LONDON (AlertNet) - Millions of Pakistanis still need humanitarian assistance due to three consecutive years of monsoon flooding, persistent insecurity and government restrictions on aid workers, which are worsening poverty and hunger across the country.
Those who require help include flood-hit farmers in southern Sindh province who could not plant their wheat crop last November due to standing water and a lack of seeds, and families who have been living in camps in the northwest for three or four years after fleeing clashes between the army and Islamist militants.
More broadly, the latest data shows that nearly 60 percent of the population of around 190 million are food insecure, meaning they do not eat enough nutritious food each day to lead a healthy, active life, according to the U.N. World Food Programme (WFP).
"I consider that...the humanitarian situation, especially for the poorest of the poor, is still very bad, if not to say alarming," said Jean-Luc Siblot, WFP's country director for Pakistan. "The repetitive floods and the insecurity in KP (Khyber Pakhtunkhwa), FATA (Federally Administered Tribal Areas) and Baluchistan are definitely factors which are aggravating an already bad situation."
Some 4.8 million people were affected by flooding last year - many for the third year in a row. There are 758,000 people uprooted by fighting in KP and FATA, more than half of them children, who have not been able to return home. Of the 1.3 million who have gone back to FATA since 2010, many still need help. On top of this, Pakistan hosts nearly 1.7 million refugees from the conflict in Afghanistan, spread across the country.
International aid agencies say meeting the needs of these communities will be a major challenge this year, as attacks on health workers and other staff have intensified, and the government has tightened restrictions on visas and travel, especially in areas affected by conflict.
At least 27 aid workers were killed, seven kidnapped and 22 injured in 62 reported incidents in 2012, according to the United Nations Department of Safety and Security. That includes 14 attacks on health workers carrying out polio vaccinations - who have been targeted by extremist groups - resulting in 11 deaths.
"The United Nations is very concerned about these recent attacks on aid workers, and we're looking to work with the government on how to ensure that aid workers can carry out their assistance in a secure environment," said Lynn Hastings, head of the U.N. Office for the Coordination of Humanitarian Affairs (OCHA) in Pakistan.
One key problem is that Islamabad does not seem to be making much effort to help either international or local humanitarian agencies do their job. An OCHA bulletin issued in December said that delays in obtaining and extending visas contributed to a drop in the number of international aid staff from 222 in January 2012 to 162 by September.
Those who remain find it increasingly difficult to move around and reach people in need. The Brussels-based International Crisis Group noted in a report this month that, after the May 2011 U.S. raid that killed Osama bin Laden in the city of Abbottabad, the provincial government tightened restrictions on the movement of foreigners in KP, and these have been limited further in areas like Swat where the army launched operations to oust Islamist extremists in 2009.
The conflict displaced around 2.3 million residents, but though most have returned, the tourism industry - once the linchpin of the local economy - is in tatters, and "pressing humanitarian needs remain unmet" due to "continued instability and short-sighted military-dictated policies and methods", the ICG report says.
"When you are left with no source of livelihood, that is a humanitarian crisis," said Samina Ahmed, ICG's project director for South Asia. "How do you survive unless you have that provision of basic services?"
Aid agencies have been unable to fill the gaps in services which the state is not delivering, such as health and education, because of the difficulties they face in working in these areas, she added. Cash transfers could help get around the need for a presence on the ground, but international donors are wary of this approach and concerned about how aid will be delivered, she said.
"On the one hand, you have donor fatigue in general with regard to Pakistan, and it's not helpful that you have the state, instead of opening up space for international NGOs, restricting it," she told AlertNet from Islamabad.
FUNDING 'VICIOUS CYCLE'
The international community gave $290 million for humanitarian operations in Pakistan last year, but covered only 18 percent of an appeal for $440 million to help people recover from flooding.
Hastings said the aid community there is caught in a "vicious cycle", where contributions run out every few months and donor interest has to be regenerated to keep activities going.
U.N. agencies and international aid groups are asking donor governments for around $190 million for humanitarian operations in Pakistan in the first half of 2013 - $120 million up to the end of March to help people recover from the monsoon floods and $71 million to provide essential supplies and services for displaced people in the northwest over the next six months.
The European Commission said on Jan. 10 it would provide €42 million in humanitarian aid for Pakistan in 2013. It has added the emergency caused by conflict and internal displacement in the country to its list of "forgotten crises".
In addition, the WFP has asked the Pakistani government for 150,000 tonnes of wheat, which would allow it to provide a full ration of nutrient-enriched wheat flour to 1 million displaced people during 2013. This has yet to be granted, forcing the agency to cut rations by half from January until March.
"We want the government of Pakistan to participate in feeding their own people - they have the wheat there," the WFP's Siblot said, adding that the authorities have millions of tonnes of reserves and provided 73,000 tonnes of the staple food last year.
Last week, the U.N. children's fund (UNICEF) said that funding constraints had forced it to stop supporting maternal and child health services in camps in the northwest at the end of 2012, to scale back vital child protection services and close five nutrition centres for displaced families living in host communities.
Recent donations have enabled it to carry on providing drinking water and sanitation in camps. But it warned that new displacement is expected from the South Waziristan area in the coming weeks.
OCHA's Hastings described conditions at Jalozai camp, which shelters around 65,000 displaced people in KP, as "very, very basic". "It is an extremely meagre existence," she said.
The Pakistani newspaper The News reported that residents banned aid workers from entering Jalozai on Friday, protesting that they were not receiving enough food.
Meanwhile, although Pakistan is disaster-free at present, the millions of its people who are still struggling to cope with the results of previous crises remain vulnerable to future ones, Hastings warned.
"I think the general assessment is that there will be repeated flooding, if not this year then in the near future, as a result of climate change and new monsoon patterns," she said.
To reduce the need for emergency relief in coming years, priority should be given to improving Pakistan's water management infrastructure, such as drainage, dams and embankments.
"There needs to be coordination of that whole effort within the government of Pakistan and with the international community to ensure that... when there are heavy monsoon (rains) next year or the year after, there's proper infrastructure in place... so there isn't any flooding," Hastings said.