Au Revoir Pakistan

I have decided to come home early, for many reasons. The thought of one year without freedom and only explosions for comfort weighs heavily in my mind, the mission is lacking in strategy and we are generally risking too much for too little impact. I am sorry to go, but am thrilled at the thought of home. What luxury to be able to walk freely and to roam around on my own without having to tell anyone where I'm going.

Pakistan is a culturally rich country, with a generous population and I would be delighted to return as a tourist if ever there is peace here.

Credit for these beautiful photos of the women with their children goes to Cecile, my party partner and good friend who is still in Islamabad, may God take care of her out there.

The Punjabis Versus The Pashtuns

Conflict everywhere. Fighting amongst the different breeds of Taliban, fighting all country neighbours, fighting between states. We received some complaints today regarding favouritism within the team. We try to work on our team composition, so that all tribes and ethnicities are recruited in equal portions. But the Punjabis complained today that our Logistics Supervisor was giving preferential treatment to his fellow Pashtuns; better shifts, more overtime, first pick for holidays. Looking at the rosters, their claims appear founded at first glance. I wonder, where will the next bout of conflict arise?!

Good But Suspicious News

We have been granted access for foreigners to go back into one of our remote-controlled projects, albeit only temporarily. But we cannot fathom why there has been a change of heart.

During one of our meetings with the local authorities, we were told that their communication means were tapped, and thus we could no longer continue to telephone them. Perhaps this is why they have chosen to work side by side with us for the time being, as messages cannot be passed on.

We also know of a jihadist training camp very close to the site of one of our hospitals, could it be that this is no longer a threat to us?

Some of the elders have fought with the entire community for our continued presence after seeing the quality of our work. It is crucial now that we ensure headquarters are behind us so that we can stay put and invest in the area. If we were to pull out now there would such a loss of face for those who have risked their lives to support us. We will return to our hospital and hope that this move may be permanent.

Close To Home

Another suicide bomb in Islamabad today, this one the closest yet at about 100m from the house. Way too close for comfort. I was standing outside when it went off; a deafening noise that was heard for several miles, we couldn't tell which direction it had come from, only that the birds had fled.

Wanting to be home right now, but at least I know that the end is nigh, only one more trip to Peshawar left.

The Sacrificial Slaughter

The traditional way to celebrate Eid al-Adha is to slaughter an animal allowing it to bleed to death with the head facing Mecca. I visited a family to witness the experience for myself, blood and guts a-go-go.

Good friend Esphandyer and I with the decorated cow. Little does she know...

The streets are awash with blood pouring from the gates of every house
Skinning before going into the cooking pot

You cannot find fresher meat than that! It is customary to offer the meat to family, friends and the poor, our freezer is now stocked up with enough proteins to make it through winter.

Life And Soul Of The Party

I went to a fancy dress party recently and guess who I saw strutting his stuff on the dancefloor?!?

Another Eid Mubarak!

Eid al-Adha is here. The Muslim version of Christmas, this is the biggest festival of the year in Pakistan. It is a family time focused on the offering of a animal to mark the sacrifice Ibrahim made of his son to God to show the power of his love.

Travelling back from NWFP today it was fascinating to watch the makeshift goat and cattle markets forming on the side of the road. Everyone was walking home with his goat, or a bull for the richer families. Some of the beasts were decorated, painted in neon colours and wearing garlands and tinsel, to signify a choice piece of meat. Strange marketing, but all the fuss and commotion made me want to buy one too.

Helpful Or Harmful?

I have always had a humanitarian conscience. I am by no means a saint, but in my school days I would organise fundraising events by getting the college bands to play in the name of a good cause, or I would cause controversy by handing out AIDS awareness leaflets in a Catholic school. After several independent missions I wanted to take a more permanent role in an organisation with some structure and clout in the aid arena. It was only natural that I veered towards MSF, an inspirational organisation known for being the best in the world at what it does, emergency medical care.

My scepticism has grown. I now worry at what damage an organisation with such power can do. Pakistan is an atypical context for MSF whose talents lie in rural Africa where there are limited medical facilities and qualified staff. Pakistan is not short on either. However we are active here with many consequences. Inflation caused by the presence of NGOs is not unheard of. Rent prices escalate as Western aid agencies infiltrate the towns, and pharmacies can often be put out of business as we import all of our drugs from Europe to follow pharmaceutical protocols that could be upheld locally. Japanese 4x4s cruise the town in between the rickshaws while doctors are poached from their jobs in the public sector. I acknowledge that not all we do is bad, but we should be aware of the impact we can have on a place. I cannot help reverting back to my capitalistic ethos that "trade equals aid".

