November 2010, Volume 60, Issue 11

Letter to the Editor

Pakistan — a state with a complex humanitarian emergency?

Madam, the recent bouts of loadshedding saw thousands of Pakistanis on the streets. This electricity crisis has preceded shortage of other essentials like wheat, sugar, water and fuel. The riots which were well captured by the media, showed  powerful and chilling images of the masses clashing with the  police on the streets of industrial cities. Are these energy conflicts the herald of an emerging public health disruption?
United Nations defines a complex emergency as   a humanitarian crisis in a country, region, or society where there is total or considerable breakdown of authority resulting from internal or external conflict s.1 The characteristics of a complex emergency include administrative, economic, and political social decay and collapse which has high levels of violence and increased migration or internally displaced persons .They also include catastrophic public health emergencies which put vulnerable population at greatest risk and which need external aid.2
In Pakistan, this decade has seen internal strife with soaring levels of violence and violations of Geneva conventions. This has led to exodus of internally displaced people from Swat and Baluchistan .In some parts of the country call for external aid has already been given.3 There is an ongoing marginalization of minorities as evident by targeted sectarian killings where certain religious groups are being threatened to the point of extinction. Only in the year 2009, more than fifty Mass Casualty Incidents secondary to terrorism have been reported.4
The electricity crisis has not only uncovered the gaps of resource allocation but also a suspicion of ethnic and provincial favouritism which may lead to increased competition between groups for resources. We have had warnings of epidemics in the last few years when Dengue Fever has hit the country and resulted in a severe overburdening of resources in urban areas of the country. In short Pakistan is fulfilling all the criteria of a complex humanitarian emergency on the present date.
As Health care professionals  we cannot certainly sort out the good governance issues of our country but  we can perhaps, do the following: Recognize the fact that we are at risk of an impending public health disaster and strengthen our present existing public health infrastructures which will include emphasis on basic amenities of life and provision of basic healthcare. What is also the need of the time is initiation of basic surveillance projects to at least identify our baseline demographic data and indicators.

Hunniya Waseem
Rescue 1122, Punjab Emergency Service, Pakistan.


1.Burkle FM. Complex humanitarian emergencies: a review of epidemiological and response models. J Postgrad Med 2006; 52: 110-5.
2.Burkle FM. Lessons learnt and future expectations of complex emergencies. BMJ 1999; 319: 422-6.
3.Zarocostas J. Red Cross calls for urgent medical help in face of growing civilian casualties from Pakistan conflict. BMJ 2009; 339: b4430.
4.South Asian Terrorism Portal. (Online) (Cited 2010 May 18). Available from URL:

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