RAPID ASSESMENT North Waziristan Internally Displaced · 2020-04-30 · Lakki Marwat, Karak, Dera...

North Waziristan Internally Displaced Population Assessment of IDPs in District Dera Ismail Khan,

Khyber Pakhtunkhwa, Pakistan

RAPID ASSESMENT

Relief International Rapid Assessment North Waziristan Internally Displaced Population – Dera Ismail Khan 20th to 24th June 2014 2

Contents INTRODUCTION ......................................................................................................................................... 3

ASSESSMENT OVERVIEW .......................................................................................................................... 3

ASSESSMENT OBJECTIVES ......................................................................................................................... 4

MATERIAL AND METHODOLOGY .............................................................................................................. 4

RESULTS & DISCUSSION ............................................................................................................................ 5

HOUSEHOLD NEEDS .................................................................................................................................. 5

SOURCE OF INCOME IN NORTH WAZIRISTAN ........................................................................................... 7

SHELTER AND HOUSING ............................................................................................................................ 8

ACCESSIBILITY OF HEALTH FACILITIES ....................................................................................................... 9

EDUCATION FACILITIES ........................................................................................................................... 10

GAPS IN PREVIOUS ASSUMPTIONS ......................................................................................................... 11

IDENTIFIED NEEDS ................................................................................................................................... 11


North Waziristan IDPs Rapid Assessment in District Dera Ismail Khan, Khyber Pakhtunkhwa Province, Pakistan

Relief International

INTRODUCTION The Government of Pakistan (GoP) commenced military operations 1 in the northeast region of Pakistan, in North Waziristan (NWA), on June 15th 2014, targeting the refuges of non-state armed actors. The operation has prompted large scale displacement to neighboring districts of Bannu, Lakki Marwat, Karak, Dera Ismail Khan and Kohat in Khyber Pakhtunkhwa Province; Bakkar and Fatehjang in Punjab Province, other areas of the country and across the border into Afghanistan. Reports indicate that over 14,000 people have reached Afghanistan. As of June 24th, the Federally Administered Tribal Areas (FATA) Disaster Management Authority (FDMA) has reported registering over 455,000 Internally Displaced Persons (IDPs) (36,700 families). This number far exceeds the initial estimates of 250,000 IDPs. The displacements appear to have ceased from the designated exit points from NWA, as the authorities re-imposed a curfew following a five-day relaxation that allowed over 350,000 people to move out of the conflict zone. Further displacements are expected as the security operation is extended to other parts of the Agency. 74% of the IDPs are women and children2. It is feared that the displacement will trigger a polio outbreak3, and the Ministry of Health are working to vaccinate IDP populations. The government

1 http://www.bbc.com/news/world-asia-27980938 2 OCHA Pakistan_NWA Displacements_Situation Report No. 3_ah 06/27/06 3 http://www.dawn.com/news/1115248/north-waziristan-offensive-exodus-triggers-polio-spread-fears

health teams, supported by the UN (World Health Organization), are vaccinating people at exit points from North Waziristan. The displaced are facing hardship due to security restrictions, lack of transport, and inflated prices when exiting. The government has made provisions for the fleeing families; however, the increase in number from original estimations has left government facilities overwhelmed. The government has established a camp in the Frontier Region of Bannu, yet the majority of the IDPs are choosing to live with friends and relatives in rented accommodations or in temporary shelters, such as government schools – which were closed two weeks early for summer season to accommodate the displaced families. The influx of IDPs has put a strain on the already existing facilities in the hosting areas. In addition to this, there remains the risk of flooding and bad weather for families living in temporary or badly constructed accommodation, as a result of the upcoming monsoon, and restrictions as a result of the holy month of Ramazan.

ASSESSMENT OVERVIEW This rapid assessment was carried out by staff of Relief International in the district of Dera Ismail Khan (DI Khan), province of Khyber Pakhtunkhwa. This site was chosen as a result of the initial UNOCHA report, highlighting the movement of IDPs into this district, and also in reaction to alerts raised at the field level by Relief international staff stationed in this area. Relief International has been present in Pakistan since the earthquake in 2005, actively responded to the Swat and Bajaur IDPs crisis of 2009 and was part of the response to the floods in 2010, and playing an integral role in both humanitarian responses. Relief International’s experience in humanitarian needs assessments have been developed through exposure to such emergency settings both in Pakistan and globally. Support was also provided for this assessment by Relief International’s global humanitarian response team. Taking into account


the urgency of the situation on the ground, this assessment was structured in such a way as to identify the basic needs of the displaced population, in an area where Relief International is currently implementing and thus has clear access and an existing relationship with the host population.