Another worry I have is the real motive for us being here. Afghanistan is presently the jewel in the crown of NGOs, especially those of a mindset like MSF who wish to be the first actor in place in any emergency. Some team members have hinted that our proximity to the Afghani borders could be the reason for our presence in Pakistan. We are one of only two organisations acting neutrally, and this fact is hindering our progress in the country. Refusing to adhere to government enforced security rules has meant that we cannot provide care to many IDPs who are without basic needs. It would be wrong to compromise our charter of neutrality, but it is tough to sit back watch the disadvantaged and needy go without help. Aside from the war zones in Warziristan and other parts of FATA, where we are unable to assist, Pakistan cannot be considered to be in a true state of emergency. A huge network of hospitals exist for treating blast victims, even if their quality could be questioned. During our meetings we have many a discussion on the type of interventions we should follow, and more often than not the real needs are overlooked as they aren't glamourous enough to attract media attention and consequently donors. I fear that we are not here for the right reasons, and in that case weighing up our positive impact could mean that we are not right in being here. At what price do our interventions come at? Some international actors can certainly be suspected of being here purely for the reason of publicity because Pakistan is a hot spot right now. The public perception of NGOs here in Pakistan is one of suspicion, many locals say that we are not welcome as we have an ulterior motive, thus we do more harm than good. Perhaps there is some substance to this claim. My point of view is that one cannot do everything. But what one does should be done correctly.

Peshawar Evacuated

Enough is enough. Finally the decision has been taken to evacuate all non-essential presence of foreigners from Peshawar. About time!

We had too many instances of almost being in the wrong place at the wrong time, and the team is visibly scared. Our activities have been suspended until after Eid, hopefully the town will become more peaceful after the celebrations.

Abduction

We have learned the terrible news that one of our staff has been kidnapped in the Tribal Areas. One cannot yet be sure as to whether it is related to his work with us, but for now there has been little talk of ransom and we are not so implicated. Apparently he could be kept hostage for quite some time...

Autumn In Murree

After almost three months here, I have been accorded a break. A long weekend in the mountains, in a high-altitude hill station, not too far from Islamabad. There isn't much to do there, but I have been horse riding in the woods and eating locals food in restaurants, what a novelty! The climate is chilly and all the leaves are shaded red and brown.
What freedom to walk freely in the streets, bargain with the shopkeepers and say hello to strangers on the street. It has unearthed my love of travel and made me want to see more of this country as a tourist. Next stop, Karokam Highway?!

Hate Mail

We receive many letters from the Taliban, some nicer than others. It is with much hesitation that I have decided to publish a sample, complete with spelling mistakes, it turned out that this one, found on the door of the mosque, was actually a hoax.

Public Notice from Taliban

Our addressees are those people who have cinema, non-modest films, vulgarity, music parties in the market, specially all the English doctors, nurses and all the people who are with English’ by taking huge salaries and have forgot their duties, who have widen the attempts to defame Islam. This is our challenge to all those people who have started to work with these English’ and all those people who are working with English’ in a large quantity. We (Taliban) came to know through an informer that in the market of (censored), some of the Muslims who are just the Muslims of name, have started some activities like non-modest activities, fucking, thefts, dacoit and in who shows themselves in fasting days as Muslims. We (Taliban) tell by addressing all these peoples and the English’ of civil hospital and the people who are working with them, who deals in these non-modest activities, films’ business, music, dish, television and by transferring sexual activities through computers and the things mentioned above, and the English’ in civil hospital that if they don’t evacuate within three days so civil hospital can be blown up by bomb at any time. We (Taliban) who belong from Jaish-ul-Ansar, have seen all these activities as disguisers. If English’ are not displaced or dish, cable, television, vcr, computers, non-modest activities, thefts, dacoits and vulgarity are not stopped or these things are not acted upon so whatever will be after three days that will be in front of your eyes. Pay an important role to spread this information in the common people. Because we want Islamic Sharia in (censored), if above mentioned things are not acted upon so the Taliban will have an important role to wake up the people of (censored) area from the dream of ignorance.
We (Taliban) appeal from the every common & proper (people) of (censored) area of (censored) township that all the conditions, we described, if not acted upon these so later there will be no hospital nor dish shops, cables shop, cinema hall, vulgarity, dacoits, thefts and no crimes. (Inshallah)
This is a public notice that all these things should be acted upon and specially the English’ (pigs) from civil hospital should be evacuated. Later on fright ness & fear may prevail in (censored).

