Nov 23, 2005

Travels to Azad Kashmir & North-West Frontier Province to support earthquake relief efforts

October 8th 2005 Pakistan Earthquake

Picture of the tent I lived in
These entries are from my independent self-funded project of late 2005 in the earthquake-hit regions of Pakistan. On October 8th 2005, at 8:50am (local Pakistan time), an earthquake of 7.6 magnitude hit the northern parts of Pakistan. The epicentre was near Muzaffarabad, the capital city of the disputed territory Azad Kashmir in Pakistan, with the worst-hit city being Balakot in North-West Frontier Province, which was almost completely wiped out. Other cities with severe damage that I directly worked in included Bagh (Azad Kashmir) & Abbottabad (NWFP).


I lived in a local camp, set up by a small local NGO, the Ansar Welfare Society. This camp was located in North-West Frontier Province in Bassian Village, which is just south of Balakot, north of Mansehra, just west of the Kanhar (also commonly known as Kaghan) river and east of the parallel Balakot rd. Seen in this picture is the tent I stayed in. The green tent beside mine was the pharmacy, which housed all of the local and foreign donated medicines. It is estimated that 3 million people went into tents. I must mention that I was received in this area with a great deal of love and appreciation. All of the persons I interacted with were most appreciative of the support from the international community.

My telling of this international news focuses on the hope and humanity of the people living in this area and the role that "the community" had played in the recovery and healing. Here, in the earthquake hit areas, there is no formal infrastructure for such disasters, such as 9-1-1 phone call, ambulances, firefighters, equipment to remove rubble, or any prior safety planning. However, somehow the survivors and local people knew what to do and their communal safety-net was fully functioning.

The camp was at full capacity with 200 adults and 100 children. Most of my work was in this camp and surrounding areas, including Balakot and areas along the Kanhar/Kaghan river.

The camp was guarded by Pakistani military 24hrs a day. This was usual for the smaller NGO camps. The military had also set up their own camps, which were generally larger and more formally organized.

As you can see from some of these photos, life went on as usual in the camp. Women were washing clothes, feeding children, cooking on open fires outside their tents, and children were running around playing. There were temporary schools set-up in these areas as well as schools run by the army. There were also classrooms set-up in some tents at the camp for volunteer teachers to work with the children. Much of this work was around addressing traumatization. Many of the children were orphans and in the care of surviving distant relatives. The men were less visible in the day-to-day activity of the camp. Many would go back to what was left of their homes/communities (if possible to get there and if they were able-bodied) to collect belongings or other things they could sell. Some men had business or jobs in other towns and were not with their families who resided in/near earthquake hit areas. Given this, there were more women and children in some of the camps.

In addition, given the typical routines of the people in some of the particular communities I worked in, the earthquake hit when most women were outside of the home, children were already in school and men were still at home. As a result, many children died in school and many men died in their own beds. In some other communities, most women were in their homes and majority of adult deaths were those of women and most reports agree with this. I visited a particular women's mass grave site of 500 highschool girls in Balakot.

In this last picture of tent life within the camps, these small logs of wood and the clothes drying on the tents are all that this family owns. The food being cooked was donated. Food was donated to the local camp organizers and then distributed among residents, along with clothes, blankets and clean water.


Cuban nurse assisting a quake survivor

Within the camp, there was also a medical clinic, Khanpur Medical Clinic. Cuban and Malaysian medical teams were working in the clinic. The Malaysian doctors were usually in a team of 2 or 3, that rotated weekly from Malaysia, and the Malaysian government had rented a small house for them a few minutes down the main road. It is important to recognize that the Cuban government sent 2, 000 volunteer medical professionals (most compared to all donating countries) to the region and created 30 hospitals complete with emergency medical equipment for a period of 6 months. In this particular camp, there were 21 Cuban doctors living in the camp along with 7 nurses.

The Khanpur Medical Clinic was open to all earthquake survivors and we averaged 400-500 patients per day. The most commonly dispensed medicines were for illnesses resulting from living in the camps such as scabies, diarrhea, constipation, vomiting, fever, cold, flu, infections of the throat, ear, respiratory tract and bladder/urinary tract. In these cases antibiotics for adults and children were a necessary drug. Many of the patients came with severe injuries from the quake such as broken limbs, requiring stitching and casting/recasting. The clinic also provided vitamins, supplements and ultrasounds (at hospital) for expecting mothers and sometimes, based on the stock available, contraceptives.

