Pakistan: Unofficial healthcare discrimination against Bengalis

KARACHI, 7 April 2010 (IRIN) - All housemaid Shehr Bano needed to survive the late stages of Hepatitis B was good palliative care. But despite having an official Pakistani national identity card (NIC), her Bengali origin and meagre income meant she could not get treatment and she died in August 2009.

Her husband and children are all Hepatitis positive but have no means of getting treatment and continue doing their day-to-day odd jobs.

Accounts of Bengali Pakistanis being turned away from public hospitals and clinics are common. It is not officially condoned by any means, but rather an underlying prejudice against this ethnic group by some health workers, experts say.

"A lot of it has to do with the mindset of people in power and that is what trickles down," Muhammad Kamran, a community worker in Karachi, said.

"After 1971, when Bangladesh was created, a lot of Bengalis left [Pakistan] for the new country [Bangladesh] but came back again in the 80s due to better opportunities, and many of them managed to get the Pakistani NICs."

Rights groups say there are around three million Bengalis in Pakistan (a small, but significant proportion of Pakistan's estimated 172 million population) most of whom live in Karachi, and they are the poorest segment of Pakistani society. Some are hindered by their status as aliens in the country, but many others who hold official documentation still face marginalization when it comes to public services.

"The same NIC and CNIC [computerized national identity cards] are used when the elections are held and no one questions if a Bengali speaking person is a Pakistani or not then. However, when it comes to treating the Bengalis as Pakistani citizens, there are always hurdles," Kamran said.

Language and identity

Asma, who prefers to give just her first name, is another poor Bengali who was denied treatment at the Civil Hospital Karachi (CHK), the same place Bano was turned away from. Asma was diagnosed with Hepatitis C positive in a public health clinic in her Karachi neighbourhood of Khuda Ki Basti and referred to CHK in mid-2009 under the province's Hepatitis Prevention and Control Program (HPCP).

"They wanted to see a computerized NIC. I don't have a CNIC because I have been refused by theNational Database and Registration Authority (NADRA) personnel time after time. They keep on telling us to prove our citizenship. I was born here and do have a NIC; what more proof do I need give them?" she asked.

"One of the doctors was kind enough to tell me that I should get a certificate from the area councillor that I am Pakistani. However, the councillor demanded an amount of money that I couldn't give. So no CNIC, no treatment!"

Kamran noted that much of the discrimination levelled against Bengalis is because of their accent or inability to communicate effectively with the rest of the population.

"As compared to Afghans, who speak Pushto and are often taken as Pakistanis, Bengali speakers are easy to spot," he said. "Also, most Bengali women are unable to comprehend what the doctors or officials are telling them. It would be helpful if there is a Bengali translator deputed at public health care facilities as well as other government offices in order to make it easy for them to understand."

Discrimination denied

Abdul Majeed Chutto, programme manager for HPCP in Sindh Province, told IRIN the programme treats each and every citizen as equal, and there is no bias on the basis of language or ethnicity.

"All Pakistanis are eligible for treatment under the hepatitis control programme. As far as the question of being a 'valid' citizen is concerned, we do ask the patients to provide a copy of their NIC or CNIC so as to ascertain which area they reside in and then we refer them to a public facility there," he said.

"However, at the end of the day, it's our aim to treat the maximum number of people and I stand by my word when I say we do so without any discrimination."

Jamal (not his real name), who works at the Lyari General Hospital in Karachi, confirmed there was no official policy of discrimination against Bengalis but that it happened frequently nonetheless.

"We have a lot of Bengalis coming here for treatment. However, they are often sidelined by the doctors and even insulted by the locals. It's just something that has been ingrained into our minds that these people are traitors and our enemies. I have seen a Bengali man die as the doctor was busy attending a personal phone call. All the doctor had to say was 'this is God's will'. Being poor and being a Bengali doesn't do anyone any favours."

sj/ed/cb