From Taliban (servants of Islam)

Clipping From The Newspaper

This is what we are fighting to do in Dera Ismail Khan...whether we will succeed or not is a huge question.

Our Mission Is In Question

We cannot access the places where help is needed the most, and we are inexperienced in negotiating with the authorities in a context like Pakistan.

It has come to the point where we have to weigh up the balance of the impact of our activities and the risk we are taking in being here. Watch this space!

Be Nice To The Neighbours

After having the internet at home down for the last three weeks, I hope to be back online soon! I have taken to slyly surfing on the neighbour’s connection. Imagine my horror when we discovered that one network available went under the name of “The Quiet Killers”. Could there be terrorists in town?!

السلام عليكم

The highlight of my week has to be my language classes. Keen to mix my minimal Hindi and Arabic together, I hope to end up by speaking Urdu!

The lessons are much fun, and concentrating on something other than work for ninety minutes provides great release. So, kya aap ko meri samajh aa rahey hai ?!

Hiring And Firing

The least favourite part of my job is my involvement in recruitment. I tend to leave the dirty work to the HR Coordinator but I do have a part to play and I don’t enjoy it. We have had to fire someone for gross misconduct and it wasn’t pretty. For the first time since university I am finally relying on and applying my law studies. I contact my lawyer regularly and am becoming very familiar with the Pakistani employment and contract law. It is sad to have to let people go, knowing that they have an entire family to support on an already pitiful wage.

Hiring can also be problematic; balancing Sunnis and Shiites, Pashtuns and Punjabis, males and females to ensure a fair team composition whilst avoiding nepotism is not simple. As soon as a position opens we receive an influx of applications from our staff who all want their brother, uncle, or nephew to take the role. There is the added complication that many take a cut of the salary if they manage to find them work, a situation we try to avert at all costs. I have at least been able to save the jobs of a few and for that I am glad.

Kept Behind Curtains

Being a woman in Pakistan is not as easy as it looks. Their role in society differs greatly to how us girls run the show in Europe. Many members of our staff have had to quit working due to family pressures; outside of Islamabad most ladies keep themselves covered up; and to be seen with any other man aside from their husband can be considered extremely controversial. I am not allowed to walk to my office on my own whereas men are. In NWFP we are not supposed to sit next to men in the car. The famous “bise” (the French alternative to shaking hands – greeting by kissing both cheeks) is absolutely forbidden amongst expatriates of different sexes in the presence of locals.

Today I went to a restaurant, with a female friend of course, and chose my own table. Shortly after a family including women walked in and they were immediately ushered into a booth hidden behind a curtain safe from prying eyes. Privacy for wives is so sacred here and I respect their choice but I cannot imagine what it must feel like to be kept behind curtains like that.

Me, complete with my own central heating, sitting on the wrong side of the curtain. I hope I haven't offended the local population too much.

Wearing The Shalwar Kameez

On The Way To Winter

Did I say that it is unbearably hot here? I have changed my mind with the seasons. The monsoon is over and the temperature has dropped along with the leaves on the trees. The mornings and evenings are getting cooler everyday, and though we are equipped with fans and air conditioning for summer, heating is a rare concept here. Guards huddle around hand-made fires on the streets, and purchases of Kashmiri cashmere are on the up. How ironic that I am now craving the heat that I found so stifling only a month ago...

A game of cricket in Jinnah Park late one Sunday

The Sugar Crisis

The subject on the tip of everyone tongues is the sugar crisis. When I arrived during Ramazan the government had capped the price per kilo at forty rupees. Since then the rate has risen to over one hundred in certain areas and the locals are fuming. Queues for those who can afford it wrap round the bazaars, while the poorer families have no choice but to accept a brown sweetener substitute. Sugar supplies in the office now have to be kept under lock and key as the temptation encourages sticky fingers.

Us foreigners can, of course, purchase the real thing without great difficulty. But I for one could do with a little less sugar. All day long I sip sweet milky chai. And in the evenings with little else to do I take to gorging on the delights of my cook; heavy but delicious dishes laden with ghee and rich in oil. Meat and carbohydrates may be similar to a typical Welsh diet but when combined with not being allowed to walk anywhere it mean I might return somewhat plumper!

