-driven conflict over the spoils was ignited last November at a desert checkpoint.

A weak response from the Tripoli-based government and international community did little to quell a raging battle in February, which broke out again in April and June.

Almost 200 were killed, the majority Tabu, with hundreds more injured before the ceasefire took hold.

While the Tebu move freely across the area’s desert, the Zwai control Kufra’s local government, downtown commercial zone and the airport. During the clashes the Zwai held sway over who entered the town, including humanitarian aid.

The defence ministry’s decision in March to assign as peacekeepers the Shield of Libya – a loose-knit collection of ill-disciplined militias from the northeast – disastrously backfired.

Biased towards Zwai claims that Kufra was under attack from Tabu ‘outsiders’, the fighters soon aimed their weapons at the Tabu in besieged Gadarfai and Shura communities.

Halim Abdullah Mohammed, 26, was a core staff member working a 24-hour shift throughout the February clashes at the Gadarfai clinic, sandwiched between two Zwai checkpoints and often under direct fire.

They received over 200 patients then, half of whom are recorded as women and children.

She admits her first aid training was hopelessly inadequate for the patients they received. There was the 12-year old girl whose head was partially blown off by a mortar and died, and the 29-year-old man with a bullet in his head that they managed to save.

“We controlled bleeding with bandages, used local anesthetic and sutures,” Mohammed says.

With electricity cuts there was no water, no refrigeration, and little medication. They operated with flashlights, using dirty well water and direct blood transfusions.

Unable to bury the dead for fear of being shot themselves, the medical staff stacked bodies in the compound’s guardroom. They decomposed in the desert heat.

Across town, in Shura neighbourhood, Rajab Hamid Suri quietly sobs as he recounts the death of his 16-year old son Mohammed. Hit by a mortar targeting their home, he bled to death slowly at Shura’s makeshift clinic next door. “He was talking. We didn’t expect him to die,” he says.

Tabu medical staff underscore the lack of aid they received under siege, and describe how they were forced to ferry some seriously wounded across the desert hundreds of miles west to Murzuq for treatment.

They say they received no support from the local Red Crescent Society, and that the Tripoli-based International Committee for the Red Cross (ICRC) conducted medical evacuations only.

In April, Amnesty International released an urgent statement appealing for humanitarian access. “We also asked that individuals should not be denied health care based on their identity, and should be protected when seeking care in the Kufra hospital,” says Libya researcher Diana Eltahawy.

“In terms of the Red Crescent, there is some truth to what the Tabu are saying,” she explains. “However, when a member of the Red Crescent tried to deliver aid someone on the Tabu side attacked him and no one tried to intervene. So the picture is a bit mixed.”

Laurent Perrelet, an ICRC protection delegate, was in Kufra in June during an evacuation of wounded. “It was most dangerous transporting Tabu from the clinics to the airport in vehicles,” he describes.

“What was striking were the clinics. There were a lot of wounded and not enough space to accommodate them. They were outside the clinic – within the compounds, but outside.”

Perrelet believes training Tabu and Zwai Red Crescent volunteers should be a primary focus, as well as figuring out “how we can work together in Kufra, and with the Red Crescent.”

Halima Salah, an energetic 28-year old nurse, juggles her intensive schedule at the Shura clinic with caring for a son with cerebral palsy, and her civil society organisation that promotes dialogue between Tabu and Zwai.

“I still talk with one of my close Zwai friends,” she says. “During the clashes we couldn’t because it involved families. But now we do and we ask each other: ‘Why are you sending mortars instead of tomatoes?’”