Photo: Jefri Aries/IRIN

A student surveys the remains of her house in a village in West Aceh after the 2004 Indian Ocean tsunami. The student survived because she had left the village for a holiday, but she lost 40 members of her family

BANGKOK,  – More funds and policies are needed for disaster risk reduction to protect vulnerable communities in the Asia Pacific region, says the International Federation of Red Cross and Red Crescent Societies (IFRC).

The call comes as the IFRC marks the fifth anniversary of the December 2004 Indian Ocean tsunami that killed 226,000 people in 13 countries, including more than 50,000 people whose bodies were never found.

“We’re calling for greater awareness, greater commitment, in terms of funding but also in terms of actions on all of our part, because that’s really what we believe is going to save lives in the long run,” Al Panico, head of the IFRC’s tsunami unit, told reporters at a 17 December briefing on lessons learnt after the tsunami.

That means “developing a policy, including it in programmes and … incorporating it into the response areas that are funded by donors, doing what people said they would do, and connecting the early warning systems to the community”, he said.

The Asia Pacific region experiences major disasters but the IFRC said the main threat came from localized, small-scale disasters – which have increased from an average of 21 in 2004 to 51 in 2008 – and more risk-reduction activities were needed.

Panico said much had been done to improve early warning systems in the region after the tsunami, but there was a gap in communicating warnings to people potentially affected by disasters.

“Getting [messages] to the people who need to act, the people in the community, the people on the ground who need to … protect themselves in some way, is the challenge. And that’s where there is a gap,” he said.

Humanitarian reform

The tsunami was caused by a 9.15 magnitude earthquake off Indonesia, which lasted for nearly 10 minutes. It led to destruction on an immense scale, but was matched by an unprecedented outpouring of donations, and the biggest response and recovery operation since World War II, said Panico.

“This disaster touched everyone, everywhere,” he said.

The cost of rebuilding damaged infrastructure has been estimated at US$10.9 billion, according to the IFRC, citing UN and government agencies.

By December 2005, $14 billion had been pledged, with $11.6 billion either committed or received by NGOs, the Red Cross movement and UN agencies.

Challenges included a lack of government capacity in the coordination of relief efforts, immense logistical problems with infrastructure destroyed, as well as demands for increased accountability.

However, Panico said the disaster had also sparked reform of humanitarian action by a number of governments. It also helped establish the cluster system – which better coordinates agencies’ efforts – and brought in recovery activities as a key element of disaster relief.

Having learnt these lessons, efforts moved from relief to recovery in three months following the earthquake off West Sumatra in Indonesia in September this year, which Panico said was “unheard of in previous disasters”.

The tsunami “has changed for ever the way that we respond”, he added.

The IFRC, with the Thomson Reuters Foundation, also launched a multimedia web documentary on how tsunami survivors have recovered since the disaster.

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PHILIPPINES: Volcano evacuees face months in camps

Photo: Wikimedia Commons

MANILA,  – Nearly 50,000 people are still crammed in 29 evacuation centres in the eastern Philippine province of Albay after scientists raised the alert level of the Mayon volcano from three to four on a five-step alert system on 20 December.

Evacuees spent Christmas in the centres – schools converted into temporary shelters – and will likely spend up to four months there should the volcano continue rumbling, according to provincial authorities.

“I have already declared my province open season for all aid agencies,” Governor Joey Salceda told IRIN.

“They don’t have to go to my office any more to secure permission. We need all the help we can get at this hour of need.”

Standby emergency funds from the local government may only last for four weeks, and resources were fast dwindling, he warned.

“Our hope is that Mayon will not continue with this phase since the schools have to re-open after the Christmas break,” he said.

But the deep rumblings, ash fall and lava flows are indicative of a dangerous and imminent eruption.

To date, close to 10,000 families or 47,285 people from hundreds of villages in five townships inside an extended 8km danger zone have been evacuated since volcanic activity started on 14 December.

Since the evacuation, however, many of the men were reportedly sneaking out of the camps in the daytime to check on their farms in the foothills of Mayon.

While they are “actively being discouraged” from doing so, Governor Salceda said it was almost impossible to monitor each and every person in the camps.

No room for complacency

Photo: ReliefWeb

A map of the Philippines showing the location of Mayon Volcano in Albay Province

Meanwhile, experts have reiterated the need not to be complacent: Renato Solidum, head of the Philippine Institute of Volcanology and Seismology, said “a hazardous eruption remains likely within days.”