A Breath Of Fresh Air

This Sunday I went to Margalla Hills. Only thirty minutes from my house, there you can find a small range of hills from which you can look out over the city. It is a popular outing for the Islamabadites at the weekend so we arrived early and took one of the trails leading up to the summit. At midday it was hot and portions of the trail fell out of the shade. My first real exercise since arriving it was a real pleasure to stretch my legs. What was more satisfying however, was the sense of freedom. Being able to simply walk without fear was fantastic. At the summit we paused to admire the view. No luck. It was hidden behind the cloud of pollution that hangs over the city. Breathing in the air deeply, it was a long time before we descended back down into the dirty air.

You can just about see the lake through the smog

Scammed by the children - I spent twenty rupees on a decoration and they wouldn't even give it to me! Fayzal, pictured below, was the guilty party.

Peshawar Troubled Again

I returned from Peshawar yesterday with no problems, unlike the last time when I was held there an additional night as the journey was deemed too risky. The region has been the consistent target of explosions every other day since I arrived in Pakistan, and has to be considered as one of the most dangerous places on earth right now for innocent civilians.

Today saw the largest blast yet with 118 fatalities and many more injured. The bomb went off in the middle of a crowded market and no one has claimed responsibility, including the Tehrik-e Taliban Pakistan (TTP) who is usually the proud culprit. Speculation of where the blame lies is rampant in the country. Popular theories of suspects include the government - keen to gain public support for the violence in Warziristan in the war of hearts and minds, and of course, age-old enemy India.

Whoever is to blame, their wrath is brutal and has once again instilled fear in our team.

In Sickness And In Health

Ahhh, the joys of team life. Everything here happens in a communal sense. We do everything together 24 hours a day. For a girl of almost thirty years old, it can be testing even after years of sharing with flatmates but especially so since my recent experience of blissful cohabitation. In our home and office we share everything; joys and triumphs, obstacles, food, air and germs.

Some of my fellow team members do not have the strong stomach that I can boast of. Unfortunately, this means that our cook largely ignores my requests for local dishes such as dhal and biryani. He prefers to make pizza and pasta for their delicate tummies. In any case it doesn’t make much difference as the water still affects them. What the French affectionately term “la chiasse” is a regular occurrence that is passed around the group every week, with expat after expat falling ill at their turn. I cannot help thinking that a little of the local food may strengthen their bellies in the long run.

It will come as no surprise to my closer friends, but I have managed to find myself quite a buzzing social life outside of my work (a big Shukria to my new Pakistani friends!) even if the MSF old-timers would choose to keep everyone inside the vacuum. We do not have the right to a private life within MSF. For those who have spent twenty years hopping from mission to mission, they are quick to frown upon those who break away from the circle. They are here on short-term contracts, and do not have the same level of personal investment as those who are here for the long haul. I personally cannot express in words the marvellous feeling it is to make local friends, enhancing my understanding of their culture. It isn’t always easy to get away. Sometimes we are up to fifteen expatriates at a time in the one house, with only one car between us. Organising lifts can be a very frustrating game to play, as each individual fights for their chance to escape from the MSF organism. But I persevere and consider myself very lucky to have found my new friends. Zabardast!

The Diplomatic Scene

I live in what sometimes seems to be another world. It can feel like the people here are also living in their own world, I think living in such a tense situation can do that to you. Around the dinner table in the evening, the subject of our projects and our internal politics never tires us. I am living and breathing MSF 24 hours a day, it would seem!

In pursuit of respite, and to receive some objectivity from outside of my organisation, I have been making friends who are outside of our vacuum. I have been lucky to meet some nice people, both Pakistani and foreign. One circle I have been mingling in is that of the diplomats. Friends of friends have kindly approved my membership to the British High Commission club, which means I now have access to fish and chips, an enormous swimming pool and of course, liquor to stave off the dryness.

It is a world away from how we live as volunteers and they too appear to live in their own world. They seem not to want for much and many have a lifestyle more comfortable that they would have at home. At times I am rather envious! They live under the same security pressures as us, however, and it is heartening to see that everyone shares identical worries, though we all carry on as if there was nothing to worry about.

Lazying down at the British Club on a Sunday afternoon

Yes Means No

Something I have noticed about Pakistanis, is that some of them have real difficulty in saying no. At first I thought it was a language barrier, but my experiences with the most fluent of English speakers tell me otherwise. When asking for directions, work-related questions, or even just asking if something has been done, I am always replied with a yes, even when I know it is not the case. In the UK this would be a downright lie, but here it is far less sinister. My guess is that they are reluctant to disappoint and prefer to give a positive answer time after time. So there you go, in Pakistan , yes can mean no.

