I recently heard from Jacqueline Koch, a senior communications officer with the global medical aid group, Merlin. As described in a recent AJN photo-essay on Merlin’s work in Gaza (for the best view, click through to the PDF version), the organization partners with local health organizations and trains health workers to provide care in response to natural and man-made disasters. Ms. Koch has now shared with AJN a first-person account of one Pakistani woman’s experiences working with flood victims, which includes a description of that worker’s own family’s suffering as a result of the flood. This account, which will appear tomorrow along with several photos, is prefaced below by Ms. Koch, who provides context for Azra Habib’s story. The security issues raised by Ms. Koch are frightening, in that we now see an already taxing kind of health care work becoming even more perilous because of the threat of physical attacks like the murder of 10 medical aid workers in Afghanistan back in August.—Jacob Molyneux, senior editor/blog editor

A toddler recovering from dehydration brought on by acute watery diarrhea in Merlin's DTU in Charsadda.

‘Senseless but simple.’ In Pakistan, alongside a breadth of man-made and natural disasters, there are many occupational hazards and cruel ironies, especially for aid and health workers. It’s senseless but simple: delivering aid, providing medical care, and saving lives can potentially make you a target.

For any Pakistani national health worker who is working for an international nongovernmental organization (INGO), the danger multiplies. Not only can they themselves be threatened, but so can their parents, siblings, spouses, children, and extended families. They face armed attacks, death threats, robbery, kidnapping for high ransom, and the very real possibility of murder.

Many must navigate these dangers by refraining from visiting nearby family, living in close proximity of their offices, and hiring guards to escort their children to and from school. When working in the field, many opt to leave hats and jackets with INGO logos and ID cards behind, alongside their BlackBerries and anything else that might identify them. They have little choice but to dramatically alter the rhythm of their lives in order to save lives—including their own. But these measures are not always foolproof.

Not just in Pakistan. Merlin, an international medical aid organization, recently published a report outlining the impact of violence, conflict, and insecure environments on health workers, who are central to achieving the United Nations Millennium Development Goals. For those delivering essential health care in fragile or conflict-affected states, it is “A Grave New World.”

As one female health worker in Pakistan in conflict-affected Swat Valley (and who asked for anonymity) noted:

“The militants were against family planning, saying women must stay in the home. As a Lady Health Visitor, I was suspected of providing family planning and therefore at risk. During the militant regime, I could not reach women, I couldn’t meet my patients. If someone knew what my job was, they would have cut me to pieces. I often think about it, I think about my children, because my job is something my family needs. My family needs my job to survive. But I had to stop working here during the regime. I left. While I was away, I thought about my patients, I thought about those who I left behind and who didn’t have anyone to care for their health.”

Despite the threat, thousands are still willing to take the risk. In this unprecedented flooding disaster, Pakistan’s health workers are vital to the relief and recovery effort. Merlin’s emergency response in Pakistan is built on a 5-year-old national-led program—over 800 strong—and founded on a health care program that supports the health system while training health workers. Like many of the international aid organizations working here, Merlin has adopted various measures to mitigate risk: implementing stringent security guidelines and maintaining low visibility, while raising awareness of the issue and advocating for greater funding to ensure health systems can cope in insecure environments.

Jacqueline Koch
Pakistan Emergency Response 
Senior Communications Officer

(As noted above, tomorrow we will be publishing a first-person account by Azra Habib, who has been working for Merlin’s diarrhea treatment unit (DTU) in the flood-affected Charsadda district of Khyber Pakthunkhwa, Pakistan. She, like many health workers here, have opted not to focus on the potential risk they face, but the immediate need for their services.)

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