The institute’s observatory in Legaspi city near Mayon reported at least nine ash explosions accompanied by rumblings in the 24 hours up till 7am on 28 December.

The explosions sent ash and lava fragments up to 2,000m into the air, covering villages and towns with a thin layer of fine particles that scientists warn could also cause respiratory and skin problems.

Some 44 volcanic quakes were also recorded by seismic machines, it said.

Relief supplies

Tons of relief supplies have been trucked into the evacuation centres, and temporary tent clinics and hospitals have also been set up. Water and sanitation facilities, however, were in critically short supply.

The UN Children’s Fund (UNICEF) said it had provided over US$100,000 in supplies to address the urgent needs of children and their families, including water kits and medical supplies such as face masks.

“Our hearts go out to the thousands of children and families who have been affected by the eruption,” UNICEF country representative Vanessa Tobin said, but expressed relief that there had so far been no reports of any casualties.

UNICEF said it was concerned for the more than 24,000 children whose schools have been converted into temporary shelters, and promised to bring in school tents and tuition packs to ensure classes can resume after the Christmas break.

Breathing problems

Photo: Wikimedia Commons

Pyroclastic flows descend the south-eastern flank of Mayon Volcano, Philippines in a past eruption

Meanwhile, Eric Tayag, head of the National Epidemiology Centre, has advised those in evacuation centres to protect their children from Mayon’s fine ash, warning that it could exacerbate asthma, bronchitis and respiratory-related illnesses.

“While illnesses caused by ash fall may not be that dangerous, people should take precautions and stay indoors if they can. For those in evacuation centres, prepare a wet cloth to cover the nose and mouth in cases of heavy ash fall. Those with asthma, bronchitis and emphysema should take precautions,” he said.

“They may experience increased attacks because ash fall, when inhaled, can trigger breathing problems.”

The 2,460m high Mayon is the most active of the Philippines 22 active volcanoes. It has erupted 48 times in recorded history, and in 1814 buried the entire town of Cagsawa, killing over 1,200 people.

Three months after it last erupted – in August 2006 – a typhoon dislodged tons of volcanic debris from its slopes, triggering a mudslide that buried entire villages and leaving over 1,000 dead.

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BANGLADESH: Ever so vulnerable to storms, floods and sea level rises

Photo: David Swanson/IRIN

DHAKA, – Low-lying Bangladesh with its 230 rivers and dense population of over 150 million has long been prone to flooding, soil erosion and saltwater intrusion, but climate change could aggravate the situation, experts and government officials warn.

In a report entitled A Global Report: Reducing Disaster Risk: A Challenge for Development, the UN Development Programme (UNDP) has identified Bangladesh as the country most vulnerable to tropical cyclones and sixth most vulnerable to floods.

According to data from the government’s Centre for Environmental and Geographic Information Systems (CEGIS), two-thirds of the country is only five metres above sea level, rendering it particularly vulnerable to sea level rises and tidal waves.

Melting Himalayan glaciers and an encroaching Bay of Bengal in the south, further increase the risk of flooding, experts say.

The fourth assessment report by the Intergovernmental Panel on Climate Change (IPCC) predicts that an increase in monsoon rainfall across South East Asia and melting Himalayan glaciers will result in increased water volumes in rivers that flow into Bangladesh from India, Nepal, Bhutan and China.

Damaged embankments

Photo: Peter Murimi/IRIN

A farmer tends his crops on Kutubdia Island, southern Bangladesh

Low-lying southern coastal regions are the most vulnerable, despite being protected by a 5,107km-long network of flood embankments.

Almost half of this embankment network was damaged by recent cyclones (Sidr and Aila), leaving the whole region vulnerable to the tides, according to Bangladesh’s Comprehensive Disaster Management Programme.

High population density means many Bangladeshis are forced to live on and cultivate flood-prone land.

“Our fields are dying because of the salty water… It is impossible to grow anything in them any more,” lamented Abbasuddin Mollah, a 60-year-old farmer from the coastal district of Bagerhat.

“Without the dykes to protect us, the tides rush in twice daily and swamp the croplands,” he told IRIN.

“This is the sort of effect rising sea levels will have on Bangladesh. We are fighting climate change on the front line,” said Ainun Nishat, one of the country’s leading environmentalists.

Government response

But according to Hasan Mahmud, state minister of environment and forestry, the government is working to address the issue.