No Arms

We don't get out much in Pakistan. So when I was invited to a random party last Friday I jumped at the chance to make some new friends. Our group was the first to arrive and we were welcomed and shown to the terrace. Imagine my shock when I spotted a large gun on the table! I asked that it be put away and the host casually picked it up, pointed it at me, then told me it was a fake. Hence the photo. First I am standing in front of the no arms sticker at our Peshawar office, now look what I have become! In fact the gun was bought from the bazaar. I have been told that in the smuggler's bazaar in Peshawar it is possible to pick up anything. Authentic military informs, weapons, bomb recipes, and all kinds of drugs. I have even heard rumours that if you buy enough opium in bulk, you receive a free Kalashnikov. In any case, you would probably need one carrying that much dope, that is if you didn't have one already.

Evidently it is forbidden for us to visit the bazaars...

My First Quake

Awoken last night, I felt a strange but strong sensation. As if the house was shaking vigorously. Half dreaming I wondered if it could be the impact of another explosion nearby. Everyone came out of their rooms, sleepy-eyed, and we learned that it was an earthquake. It was a very strong jolt, two large tremors. The result of a 6.2 quake of which the epicentre was in Afghanistan. What a bump in the night!

Paranoia Attacks Pakistan

After the explosion yesterday at the Islamic University in Islamabad, I officially declare that everyone is going crazy. People won't leave their homes, suspicions of being followed are common, and you can feel nerves are on the edge. Text messages are the main culprit, breeding fear in everyone by sending leaked details of alleged next bombings. There is a message circulating today that reads as if you will trigger a suicide bomb by pressing a key on your mobile phone...

All the education centres have closed for the week, what has this place come to when the children cannot even go to school? Security checkpoints are multiplying, and while waiting in a traffic jam today I truly lost it for a moment, scared at all the 'what if' scenarios that were filling my mind. I always thought I was attracted to danger and could keep my cool. Apparently not this kind of danger.

Luckily I have support here for that, and after calming down it is simple to calculate that the risk is largely exaggerated. I pity the local population so much. I can always choose to return home if the situation becomes too tense to bear. They, however, have their lives, homes and families here. Where can they go?

The War In Warziristan

The military operation in Warziristan that we have been expecting for months is well under way and we are unable to do anything about it. By now we were supposed to have rehabilitated the hospital and opened up our trauma centre, but because we do not have the authorisation to operate neutrally without army protection, we are helpless, just like the IDPs. It is now that we need to be present, not in a few months time.

I hope that when the head of mission returns from Lahore today, he will have the signed papers in his hand and it will be full speed ahead for our project. Inshallah...

The Pashtuns And Their Pashtunwali

Not all Pakistanis have dark features. Those from the northern mountain ranges and Afghani borders have fair skin, light coloured hair and green eyes. Often I believe I have spotted a rare foreigner on the streets, but their traditional dress sense gives them away. These are the Pashtuns, an ethnic majority, closely knit thanks to a clan system. They are governed not by the state but by a common code of conduct, the Pashtunwali. Their unique identity, reinforced by feudal systems of honour, makes them an interesting tribe to learn about and very nice people to meet.

Children collecting water to prepare chai for the gori (foreigner)

Why We Are Here

I visited one of our projects. A basic health unit tucked away in a village near Peshawar where IDPs arrive daily for treatment. I was thrilled to mix with the community, and interacted with the children using my pitiful Urdu mixed with the occasional word of Pashtun. The nicest part of the visit was when an elderly man came to pay his respects and thanks. A refugee from Khyber, he had walked eight miles to obtain healthcare, with only one hundred rupees (less than £1) in his hand. Upon asking what he could receive for that amount, he was delighted to discover that his treatment would be comprehensive and free. Although I couldn’t understand him, his smile spoke volumes. This moment added a real feel-good factor to the day!

Children receive health education to improve hygiene standards while their mothers are treated in the clinic.

Peshawari Transport

Peshawar

Peshawar. The name evokes romantic notions and now I see why. Strategically positioned near to the Khyber Pass and the now closed roads to Afghanistan, it remains an almost ungovernable town. The British couldn’t capture the region back in the days of the empire and neither could the Pakistani government after independence. It is hard to say who rules the town even now. After Islamabad it is where I spend most of my time supporting and auditing the fieldwork.