ASSESSMENT OBJECTIVES • To identify and collect information from

internally displaced persons from North Waziristan Agency, identifying basic needs and livelihood requirements for both the displaced population and the families hosting them.

• To collect information and practices related to personal hygiene at the household level and integrate IDP disease reporting through CAHWs at district level.

MATERIAL AND METHODOLOGY The UNCOHA field office in Dera Ismail Khan reported that by June 18th 2014, 22,000 IDPs had crossed the district border into DI Khan, and settled throughout the district. Relief International surveyed 279 households from the IDP population. The assessment commenced after permission was granted by the district administration. The population of IDP’s is increasing every day. The current trend would suggest that the population has the potential to increase to 100,000 in DI Khan in the coming weeks. A process of personal interviews and Focus Group Discussions (FGDs) were utilized for this needs assessment. Besides interviewing male heads of IDP households, the information from women headed households were received from the male relatives during assessment, from the DI Khan Union Councils of Kaich, Paharpur and Shorkot which border South Waziristan. The needs assessment also included two FGDs, in Suigan and Kaich villages. The FGDs focused on general

questions regarding the wellbeing of the participants and their access to basic services, and included questions to gather qualitative and quantitative information on needs. The data was collected over a period of five days, from June 20th to June 24th, 2014.

In the focus group discussion the following findings were observed and data was collected on: Critical Needs as defined by IDPs in Surveys and Focus Group Discussions

• Basic Food Items (BFI) • Non Food Items (NFIs) • Hygiene Kit • WASH • Disease prevention • Neonatal child health care • Health care • Animal feed and vaccination

Priorities as defined by IDPs in Surveys and Focus Group Discussions

• Cash for rent for houses. • Water and sanitation facilities need to be

provided where IDPs are residing with their host communities. There exists a traditional drainage system, but this is overburdened by the increase in population in the area; systems are backing up and there is a lot of stagnant water – creating hotspots for dengue and malaria.

• Drinking water provision through hand pumps; prior to the digging of new wells, water should be tested to ascertain that it is safe for human consumption (the provision of additional drinking water facilities is necessary because in DI Khan much of the water is not palatable and may risk contamination).

• Temporary shelters need to be provided in the area for those in the population that are not being hosted. (shelter in


hosted community as per space and need base).

• Primary education facilities or ‘safe spaces’ for children. (School age children may be enrolled in the government schools in host community and safe spaces for children may be allocated. However school are currently closed for the summer vacation)

• Fodder and feed for livestock that accompanied the IDPs.

• Solar fans with back up support • Solar lanterns with back up support • Support for disabled individual that have

been displaced, for example, wheel chairs and provision of medicines.

• They did not have time to properly pack basic household effects, clothes, bedding, kitchen utensils. During the assessment, IDPs reported that they were given two days notice by the administration to leave. However, previous negative experience of military action in the area, in particular the Mir Ali4 strikes a few months before in where the Government of Pakistan reacted to a suicide bombing to devastating effect on the local population, compelled them to leave in great haste.

Observations of Relief International’s Rapid Assessment Team:

1- Hygiene kits 2- Dignity kits for women 3- Vocational training and kit specially

tailoring and sewing 4- Household latrine kit for women 5- Training/awareness on health hygiene

and health related awareness materials.

4 Key TTP commander gunned down in Mir Alihttp://www.dawn.com/news/1110733

RESULTS & DISCUSSION

HOUSEHOLD NEEDS Household-level semi structured interviews focused on current basic needs and gaps in the support they are receiving. Availability of food and potable water is the most pressing current need for the IDPs. Water is available in DI Khan but it is not palatable due to high salanity and possible contamination.

