"When Taj Bibi came to us she had already been in labor for two days. And in this extreme anguish, she walked barefoot for one kilometer to reach our medical camp," said Dr Khalid Khan, District Programme Officer, United Nations Population Fund (UNFPA), Swabi, North West Frontier Province (NWFP). While praising the young woman's resilience, he added that Bibi had found good medical assistance thanks to the fact that the UNFPA had just set up a Mother and Child (M&C) centre at Yar Hussain camp in Swabi district of the strife-torn North West Frontier Province (NWFP). The centre has just begun work and is equipped to handle deliveries.

At the moment, the Yar Hussain camp is home to some 24,000 Internally Displaced Persons (IDPs).

According to the United Nations High Commissioner for Refugees (UNHCR), approximately three million people have so far fled the conflict zone in the Malakand Division of NWFP ever since fighting broke between the military and the militants of the Tehrik-e-Taliban Pakistan (TTP). There are more than 69,300 pregnant women among them.

Only 10 per cent of the IDPs live in the 21 government-run camps set up across the five districts of NWFP. Most are either living in schools, in makeshift camps or with relatives and friends. Living in temporary settlements, with limited medical facilities has put literally thousands of expectant mothers at great risk. "Of the 6,000 women who will deliver babies this month (approximate estimate), some 15 per cent are in danger of developing complications. They may require blood transfusions or even surgery," observed Khan. He said in a conflict situation, pregnancy-related complications only get exacerbated.

"Ideally, we would have referred Bibi to the nearby rural health centre since she was hypertensive. But there was danger of her delivering on the way and it may have endangered her life or that of the baby or mother or both," said Tahera Bano, a woman health visitor working in the M&C centre.

Within half an hour of her reaching the labor room, Bibi delivered a healthy baby girl, her second, and in a couple of hours she even insisted on going back to her tent. "When we asked her why she hadn't sought any help when her pains had started, Bibi just said there there was no female in her tent to whom she could confide and her husband didn't know about these things," said Bano.

This was Bibi's first delivery at a facility. Her first child was born at home in Swat even though her home was just a walk of 15 minutes from the local Saidu Teaching Hospital. According to Dr Sadiqua Jaffery, chairperson of the National Commission on Maternal, Neonatal and Child Health, Karachi, 80 per cent of babies are born at home in Pakistan, and this is not a practice peculiar to rural areas but also to peri-urban and urban slums.

The Pakistan Demographic and Health Survey - 2006-07, carried out by the National Institute of Population Studies (NIPS), reports the maternal mortality rate (MMR) at 276 per 100,000 live births. However, many experts remain skeptical about the figures and argue that if rural areas are taken into account separately, the numbers would be far higher.

When Punjab chief minister Shahbaz Sharif Khan visited the IDP camps last month, on May 15, he decided that in addition to helping the NWFP government with relief goods, his province would concentrate on providing quality healthcare by reviving the dysfunctional facilities in the region. The first beneficiary of this initiative was the sprawling government-owned Mardan Medical Complex in the district of Mardan. Spread over a massive 57 acres (275, 880 square yards), there was no doubt that the complex was big but until his visit it had no labor rooms and even the other wards were barely operational.

Within a week of his visit, the Punjab chief minister had sent a medical team of 140, which included 30-40 women, in a bid to refurbish the Mardan Medical Complex. Besides doctors, surgeons and paramedics, essentials such as drugs, machines and ambulances were also made available. "By May 20 we had begun the OPD (Out Patients Department), sent teams for outreach to camps and conducted surgeries. On May 22, our doctors carried out their first delivery, which was a caesarean section and the father, Ali Ahmed Khan, decided to name his son Shahbaz Sharif Khan, after the chief minister," said Dr Raja Shafiq, who had been deputed at Mardan that week.

After these improvements, an institution that Dr Amatullah Zain had described as "completely deserted" when she first arrived at the Mardan Medical Complex, is now bustling with activity. Ever since Sharif's namesake was born, they have delivered innumerable babies and performed several C-sections here.

Zain meets all sorts of women, who come clad in heavy 'burqas' (a piece of clothing that covers a woman from head to foot). Said Zain, describing her daily interactions with women IDPs, "When they come here many are in advanced stages of labor, even obstructed labor; they are dehydrated and often complain of not being able to eat well. Quite a few have gastroenteritis as well. Many also say that this is their first visit to a hospital."  

Zain admits though that it was not easy to leave the comforts of her home in Lahore, where she heads the Gynecological Ward at Jinnah Hospital - she is also an associate professor at Allama Iqbal Medical College. But she volunteered to do this. As she put it, "It is my honor to serve these people, who have suffered such huge losses."

She also makes sure the women who come to her for check-ups and deliveries do not go empty-handed. "I had brought light, loose cotton clothes for women and children, dried milk powder and some toys to give to them because when they fled, they had nothing but the clothes on their backs," she said, adding, "But it's all done very discreetly, so that their dignity is not hurt."

"For the first time, not just the IDPs but even the local residents are getting a state-of-the-art gynecological facility here in Mardan. The most expert hands perform safe deliveries," said Dr Islam Zafar, Director, Health, Punjab, who heads the team at Mardan. And all this is absolutely free of cost. "We do not charge them even for a syringe. It is free for everyone, not just IDPs," added Zafar.

According to the good doctor, despite bringing in many female health providers from Punjab, they are still outnumbered by the growing populace here. "Even for ordinary ailments, women in these regions refuse to be examined by male doctors let alone seek help for reproductive health issues," he said.

Right now, the number one priority is to ensure that there are no deliveries in tents. "Safe delivery is not possible in tents and the distance between hospitals and camps fortunately is not too much," observed Dr Aurang Zeb, Executive Director of Health Society, an NGO working in IDP camps in Mardan.

"There are enough ambulances and the deliveries are free. So we are encouraging the IDPs to avail this facility," said Zain.

While the pregnant women in the camps are getting the best available reproductive facilities, accessing the out-of-camp population is difficult, remarked Dr Zafar. The good thing is that word is spreading and every day their patient load is increasing. Said Dr Zafar, "There are vaccination teams that are going from door-to-door. Now it is generally known that women can now have access to safe deliveries carried out by female healthcare providers."