The patients were sent to the Cuban hospital located just a few walking minutes down the main road for blood tests, X-rays, ultrasounds and surgeries. Patients who were not able to walk were often brought to the clinic in wheelbarrows by neighbours. The clinic was able to utilize a small donated van as an ambulance to transport patients, if possible to do so by road. Residents living higher-up or deeper-in the mountains could not escape by road. In most cases, this meant that supplies were provided via helicopter and that maybe one or two members of the remote area would come and go with medications, food and other items on behalf of everyone living there. As you can imagine, it was challenging in the clinic to diagnose or dispense medicines for patients we have not seen and only based on the descriptions provided by the messengers.

Most of my work in the clinic was health education and translation. The Cuban doctors spoke little English as all education in Cuba is in Spanish. The patients accessing the clinic spoke a variety of languages and dialects, such as Urdu, Kashmiri, Pashto, Sindhi, Balochi and Farsi. Many of the patients were not aware of what antibiotics were or how to take them.

One common issue was "patient non-compliance" (term used in pharmacy) in that patients would take the antibiotics for 2-4 days and if they were seeing an improvement, would then share the rest of the tablets with their relatives or neighbours. Some of the reasons for this were a lack of understanding on how antibiotics work, fear (based on reality of circumstances) of not having enough donated and free-of-charge medicines to go around, and the cultural and communal practice of "sharing". Basic health care, hygiene and preventative measures were some of the topics of my discussions with the patients and local NGOs. We also discussed the importance of considering the impacts of cultural, religious and gender norms on relief strategies and vice-versa. Sustainable programming and support was also a main concern voiced by NGOs because temporary emergency health care was not enough given the preexisting issues as well as the many years of earthquake aftermath and survivorship to come.

The clinic closed at sunset, around 5:00pm, as it was too dark after this time to fly helicopters or to travel. It was extremely cold without the sun, up to minus fourteen degrees celcius. We used gas heaters in the tents while we were awake and sometimes electric heaters throughout the night. We did have electricity on the campsite, but due to periodic load-shedding, we were not able to rely on electrical source of heat.

To learn more about patients in the clinic please see video:
Pakistan 2005 Earthquake Relief Efforts Part 1: Medical Clinic
Tahmena Bokhari
(Urdu, approx 8min)
Please be aware that these videos present graphic images and sensitive subject matter.

Sometimes during the sunsets, the camp staff, doctors, nurses and social workers would go down the mountain, about 1500 metres, to Kanhar/Kaghan river along the Kanhar/Kaghan mountain range. In the far distances we could see the snowcapped mountains of the Himalayas.

This beauty was a high contrast to the work being done in the more populated and more devastated areas such as Balakot. We walked along the main Balakot road as it was too steep for vehicles. Balakot (seen in photos below) was one of the most destroyed cities after the Oct 8th earthquake and very unstable during the countless aftershocks in the following weeks. With the aftershocks lasting two months, reaching various cities in Pakistan, and totaling over 140, the areas became more and more unsafe for survivors and rescue teams. This combined with winter approaching, survivors living in camps with decreasing sanitation and little access to showers and clean water, were now at further risk of infections, diseases, and death. Many survivors were given tents to set-up near their broken homes. Many survivors did not want to leave their land and go into a campsite. Many stayed and dug for wood and metal to sell for money or food (as seen in one of these photos).


Two graves next to broken home and tents

The first picture taken in Balakot, seen here of two graves, was the typical site in Balakot. Amongst the remains of what was a fully functioning and beautiful community, one would see small plots with a broken home, a couple of tents in which survivors were living, and a few graves. The few solid ruins of the homes indicated extravagant exterior designs borrowing from Chinese, Persian and European influences. The graves made here were considered a blessing as many were buried in mass graves. Many survivors were not able to identify the location of their deceased family members.

In reflecting on the strength of the people, what stood out most for me in this experience was the very raw ways in which individual human beings were connected to their "self" and how sure of their realities they were. Many living in the West may not be able to relate to such a connection with self or with community, yet this connection to self can be seen as a main aspect of the highest quality of life. This "connection to self", as I have labeled it, can be categorized under "self-actualization", the highest of Maslow's 5-level "Hierarchy of Needs". I found this highest quality here, among the people, secluded in the mountains of the third world and, hidden behind what the West see as images of terror, tribalism, political conflict, and insurgence.