A massive river dredging project at an estimated cost of US$2 billion has already been undertaken by the government in order to conserve water, increase the capacity of the rivers, and channel more fresh water into them to decrease their salinity.

For Bangladesh, effects of climate change are no longer a future threat. It is already a reality for us.

“There are four indicators to measure the extent of damage that a country will have to face due to global climate change: the direct harmful impact of climate change; increasing natural disasters; the number of people facing these dangers; and the measures already undertaken by that country to reduce the negative impacts of climate change. Bangladesh is eligible on all counts,” Mahmud said.

The 2009 Bangladesh Climate Change Strategy and Action Plan published by the Ministry of Environment predicts that within the next 50 years, over 20 million people could be displaced and become “climate change refugees”, if sea and salinity levels rise.

The Plan recommends combating the effects of climate change by focusing on social security, disaster management, infrastructure development, research and knowledge management, low carbon development options and institutional capacity development.

Meanwhile experts warn of the increasing frequency and/or intensity of tropical storms in the Bay of Bengal.

“For Bangladesh, effects of climate change are no longer a future threat. It is already a reality for us,” State Minister Hasan Mahmud said.

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LAOS-MYANMAR: “Worrying trend” of rising opium poppy cultivation

Photo: UNODC Laos Opium Survey

BANGKOK,  – Fuelled by political instability and lacklustre crop prices, opium poppy cultivation is on the rise in Myanmar in a worrying trend that may undo containment strategies, the UN Office on Drugs and Crime (UNODC) warns.

Poppy cultivation is also on the rise in Laos, where farmers are struggling as commodity prices fall, according to the UNODC’s latest survey of opium poppy cultivation in the two countries in 2009, launched on 14 December in Bangkok.

“We are worried about trends, especially in Myanmar, where we see the potential unravelling of much of what containment has produced over the past two decades,” said Gary Lewis, the UNODC Representative for East Asia and the Pacific at the launch.

“In the past three years we have seen incremental cultivation increases, and this is of [concern] to us … In conclusion, containment is under threat,” he said.

Southeast Asia is home to the infamous “Golden Triangle” of countries comprising Laos, Myanmar and Thailand, once the world’s major supplier of opium, but overtaken by Afghanistan since 1991.

Eradication efforts in the past few decades have slashed opium cultivation in Southeast Asia to about 5 percent of the world’s supply, although the region is now battling the production and consumption of amphetamine-type drugs.

Most opium cultivation in the Southeast Asian region still takes place in these three countries, mostly in Myanmar; from there the drug is shipped primarily to China and Vietnam, although it is also distributed worldwide.

The UNODC says a combination of political instability in Myanmar, and falling commodity prices over the past year has tempted farmers to turn back to poppy growing.

“We have prices of commodity items such as maize and rubber dropping more than 50 percent, and at the same time we have seen an increase in opium prices,” said Leik Boonwaat, the UNODC’s representative in Laos.

“Demand has been stable, the prices have increased and this has made it more tempting for farmers to increase production,” he said.

Photo:

Map showing Laos, Myanmar and surrounding countries

Instability threat

The Myanmar government has maintained ceasefires for years with a number of ethnic groups, including those in the country’s east, who have been allowed a certain degree of autonomy.

However, pro-democracy activists say the government has now told these groups they must join a government border-patrol force, sparking fears of armed confrontations.

“Increased instability in northeastern Myanmar is affecting the opium market,” wrote UNODC’s executive director Antonio Maria Costa in the report’s introduction.

“Ceasefire groups – autonomous ethnic militias like the Wa and Kachin – are selling drugs to buy weapons and moving stocks to avoid detection,” he said.

Cultivation has increased for the third consecutive year in Myanmar, with opium-producing land increasing by 11 percent compared with the previous year and 50 percent since 2006 to a total of 31,700ha, according to the survey.

More than one million people are involved in poppy cultivation in Myanmar, where 95 percent of the poppy is grown in northeastern Shan state, it said.

In Laos, cultivation was up 19 percent to a total of 1,900ha and opium is fetching a high retail price of US$1,327/kg, compared with the farm-gate price of $317/kg in Myanmar. Boonwaat attributed the difference to a scarcity in demand and a population of some 12,000 drug addicts in Laos.

To stem the cultivation, governments and donors needed to maintain vigilance and continue their support to help poppy cultivators find alternative livelihoods, the UNODC said.

