Two years after the devastating earthquake in Northern Pakistan, life has not yet returned to normal. The health care facilities that were destroyed have to be rebuilt to provide basic medical services.

Taj Gohar Awan worked for many years as Medical Officer in the Jabba Health Centre in North-West Frontier Province (NWFP). Every day, he and his team treated about 30 patients. Although this walk-in unit provided “only” basic medical services, the centre was an important link in the regional health-care chain. There was – and still is – no alternative to this facility which undertakes exploratory examinations, treats injuries or dispenses essential medication. If patients had to be admitted to the district hospital for instance, they were first stabilized for the journey in Jabba.

Suddenly, everything was more difficult
“Immediately after the earthquake on 8 October 2005 was a very difficult time”, Awan recalls. “The buildings were totally destroyed and the medical equipment damaged, and suddenly we had to treat nearly 100 patients a day.” Foreign aid provided tents, support for local staff and urgently needed bandages and medicines, making it possible to continue functioning despite the difficult conditions. The range of services was restricted because there was no electricity or water, with the result that medical instruments could not be sterilized. What is more, locals were sceptical of health care that was provided in tents. The approach of winter created further working-condition problems. Although the tents themselves could be heated, patients had to wait outside, at the mercy of the elements.

Short planning phase
Initial investigation by Switzerland’s Humanitarian Aid (HA) revealed extensive requirements. Once reconstruction on the previous site had been authorized by the Pakistan Ministry of Health and the Earthquake Reconstruction and Rehabilitation Authority (ERRA), planning work immediately went ahead. As Ali Yad Khan, HA’s engineer on the spot in Mansehra explains: “Involving Peshawar University of Engineering and Technology meant the health centre concept could be developed quickly. And account was taken of local requirements (such as separation of women and men) and of international earthquake-resistant building standards from the word ‘go’.” This close cooperation also meant that legal requirements were complied with from the very outset, so an authorized building project was available after just three months of planning.

Built to a modular earthquake-resistant design: the Jabba Health Centre

No more improvised medical care
At the inauguration celebrations, relief was written all over the face of Taj Gohar Awan, Jabba’s Medical Officer. “Now we have proper patient examination facilities, waiting rooms as well as sterilization and storage areas again. And electricity, running hot and cold water and fans mean we can meet the necessary hygiene requirements,” he explained enthusiastically. The reconstruction programme watchword was “Build back better”, and Awan also expects patient numbers to quickly exceed pre-earthquake levels due to the improved infrastructure.