This is followed by access to shelter, health care and education. Families who are not able to secure housing with friends or families are becoming victims of vastly inflated rent prices as a result of the increase in demand. 50% of

respondents prioritized finding a house to rent as one of their major priorities. Healthcare remains a concern, especially taking into account the overcrowding and the stress that is placed on families (travelling 26 miles in severe heat/ 74% of the population are women and children5). The mass evacuation has the potential to exacerbate existing health conditions, and instigate a spike in communicable diseases and gastrointestinal infections as a result of overcrowding and compromised immune systems. 5 OCHA Pakistan_NWA Displacements_Situation Report No. 3_ah 06/27/06


In the medium term, IDP’s are very conscious of the disruption to their children’s education as a result of this migration. In North Waziristan schools are closed in winter, and open in summer. The opposite is true in Dera Ismail Khan, meaning that as the displaced children arrive in DI Khan, the summer holidays in schools are beginning. There remains no current provision for the children of IDPs throughout the summer months.

Figure 1: Household Needs

Discussion With the pressures of an increase in population numbers in the district, there has been a corresponding increase in the cost of basic foodstuffs at village and Union Council level, since the arrival of North Waziristan IDPs. These unofficial and demand driven increases in the price of staple foods prices out the vulnerable IDPs out of the market. Figures collected by the assessment team show an overall increase of approximately 6%. These prices vary enormously dependent on quality; rice has four different qualities, also pulses prices ranges from Rs 60 to Rs150.

Perceived Condition of IDPs’ Point of Origin Housing 45% reported that when they departed, their houses were still intact. 6% reported that they believe that their houses were destroyed after their exit from the area. 49% did not have any information regarding the status of the houses they left behind. However, many IDPs indicated that they are worried that the houses they have left behind have been, or will be destroyed, making the move back to North Waziristan unlikely in the near future. This was demonstrated from the first pictures obtained by BBC.6

6 http://www.telegraph.co.uk/news/worldnews/asia/pakistan/10939895/Inside-Pakistans-kill-zone.html

Basic Good June 1st to 15th

June 16th to 30th

Rice Kainat 1 kg 125 135 Rice Super Kernal 1 kg 120 127

Rice Basmati 1 1 kg 115 122 Rice Basmati 2 1 kg 80 90

Flour 1 kg 38 44 Pulse Quality 1 1 kg 65 76

Pulse Quality 2 1 kg 60 58

Fresh Milk 1 liter 60 70

Ghee 1 kg 160 178 Sugar 1 kg 54 58

Milk Pack 27 pkt 770 790

1647 1748


Discussion RI’s past experience of working with IDPs during the Swat and Bajaur military operations and views shared by the respondents would suggest that the destruction of infrastructure and assets will make it unlikely that the IDPs will return soon after cessation of fighting. Prolonged displacement may well eventually require repatriation packages of assets and livelihood inputs to facilitate return after hostilities subside.

SOURCE OF INCOME IN NORTH WAZIRISTAN In the area they were displaced from, 64% of the IDP respondents used to work as daily wage laborers. 29% were dependent on other sources of income, including foreign remittances, support from family in country, and public and private sector employment. 4% of the IDPs are involved in agricultural crop production in North Waziristan. In the new communities where they have been displaced there are no such opportunities for employment, and IDPs are dependent on support from the Government of Pakistan and NGOs to meet their basic daily needs. The only assets the IDPs were able to bring were livestock, numbering, for those that brought them, between eight and ten animals per family, confirmed as part of the survey. These animals represent their only viable asset, and as such their health and wellbeing is integral to that of the families that are dependent on them. The Government of Pakistan (GoP) announced that it would provide a compensation package of PKR 5,000 for transport, and a family support package of 7,000 PKR to registered IDPs (120,000 PKR in total). This will be distributed via recharge cards, as most of the IDPs do not have bank accounts. The concentration of skilled labor is very low among the IDP’s, however the 3% of skilled

workers might be able to access employment opportunities in the host districts. Many of those IDPs that are from North Waziristan, but who had left to pursue employment opportunities in the cities have returned to protect their families, creating even higher rates of joblessness.

Figure 2: Income sources before displacement in North Waziristan

Discussion 64% of the IDP population was dependent on daily wage labor in North Waziristan and have had no access to the government led schemes such as Benazir Income Support Program (BISP) or Pakistan Bait-ul- Maal. The IDPs in DI Khan, are not employed. Women are only able to access a very small percentage of the income in a family. Although women cover 75% of the duties related to livestock management, they are not able to capitalize on this main asset, and do not control the utilization of income from livestock (milk & milk products, fattening & selling etc.). Since the IDP population does not have any current access to income generation activities, livestock can play a vital role in this regard.


