Pakistan: dealing with armed violence and two natural disasters in three years

The outgoing head of the ICRC delegation in Pakistan, Pascal Cuttat, talks about coping simultaneously with the consequences of armed violence, natural disaster and a changing security environment in the country over the last three years.

Pascal Cuttat has just finished a three-year stint as head of the ICRC delegation in Pakistan. Just after his posting started in 2008, the ICRC launched a major operation in response to the earthquake in Balochistan. Then, in 2009, over two million people fled their homes because of fighting in the north. Today, thousands of people still suffer the consequences of last year's floods, while armed violence continues in various parts of the country. According to Cuttat, the major challenge is the same in all these situations: you can't help if you don't have access.

After three years as head of delegation, what major changes have you seen in Pakistan?

For much of the last decade, ICRC staff in Pakistan played a supporting role to our larger operation in Afghanistan. That all changed with the Malakand military operation in 2009. The enormous humanitarian consequences of that fighting, and of the operations that followed, transformed the humanitarian landscape in Pakistan. The ICRC was faced with a major man-made humanitarian crisis, with huge damage to social infrastructure and two million displaced persons. We had to step up our operations to help fighting-affected communities in the north-west, the need for medical care and physical rehabilitation sky-rocketed, and the number of expatriates and national staff grew in response to the situation.

Successive military operations in the Federally Administered Tribal Areas, multiple natural disasters – the Balochistan earthquake and the 2010 monsoon floods – and the general spill-over of violence to major cities led to increased humanitarian needs. By 2010, ICRC activities in Pakistan were anything but a support operation. The operating environment in Pakistan became more complex and security less predictable than in many other countries.

By the nature of your work, security is always an issue. Is it more difficult in Pakistan than in other places where you have worked?

Pakistan enjoys a complex mixture of ethnicity, religion and culture. This brings strength and diversity to Pakistani society, but it also creates some potential fault-lines. In the last three years, there has been an increasing tendency for the ethnic, political and religious divisions in Pakistan to be expressed violently. This violence both creates victims who require help and poses challenges to those who are trying to offer that help. The fighting in the north-west has spilled over to other areas of the country. At the same time there's the insurgency in Balochistan, political and sectarian violence elsewhere and, sometimes, high levels of crime. Together, these factors mean that Pakistan can be less predictable than other places. In dangerous but predictable environments you can take steps to avoid or mitigate risks. In highly insecure and unpredictable environments you simply have to react to the situation.

Anti-western suspicion in Pakistan has increased during 2011, and concerns about sovereignty have affected security. The ICRC's main focus is on communities affected by fighting, which puts us in precisely those areas where danger is greatest and suspicions at their highest. You can't help victims if you become a victim yourself, so we take the appropriate measures to ensure our own security. We make enormous efforts to balance the needs of victims with the safety of our staff; as a victim-focused organization we are always reluctant to see people in need left unassisted.

In the last three years we have seen a major escalation in fighting in the FATA, plus two major natural disasters. What were the major strengths and challenges in relation to these humanitarian crises?

Our strong partnership with the Pakistan Red Crescent Society is a major factor in our being able to reach the victims of both fighting and natural disaster. The wide reach of the PRCS branches helps us to assess needs and to start relief work quickly. The skills, dedication and hard work of our national and expatriate staff in Pakistan enabled us to manage the crises of 2010 with very few additional personnel. Although the costs of our operation in Pakistan rose rapidly in 2010, to about $130 million, we were able to maintain our existing, very low overheads. Finally, the response of our donors was both a measure of their commitment to Pakistan and a vote of confidence regarding the way the ICRC operates.

The ICRC focuses primarily on fighting-affected communities, but the scale of recent natural disasters in Pakistan, especially the devastation caused by the 2010 monsoon floods, means that everyone has to help. We maintained our support to more than 200,000 people displaced by fighting throughout 2010, while working with the PRCS to help over two million flood victims. We conducted months of relief operations in every province in Pakistan except the northern areas, and then shifted to helping people resume farming in Khyber Pakhtunkhwa, Balochistan and Sindh. Now, almost 12 months on, many of the subsistence farmers we helped have already harvested their first crop, and have a head start on getting back to normal life.

The major challenge is the same whether we're trying to help people affected by fighting or those suffering the effects of natural disaster: you can't help if you don't have access. We believe that the transparency with which we work, our strict adherence to the principles of neutrality, impartiality and independence, and our solely humanitarian focus means that we are sufficiently well-known to work in most areas, even those where security is questionable for other organizations. Simply put, the greatest challenge is being allowed to get on with our job of helping victims.

What are your regrets?

I'm sad to see that the standard of living in Pakistan is falling. Insecurity, economic factors and the combined effects of the fighting in the north-west and the Baloch insurgency are making life hard for increasing numbers of Pakistanis, and this is creating increasing humanitarian needs. At the same time, access to many victims of the fighting is now more difficult and there are some people whom we cannot reach at all. Our aid activities have been well enough regarded in Pakistan, but we have had little acknowledgment that the ICRC can help find solutions to other problems affecting the country, such as those arising in the areas of arrest and detention. We are convinced that we can help with some critically important long-term issues, and we hope to generate goodwill and agreement from the authorities about the positive role that we could play.

What were the highlights?

The medical care we provide is certainly one major highlight. Since opening in February 2009, our surgical hospital in Peshawar has treated more than 3,000 patients, many of whom had life-threatening injuries. We also treat over 2,500 weapon-wounded patients in Quetta clinics each year. In the last 12 months alone we have helped almost 12,000 people with disabilities to start the process of recovery, and we have provided material support to many PRCS health units and a large number of district hospitals in more remote locations.

The speed with which we and the PRCS reacted to the floods was another highlight, albeit in a very sad chapter of Pakistan's history. Together, we reacted quickly and effectively and made a very substantial contribution to relief and recovery, while still meeting our existing commitments to people affected by the fighting.

Perhaps the best thing was simply that we kept doing what we have been doing here for the last 60 years: through three major wars and in every situation of violence or natural disaster, we identified people in desperate need of help and we helped them. Throughout this time, we maintained our integrity by working in accordance with humanitarian principles, and we were recognized for having the courage to do so. Furthermore, in meeting the expanding humanitarian needs in Pakistan we attracted a large number of highly dedicated and talented national and expatriate staff to the ICRC team.