“It’s in areas where alternative development has had a chance to take place that we’ve seen less opium, and in places that are more isolated and remote that we are seeing more opium growing,” Boonwaat told IRIN.

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PAKISTAN: Warning over maternal, infant mortality goals

Photo: Sumaira Jajja/IRIN

KARACHI,  – With just five years left until the 2015 UN Millennium Development Goals (MDGs) deadline, health care professionals have warned that the country is unlikely to reach its targets for goals four and five, child health and maternal health.

“In Pakistan, a lot of things are lacking, including quality healthcare. There is political instability and an even greater lack of awareness,” Andro Shilakadze, chief field officer in Pakistan for the UN Children’s Fund (UNICEF), told IRIN. “Even small steps like focusing on and promoting hygiene and sanitation, and stressing exclusive breast-feeding can lead to improved health but these are put on the backburner.”

MDG four stipulates that Pakistan must reduce its under-five child mortality rate by two thirds between 1990 and 2015; from 130 deaths per 1,000 children in 1990 to 85 per 1,000 in 2015. According to the Pakistan Demographic Health Survey (PDHS) in 2006-2007, this rate was 94 per 1,000 in 2006/7.

“This seems reachable, especially in urban centres, but things are different in rural areas. Also, the ongoing strife in NWFP [North West Frontier Province] and Balochistan has put a large number of children at risk,” said Amir Dawood, president of the Balochistan branch of the Pakistan Paediatrics Association (PPA).

MDG four also states that the country’s infant mortality rate (IMR) should be reduced from 100 per 1,000 children in 1990 to 40 per 1,000 in 2015. In 2006/7, the rate was 78 per 1,000, according to the PDHS.

MDG five stipulates that Pakistan’s maternal mortality ratio (MMR) be reduced by three-quarters during the same period; from 550 per 100,000 in 1990 to 140 per 100,000 in 2015. In 2006/7 the MMR was 276 per 1,000 births nationwide, with a much higher rate in rural areas.

“Given these figures, if anyone thinks that we can reach the MDGs by 2015, they are mistaken. By a long haul this is not a possibility,” said Dawood.

Backward province

Photo: Ali Mohammad Sabawoon/IRIN

Abdul Ghafoor, 38, lost his wife when she went into delivery and must now care for his five children alone. Maternal mortality rates in Balochistan remain particularly high

Summing up the scenario in Balochistan, he said: “Balochistan is the most backward province in Pakistan and with regards to health care, the situation there is dismal. While the national [IMR] average is 77 per 1,000, according to a PPA survey conducted in 2005, out of a 1,000 live births, 102 did not survive. Ten percent of children in Balochistan have not had a single immunization.”

He said the pending Child Protection Bill, which provides an institutional framework geared specifically towards prevention and protection of children from abuse, should be passed in parliament as soon as possible and newborn care should be prioritized.

He added that the Expanded Immunization Programme, which aims to provide free protection to every newborn child in Pakistan against eight deadly diseases, must be strengthened financially and administratively. “We have a lot of appointments on a political basis and this practice needs to end. It’s human lives that we are dealing with.”

Many health care professionals say the government needs to put its money where its mouth is and back up the commitments it has made.

“Over the time that I have spent conducting courses all over Pakistan I have often noticed that vaccinators have not been paid,” said paediatrician D.S. Akram, founder of the Health, Education and Literacy Programme (HELP).

“There is no money for purchasing fuel. In many cases vehicles given to lady health visitor supervisors have been taken away by politicians, or in a tribal area the service provider was not allowed to work due to ongoing warfare. How and why would they work?”

Keeping track of performance

She said that although the government had introduced many positive initiatives, such as the lady health visitor programme, which has proven successful in rural areas, it needed to monitor and evaluate its efforts.

“The government and donor agencies must keep a tab on performance. I can tell you for a fact that of all the people we trained, hardly 10 percent follow the proper protocol. Not only is that a waste of training but also this increases the burden on the healthcare system,” she said.

UNICEF’s Shilakadze said the government could not be expected to achieve the MDGs alone. “The best way out is to strengthen the public-private partnership. Also, an increase in funding is important, along with monitoring that the funds are used adequately,” he said.

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LAOS: Storm survivors dependent on food assistance

Photo: Peter Lappe/WFP

VIENTIANE,  – Three months after tropical storm Ketsana struck southern Laos, leaving 28 people dead and more than US$90 million in damages, thousands of survivors now find themselves food insecure.