SHELTER AND HOUSING The IDP interviewees are not currently living in tents, but reside in mud houses in the host community, either renting or with friends/relatives. These structures provide little protection with the approaching monsoon. Less than one quarter is residing with hosts in structures made of cement or brick. 34% of the IDPs are living in rented accommodation. More than 30 (15%) of the families interviewed are living with their relatives and friends in the area. 1% of the IDPs already had homes in Dera Ismail Khan. As highlighted in the priority needs section, many of the IDPs left their houses without the opportunity to gather basic necessities, aware of the impending airstrikes. The Non-Food Items (NFI) they are lacking, cover but are not limited to; water containers, kitchen utensils, bedding and clothes. As part of the assessment it was reported that IDPs that brought livestock brought on average 8-10 animals per household. Issues with the livestock can be summarized as:

• The IDPs brought lactating, pregnant animals with them, which has placed pressure on available resources for animal feed (fodder) resulting in the price being driven up by 15-20 %.

• Each community group has nominated a person to bring the animals that were left behind. With the arrival of these animals, further pressure will be placed on IDPs to find shelter and feed.

• There is chance that opportunists may exploit the situation, especially in Bannu, by capitalizing further on the increase in fodder, and by buying animals for below market price from desperate IDPs.

• In the rush to leave, animals were misplaced, representing a serious economic loss.

Figure 3 Type of shelters in DI khan

26% of houses are made of mud compared to 23% which are made using bricks and cements. 15% of people are living either with friend or relatives Discussion The IDPs as a whole highlighted that heat and purdah (the practice of women being separated from men) and the approaching monsoon have meant IDPs preferred to stay with host families, relatives or have chosen to share the high rent prices with other families - rather than living in tents. Tents are not seen as commensurate with the practice of purdah. Furthermore, there have been threats from militants against camps in Bakkakhel in the Frontier region of Bannu and further demonstrated by 10 rocket attacks on Mir Ali IDP camp on July 2, 2014. As such, the relatively cramped condition in shared housing has increased the risk of disease and stress on the sanitation systems.


ACCESSIBILITY OF HEALTH FACILITIES The assessment teams visited local health facilities, and from questions asked during the FGDs and the interviews, were able to build a picture of access to healthcare facilities for the IDP population. 11% of IDPs reside more than 15 kilometers from the nearest health facility, 16 % live five kilometers away, and the remaining 73% are within 5 kilometer radius of a health institution.

Figure 4 Accessible Health Facilities to IDPs

Discussion The displaced people face an increased risk of communicable diseases due to overcrowding in their hosted and communal rented settings, and pressures placed on overburdened sanitation facilities. Furthermore, as many families brought their livestock with them, the movement of unvaccinated livestock increases the risk of exposure to zoonotic diseases, both for the human and animals of IDP and host communities, and is compounded by a lack of adequate hygiene facilities. Three Crimean-Congo Hemorrhagic Fever cases have been reported in Karak and Bannu. During Relief International’s field assessment the team observed cases of Leishmaniasis and Scabies amongst the IDPs, and these diseases have also been reported by the World Health Organization and shared with the

health cluster. The IDPs are at risk of; malaria, eye infections, cholera, acute diarrhea.

It was observed by the RI team that the health facilities in the host communities lack basic equipment and medicine, and therefore serious cases are referred to the district hospital in Dera Ismail Khan, 25 kilometers away from their where they are currently residing. The following major health facilities can be found in the area. Health Facilities

• District Head Quarter Hospital 01

• Tehsil head Quarter Hospital 03

• Civil Hospital 04

• Basic Health Units 39

• Health Dispensaries 32

• Mother & Child Health Services 05

• Community Health Services 01

Veterinary Facilities

• Civil Veterinary Hospital 10

• Veterinary Dispensaries 29

• Veterinary Centers 15

• Artificial Insemination Center 15


EDUCATION FACILITIES Only 2% of the displaced populations have had access to school and education facilities. Discussion 42% of the IDPs are children, who have been taken out of school as a result of the conflict. Aside from the major issues of food and shelter, the length of time these children may have to go without schooling is a major concern for the IDP population. Currently all government schools are closed due to summer vacation in DI Khan District and they do not have any opportunity for their children to continue their education. Educational Level of Key Informants The majority of IDP families are headed by person who has never been to a school. Only 20% of IDPs attended primary school and 3% of heads of family attended college.