This very gentle Balakot resident lost all 9 of his family members. He built this small cemetery for them and he now spends his days and nights sitting in its centre. He is seen here on your left smoking from a traditional 'hooka' [water pipe] and on your right, if you click and zoom in, you can see some of the graves.

To learn more about the people who were directly impacted by the earthquake, please see video:
Please be aware that these videos present graphic images and sensitive subject matter.


Girl wearing donated sweater

This girl came to clinic to get medication for herself and her family members who were back in her campsite. The clinic also gave out donated sweaters and jackets when patients presented a need and based on stock.

In working with the children, I realized how much they valued education. The girl-children were very vocal about their aspirations, their dreams, their survivorship and their connection to their communities. Many wanted to know when they would go back to a "proper" school. They often asked about where I was from and some wanted to know exactly where in the world Canada is. Many wanted to know if it was possible to teach them English within the duration of my stay. They had ambitions of becoming teachers and doctors. One girl, who was now orphaned and living with her "mamoo" (mother's brother), said to me as she giggled, "I want to learn English so that I can visit your home one day and help your community" [translated from Urdu]. Another girl said that having seen the help the Cubans provided, she wants to become a doctor and maybe go to Cuba someday.

Some of the surviving parents or guardians of these girl-children also had very high aspirations for their daughters. When I talked with the children, the fathers or mothers sometimes overheard their ambitions and interrupted by saying in appreciation, "Masha Allah", meaning may God will it. The parents discussed with me options for their children around education and the possibility of them studying in different cities. Being that the community was feeling very insecure post-earthquake for various reasons, we also discussed the realities of even worse financial situations ahead for families and the region, concerns for safety given political instability of the region and country, and family-community unity. However, these were not necessarily seen as definite barriers to education of the girl-child, but rather concerns to be addressed given the contexts in which they live.

This little girl introduced herself to me quite formally as "Zubeda Bebe". Zubeda Bebe demonstrated boldness and leadership. She would announce my entry into the camp site to all the other kids. She knew I would be bringing goodies such as toys or markers and paper. She was also very curious as to where these items came from but told the other kids that it was impolite to ask such things.

The children loved the camera and loved to pose.

This little girl (looking at the medications) was very shy. Her father mentioned that before the quake, she was very talkative. She hardly spoke a word as she waited with her father for their turn in the clinic. Sometimes patients waited for over 2hrs depending on how busy the clinic was that day.

Working with the children survivors was a source of great learning. Their resilience in the face of this tragedy reminded me of the nature of the human spirit to flourish. Having buried the woman who raised me a week before my trip to this region and questioning my decision to continue with this project, the children taught me that it was some higher power that brought me back to the country in which I was raised, for my own healing journey. I am truly blessed to have been touched by these children and all the humanitarians that lead me to this path.

To learn more about the children from the children directly,
please see video:
Pakistan 2005 Earthquake Relief Efforts Part 2: The Children
Tahmena Bokhari
(Urdu, approx 15min)

Please be aware that these videos present graphic images and sensitive subject matter.


As our helicopter landed on this tiny helipad in Bagh, the children of this mountain area (where there is a large military base) came running out of the steep rocky edges. They were fascinated by planes and told us stories of different planes and people that have landed there. Ours was a Swiss helicopter donated to the Pakistani government and flown by two Italian pilots. It was being used by the military to transport food and supplies to areas that could not be reached by road. The donated helicopters that I saw from various countries, including Canada, were most importantly used to quickly and safely transport injured or sick residents to clinics or hospitals.

Despite the ugliness of death and destruction, the area was very beautiful as seen from the sky. As we traveled through the region via helicopter, I thought to myself that this landscape was one of the most breathtaking I had ever seen in my life.

If you click on these photos, you can see them enlarged and then you can zoom in once. If you do so, you will see tiny white dots on the mountains. Some of these dots are homes. From the ground and with only the naked eye, one would only know that there were communities so high-up along these mountains by tiny yellow glowing dots at night. During the load-shedding, some homes on the mountains would have a fire lit.

This is the Kanhar/Kaghan river that runs parallel to Balakot Rd.

On the helicopter!

I am grateful to Maqbool Bhatti and the team at the Ansar Welfare Society for sharing their knowledge and space with me. Above all, I know that I can never repay the individuals I met along my journey who have forever changed my life.