According to a 14 December revised UN Flash Appeal, around 126,000 people (or 70 percent of those affected) are in need of food aid over the coming three months – and some 72,000 will continue to require assistance for a further three months after that.

Farmers have very low expectations for this year’s harvest: About 28,500 hectares of rice and other crops have been damaged resulting in a 70 percent production loss, the UN appeal said.

Mountainous Samouy District, near the border with Vietnam, was the worst affected district in the southern Laos province of Saravan when the storm struck on 29 September 2009.

The total population of the district is 13,000, but only five of the 54 villages survived the floods with minimal damage, and more than half the population now faces insufficient food supplies.

Deputy Governor of Samouy Vilaysack Phomphakdy said the most serious concern for local people was the loss of 1,480 hectares of paddy fields – wiped out by the floods – which would have yielded an estimated 2,200 tons of rice at the end of the rainy season in October.

Some 1,000 families or around 6,000 people lost their staple crops to landslides and high water in the district.

More than 220 hectares of cassava, a staple part of the Lao diet, was also destroyed, as were industrial tree plantations in some areas. A large number of poultry, cattle and other livestock were also lost in the district.

“These people don’t have enough rice to eat for the next year. They need over 3,000 tons for 2010 because they will not be able to grow rice again on the hillsides and rice fields until they first clear the land,” Vilaysack told IRIN.

Bounted Sailavatay, a resident of Salava-tay village, said his main crops – including rice, cassava, and peppers – were destroyed by the storm, and floodwaters swept away rubber trees and coffee plants, as well as his family home.

Bad timing

Photo: Courtesy Lao Poverty Reduction Fund

A bridge in Samuoy District, destroyed by high waters in the wake of Ketsana

Ketsana struck right at the end of the rice growing season, when farmers throughout Laos were beginning to harvest their crops.

“All I have left is empty land and dead crops. The floodwaters swept away ripe rice. I had just started harvesting the rice a few days before, but hadn’t stored any in my house. I left it in the rice fields and the floodwater swept it away. The rice in this field would have been enough for us to eat for six months,” Bounted said.

To cope, Bounted’s family, like others in the district, are living off cassava, a staple of the Lao diet, mixed with rice donated by the World Food Programme (WFP).

“The rice is not enough to eat for a month. Each person eats at least 20kg per month,” said Bounted, commenting on the WFP donation of 10kg of rice per person in December.

He also plans to grow corn but the season for this is from January to April, so there are at least four months to wait until he can harvest a crop.

FAO aid from January 2010

The Food and Agriculture Organization (FAO) representative in Laos, Serge Andre Verniau, said the organization would provide US$1 million in vegetable seeds and agricultural tools for farmers affected by Ketsana, starting in January 2010.

Verniau said the seeds would help the farmers back towards food security in the long-run.

“FAO is mobilizing funds from many organizations to help affected people. If we receive more funds, we can support them more,” he said.

Deputy Governor of Samouy Vilaysack said around 350 of the district’s 1,000 houses were destroyed in the flood; many were swept away, while others lost roofs or were damaged beyond repair by high water and debris.

He said all those who had lost their homes were now being housed in temporary shelters provided by the government at a one-off construction cost of over $118,000.

The worst affected provinces were Saravan, Xekong and Attapeu.

To support government relief efforts, the revised UN flash appeal calls for more than $12.8 million to address the immediate needs of more than 180,000 people affected by Ketsana until April 2010. As of 29 December, 60 percent of this total had been received.

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PAKISTAN: Nine swine flu deaths prompt fear

Photo: Kamila Hyat/IRIN

ISLAMABAD,  – The death of at least nine people from H1N1 influenza since May 2009 has led to rising public fear and concern, and experts are calling on the government to introduce more preventative measures.

Screening was introduced at airports during the summer but little else has been done to combat the disease.

“The authorities are not taking effective measures to check the disease. There is no strategy in place for this,” Ashraf Nizami, president-elect of the Pakistan Medical Association in Punjab, said. Nine cases have now been confirmed in the province.

Experts say one of the factors behind the recent rise in H1N1 cases has been the return from Saudi Arabia at the end of November of thousands of pilgrims who had gone on the Haj pilgrimage.

“The return of 150,000 pilgrims in cold, dry weather raises the risk of swine flu as in these conditions the virus spreads rapidly,” Rafiq Khanani, president of the Infection Control Society of Pakistan, said at a seminar in Karachi.

