QUETTA

The September earthquakes in Balochistan offered a microcosm of aid work in Pakistan: Humanitarian needs were high - nearly 400 died and thousands lost their homes - but to respond, aid workers had to brave gunmen taking pot-shots at their vehicles and government restrictions on their work.

The country’s humanitarian situation is dire, with 1.6 million Afghan refugees living in the country, 1.5 million people affected by this year’s monsoon floods, around 1 million people internally displaced, and 15 percent of children under age five suffering acute malnourishment. And yet, for humanitarian NGOs, Pakistan remains a difficult place to deliver aid, both because of the security challenges and the paperwork.

“Security concerns have definitely affected us and restricted access to communities, notably after 2012 and the killing of our worker in Quetta,” Najum Ul-Saqib Iqbal, spokesman for the International Committee of the Red Cross (ICRC), told IRIN. The ICRC reduced activities in Pakistan after the attack, which occurred in April of last year.

“However, the need for assistance, of course, remains. We kept our presence in Pakistan and right now are seeking permission through the Foreign Office for some health projects,” Iqbal said. He told IRIN that although the ICRC enjoyed diplomatic status, in the field it faced “just the same” risks as other organizations.

“Those working in the health sector are especially at risk, and we are also trying to raise awareness about this. The killing of a doctor affects not just that person, of course, but many others, including those being served by that professional,” Iqbal said.

Risking lives to save lives

Threats associated with health work were underlined a few days ago when 11 teachers were abducted in Khyber Agency, one of seven tribal agencies on the Pakistan-Afghan border, during a polio vaccination drive at their school. Local officials blame militants opposing the administration of the vaccine.

Abdullah Siddiq, 35, a labourer in Balochistan, used to rely on a small clinic in his home town Pishin, 50km north of Quetta. But this month, when his six-year-old son fell sick, he had to travel to Quetta.

“He suffers fits, but the government hospitals have failed to help him. I cannot afford private care, and the small clinic in Pishin, which used to be run by an NGO and had doctors that really helped us, closed down two years ago,” Siddiq told IRIN.

The Pishin clinic was a victim of the insecurity. “We ran that clinic for nearly 10 years,” said Ilyas Khan of the NGO Help, headquartered in Quetta. “But then we had to close it as there were just too many threats to the doctors working there.”

The recent earthquakes in Awaran District, Balochistan Province, posed a particular challenge for aid groups, even though, for some local officials, they highlighted the need for humanitarian workers: “We need many organizations, many humanitarian groups, working here to meet needs. There are not enough right now,” Jan Muhammad Buledi, spokesman for the Balochistan provincial government, told IRIN.

Few international organizations were in place when the earthquakes hit. According to the latest annual report from the Pakistan Humanitarian Forum, which represents more than 50 international NGOs (INGOs), only 14 INGOs are active in Balochistan. Even fewer, seven, work in the Federally Administered Tribal Areas (FATA), while 38 work in Khyber Pakhtunkhwa (KP) Province. These are the three areas of Pakistan most prone to insecurity.

“The international groups do not really work in the field in places like Awaran. That is all left to us,” said Anwar Kazmi, spokesman for the Pakistani social welfare NGO Edhi Foundation.

Yet the needs are enormous in these areas. The UN Development Programme (UNDP) rates Balochistan the “least developed” of Pakistan’s four provinces, with 56 percent of its people categorized as “multi-dimensionally poor.” But work by humanitarian organizations is severely limited, principally because of an armed insurgency by separatists.

“The truth is that the NGOs, especially international groups, work in areas that are accessible, not where needs are greatest,” the head of a national NGO, who asked not to be named, told IRIN. “Going beyond Quetta in Balochistan, into districts where most work is needed, is simply not safe. The same applies in KP and FATA,”

Harder times on the horizon?

Security concerns did not stop aid workers who travelled to the earthquake-hit zones, but they do hinder humanitarian work. “Security issues do hold us back, and we struggle to offer the level of support needed,” a worker for an INGO, who asked not to be named, told IRIN from Awaran.

Red tape is also a limiting factor.

“INGOs are facing access issues,” said Soenke Ziesche, head of the Communications and Information Management Unit at the UN’s Office for the Coordination of Humanitarian Affairs (OCHA), whose most recent humanitarian bulletin, highlights the continuing issue of access constraints faced by INGOs, which need government permits to travel and work in sensitive provinces.

“The truth is that the NGOs, especially international groups, work in areas that are accessible, not where needs are greatest”

And there are fears things could worsen. The Economic Coordination Committee of the Pakistan government this month put in place a new framework under which INGOs would need to obtain government approval to carry on their work. It required a full disclosure of activities and funding sources, and stipulates that expatriate staff can only make up 10 percent of the workforce.

The proposals have not been welcomed by those working for INGOs. “More bureaucracy makes things tougher for everyone,” an aid worker employed with a humanitarian agency told IRIN.

“I believe the government has two concerns: one is security-related,” said Tahir Mehdi, executive coordinator of the community-based group Lok Sujag, which works to raise awareness about basic rights. “They are very apprehensive of foreigners now, as evident from this law. They think INGOs provide an alternative spy network. Paranoia has become a part of our policy.” He said the second concern was that the government sees NGOs as a rival in competing for international funding.

In Pakistan, the paranoia has been driven by a 2011 incident in which a doctor running a vaccination campaign allegedly helped the US Central Intelligence Agency track down Al-Qaeda leader Osama bin Laden.

Local actors

One response from international donors and humanitarian agencies has been to make greater use of local actors who face fewer restrictions. The government’s National Disaster Management Authority (NDMA) has taken a number of steps to improve its capacity, and now takes the lead in coordinating relief efforts, including during the recent monsoon floods.

A July study by the UK-based Catholic Agency for Overseas Development (CAFOD) suggested that national NGOs can respond more effectively to disasters and said international actors should concentrate more on building local capacity, including investing in “national civil society actors as an end in itself.”

“Given the situation, this may be the only answer to the access issues and growing official interventions. The priority must be to reach people,” said the former head for Pakistan of an INGO, who asked not to be named.

Ziesche from OCHA says this is already becoming practice. “It’s stated in the new ERF [Emergency Response Fund] guidelines (currently being drafted) to prefer NGOs; however no difference is made between international and national NGOs. But in fact currently the majority (56 percent) of the ERF funds goes to national NGOs,” he told IRIN via email.

But not everyone feels national NGOs are the answer to access difficulties.

Nasir Mehmood Awan is the government’s deputy district officer for the Social Welfare Rural Community Development Project in Samundri ‘tehsil’, or administrative unit, in the eastern Punjab Province, where he supervises 72 local NGOs in his jurisdiction.

“They were all running on a self-help basis at village level. Most of them are defunct now due to a lack of funding. Those behind them don’t have the ability to get foreign aid as they have no links or know-how,” he told IRIN.

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