Daily Times

Rehabilitative health care concerns are emerging in Indian Occupied Kashmir, Syria, Yemen, Occupied Palestinian Territory, and contiguous adjoining areas of Pakistan’s Tribal Areas and Khyber Pakhtunkhwa. A multifaceted humanitarian emergency involving emergency health response is unfolding in Syria .The World Health Organization is working with the Palestinian Ministry of Health and Office of the United Nations High Commissioner for Human Rights and other health partners to strengthen the protection of healthcare in the Occupied Palestinian Territory bolstered by funding from the European Union and the Swiss Agency for Development and Cooperation. It is distressing that in Occupied Palestinian territory in the months of March 2018 to June 2019 WHO logged more then 570 attacks on healthcare facilities with 125 ambulances and 22 health facilities damaged yet Israel got away with these blatant attacks. Nearer to home the Indian forces in Indian Occupied Kashmir continue to repress the indigenous uprising with impunity and blind Kashmiris with pellets while the developed world watches equally blindly to these atrocities committed.

These devious assaults on rehabilitative health facilities deprive people of vital healthcare including trauma centers and rehabilitation, exposing health workers to grave peril and destabilizing health systems whereas it is incumbent on the international community and international organizations to ensure that adequate health, rehabilitation and educational facilities are accessible without any racial, ideological or gender discrimination.

Vulnerable Segments

The United Nations High Commissioner for Refugees estimates refugees to be approximately 50 million spread in developing countries .The vulnerable segments are estimated to be 300,000 “child” soldiers exposed to armed conflicts recruited through conscription or seized from families leading to physical and psychological traumas resulting in physical, mental and psychological traumas as well as communication disorders. Another vulnerable segment is of girls and women facing threats of sexual abuse, trafficking, rape, exploitation and disfigurement. Adolescents with disabilities or special health needs like HIV do not receive adequate health care compounded by hostilities giving rise to disabilities of the visible physical variety and invisible including communication disorders, cognitive and mental thus multiplying the existing number of individuals with disabilities.

Mixed success story in Tribal Areas

In Pakistan’s Tribal Areas and Khyber Pakhtunkhwa in 2015 the Government implemented a plan to facilitate the return of internally displaced persons (IDP’s) to their abodes and by April 2017 facilitated the return and de registration of around 1.5 million IDP’s yet almost 0.4 million IDP’s remain in Khyber Pakhtunkhwa. The IDP’s return to appalling living conditions as the key health and rehabilitative infrastructure was ruthlessly damaged by militants. Fearful for their safety health personnel avoid work which coupled with issues of access to safe drinking water, sanitation and practically non existent toilets the likelihood of outbreak of waterborne disease surges and individuals contract typhoid, cholera and diarrhea both in KP and FATA. Particularly disadvantaged are females ,on account of cultural stereotyping, whose problems are manifested in mental health issues including depression, anxiety and post traumatic stress disorder.

Donor Funding in Tribal Areas

In response to the humanitarian conditions international health agencies operating in Pakistan received USD 9 million from 2016 till 2017,which is below the funding requirement, to strengthen primary health care systems in the areas of return and displacement. Major interventions included in Kurram and Orakzai are repair and rehabilitation of the health facilities and providing human resources including doctors, rehabilitation professionals like speech pathologists, orthotists and prosthetists, technicians and psychologists and provision of basic equipment and medical supplies for rehabilitative purposes.

In Yemen sustained bombings ruined the water treatment plants as well as power grids and the cholera epidemic was not controlled

Apprehension of Spread of Disease to the West

Children are more likely to die from diseases due to lack of clean water, sanitation and malnutrion than from violence in conflict affected areas especially children dying from diarrhea related illness and cholera. Since conflict restricts access to clean water UNICEF highlighted 85,000 diarrheal deaths in conflict ridden areas due to poor water, sanitation and hygiene in children from 2014 to 2016 compared with just under 31,000 deaths attributable to violence. The worst scenario is that women journeying to a water source risk being sexually assaulted.

Warfare and Health Rehabilitation Facilities Systematic Destruction

Aerial bombing of urban areas, landmines and unexploded ordnance pose the greatest risk factor for the entire population especially children. In Yemen sustained bombings ruined the water treatment plants as well as power grids and the cholera epidemic was not controlled. Protracted conflicts occasionally emerge in media as bombardment of Yemen resulting in a school bus being shelled in 2018despite the fact that half of Yemen’s population has been displaced by the conflict resulting in millions living in deplorable circumstances. The UN and Western countries can utilize GPS and satellite data to document and thus discourage attacks against health rehabilitative facilities even in inaccessible locations.

Gender equity and mainstreaming

It is imperative for health policy stake holders as well as health rehabilitation professionals in Pakistan to advocate gender equity which should compete with priority health programmes. Intervention be designed in health sector response to gender based violence ,being a multisectoral responsibility, and centered on non partisan evidence based research on existing health system capacity.

The writer is PhD in rehabilitation sciences