He suggested thermal scanners should have been placed at all airports before the Haj pilgrim influx began.

Rashid Jooma, director-general of health for the federal government, said there were 76 confirmed cases and nine deaths.

Twenty-six other people have been tested positive by the Aga Khan University Hospital in Karachi, which also reported two additional deaths in the city. Under government policy, all positive samples need to be sent to the National Institute for Health for confirmation.

Government measures

Jooma said “about two million vaccines” would be available by mid-January, with vulnerable people, including pregnant women and health workers, to be inoculated first.

“We have thermal scanners at all major airports, but at Karachi so far only one is installed at the Haj terminal. A second scanner is being installed soon to cover other travellers,” he told IRIN.

Isolation wards had also been set up at major government hospitals, he added.

However, many say the government action is too little and too late.

“There is not much point in making statements and promises now. I am not sending my two children to school. Many pupils are sick and I am worried my sons could contract swine flu,” Asiya Gul, 30, told IRIN.

Healthcare practitioners continue to try and calm fears. “The disease is manageable, especially in the early stages,” said Javed Akram, principal of the Allama Iqbal Medical College in Lahore. He advised people to “avoid public places, wash their hands frequently and consult a doctor if they had symptoms of the disease”.

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PAKISTAN: Displaced suffer as winter sets in

Photo: Abdul Majeed Goraya/IRIN

PESHAWAR,  – Thousands of internally displaced persons (IDPs) from conflict-hit areas in the North West Frontier Province (NWFP) have been experiencing increased hardship as temperatures drop to freezing in many northern regions, IDPs have told IRIN.

“It is very hard to manage now that it is so cold. We sleep on an open verandah at our host’s home because he has only two rooms indoors and these are occupied by his own family of 10,” said Waris Mehsud, aged 35.

He was displaced from South Waziristan in November when the government’s military operation against militants intensified. He now lives with relatives in Dera Ismail Khan town, NWFP. “Two of my four young children are sick with high fever and bad colds and it is hard to keep them warm at night,” he said.

An acting UN Refugee Agency (UNHCR) spokesperson told IRIN last week that up to “900,000 people could still be displaced, most of whom remain with host families”. Estimating the number of IDPs outside camps has been hard as many of them move between their homes in conflict zones and their hosts in other areas, the spokesperson said.

“We thought about going back earlier this month because our hosts were under strain because of us, but our home near Wana, [in South Waziristan] has been damaged and we cannot move back until repairs are carried out,” said Mehsud.

In addition to IDPs living with hosts, UNHCR says there are 110,368 IDPs in 13 camps – in Peshawar, Nowshera, Mardan, Charsadda, Lower Dir and Hangu districts. Most are from Bajaur Agency.

“Winterization packages”, including all-weather tents, blankets and plastic sheets, have been distributed to these IDPs but living conditions are still hard, according to an update by the Office for the Coordination of Humanitarian Affairs (OCHA) covering 26 November to 9 December 2009.

Fire risk

Photo: Abdul Majeed Goraya/IRIN

Cold weather has added to the hardships of IDPs across the North West Frontier Province in Pakistan

To keep warm some IDPs have tried to light fires very near their tents, or even inside them, and “we have had to stop them because it is dangerous,” said Muhammad Husain, an organizer for the local authorities in Hangu District, where a camp has been set up in the town of Muhammad Khoja.

Two weeks ago, four children were burnt to death after a tent caught fire at Jalala Camp in Mardan District, due to an electrical short circuit.

Tough for women, children

Life is especially tough for women and children.

“It is very hard to wash clothes or bathe the children because there is no hot water, and we cannot heat more than a small pan on our stoves,” Zareen Bibi, a displaced woman living in Muhammad Khoja Camp with some 50 other families, told IRIN.

There are also unexpected problems: “Now that it is winter, the men from our host family sleep indoors instead of in the courtyard. We can only reach the toilet if we pass through the room where my cousin and his adult sons sleep, and this is not appropriate. Sometimes my two teenage daughters and myself cannot relieve ourselves for over 14 hours, until the men leave the room,” said Uzma Bibi, 40, in Mardan.

“Upper respiratory tract infections are common in children at this time of the year. Children are especially vulnerable, and there have been reports of sickness among child IDPs,” Maheen Khan, a pediatrician in Peshawar, said.

Insecurity has hampered access to IDPs by both international agencies and female health professionals.

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