Figure 5: Education attainment level

Discussion The majority of IDP families are headed by a family member who has never been to school, meaning that they will find it hard to capitalize on the job opportunities more common in urban areas. Access to Water 14% of the displaced people do not have access to steady water supply. The remaining populations of IDPs have access to water sources either through wells or community water supply. The

IDPs are utilizing the host community’s resource which includes hand pumps, irrigational tube wells, and public health department’s water piping system. Water is available in DI khan but it is highly saline, and not palatable for consumption for the IDPs. There are basic sewage sanitation systems. The Male adults and children are resorting to defecting in open areas. Women are defecating inside the houses using traditional but not safe latrine. There is an average of 10-15 women or girls per latrine. Soap is not available.

Figure 6: main water supply sources

Discussion The IDPs are sharing water resources of the host communities. These include stagnant water ponds, water from irrigation channels and hand pumps where the water table is easily accessible. The majority of the displaced have continuous water supply, but the assessment team observed and confirmed from the health department that the water quality is not potable and therefore there is a high risk of exposure to waterborne diseases. Most host communities get their water from river Indus filtration plant or the municipal water point in the district city center. The common practice is for vendors to collect the water for the individual households who can afford this service.


GAPS IN PREVIOUS ASSUMPTIONS

• There are concerns regarding the family size, which appear to be significantly higher than the standard six used by OCHA estimates. In reality, as observed by our team and reported by FATA Disaster Management Authority /Provincial Disaster Management Authority, it would be considered 13.5 for North Waziristan IDPs.

• IDPs are reluctant to share the identity of their family members due to the fact that the district government has made announcements in the mosques and public notifications were made that no rental facility will be provided to IDPs without District Police Officer (DPO) approval. The approval process is extremely lengthy.

• Gap in information sharing with newly displaced persons is leading to confusion amongst IDPs on assistance being provided, mechanisms adopted and redress mechanisms.

• The cultural constraints and discouragement of males to approach women to interview requires female field monitors to adequately assess the needs of the female population.

IDENTIFIED NEEDS

• Members of the focus group discussion revealed that a large percentage of displaced population comprises of women and children (this is supported by the UNOCHA, which puts the number at 74% 7 ), hence reproductive health and child health care must be addressed.

• The enumerators of this assessment were told that much of the population was

7 OCHA Pakistan_NWA Displacements_Situation Report No. 3_ah 06/27/06

suffering from gastrointestinal infection, and scabies was observed in the children.

• The heads of household interviewed claimed that Safe Delivery Kits and in-depth assessment and intervention is required in Mother Neonatal Children Health (MNCH).

• Vaccination of children against polio for families that were not vaccinated at the exit points of Waziristan.

• Larger families with an average family size of 13 are residing in small houses; these cramped conditions result in unhygienic environment for food preparation and contaminated drinking water, resulting in conditions conducive to the spread of disease.

• Access to the districts where the displaced are currently residing is limited to those organizations who have received a No Objection Certificate granted by the Government of Pakistan.

• The complex nature of the emergency and the highly unpredictable environment has placed the IDPs under enormous stress, and the focus group discussions shows signs of potential psychological trauma among the population.

• Although the IDP population currently has access to water, the quality of this water is compromised according to sphere standards, as observed by the team and confirmed by the health department.

• Livestock is the main source of livelihood for many IDPs, support and protection of their livestock is one of the major challenges for the IDPs, who are also vulnerable to exposure and transfer risk of zoonotic disease. As corroborated by UNOCHA, neither the UN nor provisional level agencies have enough resources to provide vaccination for the prevention of diseases. At this time the Livestock and Dairy Department is administering vaccination for foot and mouth(FMD) and pleuropneumonia only. Further, there are no organizations that are providing


feed and water to ensure these livestock survive the harsh summer conditions and monsoon. As the Director of the Livestock Department has indicated, the following livestock support is urgently needed. - Vaccination of livestock; cattle, sheep

and goats against seasonal diseases like Hemorrhagic Septicemia, Black Quarter and Enterotoxaemia.

- Parasite control particularly ticks control to prevent incidence of Crimean Congo Hemorrhagic fever, a serious risk for the human population.

- Animal feed, which is one of the top priority areas.

- Animal shelter to minimize exposure and segregate livestock from human population to reduce disease transfer.

RAPID ASSESMENT North Waziristan Internally Displaced · 2020-04-30 · Lakki Marwat, Karak, Dera...

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