It is a crazy place; blasted day after day life goes on for the locals and judging from the traffic there are not many who are hibernating in their homes. I am not allowed to explore the town, nor walk freely. Movements are limited and we travel hidden behind curtains, the standard office to house, house to office, office back to house routine. As I peek out through the curtains, I sometimes ask myself the question if I am looking at a member of the Taliban, for their presence is unquestionable in this town. The atmosphere is tense, military planes fly overhead every few minutes on route for some more air strikes.

Culturally the area is much more conservative than Islamabad. Female flesh and hair are not part of the sights on offer and most of the women wear the full hijab or burka in public, but of a kind I have never seen before. A tent-like chaddar that covers the body and face completely, they would have diffculty finding their way if it were not for a small grill of holes from beneath which they can peer out. It comes in a variety of colours and you can tell which region a woman comes from by the colour of her clothes.

Congestion is impressive, with an amazing array of vehicles and modes of transport on the streets. The buses are my favourite. Hand painted in assorted designs, they are bright and colourful with bells and trinkets attached so that they jingle when the vehicle moves. People hang from the sides and the back and often passengers find it more roomy to sit on the roof. Taken from the safety of my car, the next post shows some examples.

My Source Of Inspiration

Everyone has their source of inspiration for doing certain things in life. And at times when the going gets tough, I rely on mine. As one reader will indeed recognise, I sometimes rely heavily on mine! You know who you are, and I thank you for being just that...my inspiration.

A Belated Eid Mubarak

I have to say that what has most impressed me about the Pakistanis, is their devotion to Islam.

I arrived during the period of Ramadan (or Ramazan as we say here) when our national employees were fasting during the hours of sunlight. Neither water nor food passed their lips during the entire day, they continued to plod along in their work without complaint in heat of up to 40°C. I would hear them rising at 4am to feed under the moonlight and regularly see them heads bowed in prayer, sometimes in the most peculiar of circumstances - on the side of the motorway or guards facing east during their break at a checkpoint.

I tried myself to fast for one day. I allowed myself sweet chai and water so effectively I was cheating, and it was still difficult! Admittedly tempers began to fray towards the end of the period, as everyone looked up optimistically for sightings of the moon in order to break the fast, but the strength of their belief must be incredible to endure such a test for a whole month. I have enormous respect for anyone who can manage this based solely on their love for Allah.

The Shalwar Kameez

Almost all women in Pakistan, including us expatriates, wear the Shalwar Kameez daily. Consisting of a tunic dress worn over baggy trousers, it is complimented by a long shawl-type scarf that can be draped over the upper body in a variety of fashions. (Photos to follow shortly, I promise).
It is quite a pretty garment, despite being designed to conceal our feminine curves and can come adorned with all sorts of beads and decorative embellishments. It has the added benefit of being comfortable and I do not have any problems wearing it…

…Aside from the technical problems it can cause. The scarf, usually several metres long, can be quite a tricky obstacle to manoeuvre in and I find myself constantly flicking it back over my shoulder or head from where it has slipped. I have had to learn how to perform a range of daily functions while wearing it. Not only have I almost strangled myself by getting it caught underneath the wheeled chair at my desk, or trapping it in the door of a moving car, it also very easy to trip over just while walking. Not to mention the challenge of avoiding dipping it in the toilet bowl every day!

Old Versus New

Islamabad is a modern city. Apart from the power cuts, of which I don't feel the pain due to the generator, one tends to feel that life here is of a modern age. Urban planning has been well thought out, and when driving along the roads armoured jeeps and other new cars imported from Japan are common sights. There is not so much to see out of the window that will tell you that you are in South Asia.

The town of Islamabad has an older sister called Rawalpindi that is what I would consider as much more authentic, only a few kilometres away. Going there is forbidden for us and this makes us even more curious to visit but sometimes we do get to see the traffic headed in that direction from the Margalla hills.

Tonight on our way home, we passed a donkey driven cart doing just that. With a family of seven on the cart travelling somewhere with what looked like almost all of their wordly possessions, it made me aware of where I was. A small but pleasant reminder that I am in South Asia after all and that not everything has been lost to modernism!

Insecurity Increases...

Bad news. The Taliban are supposedly united and strengthening; they are looking to cause trouble. And trouble they have caused. In just two weeks they have shook the country with daily bombings, five of which cannot be considered insignificant. Two with a direct impact on us.

The first, in Peshawar, led to the loss of one of our drivers who was off-duty that day and happened to be in the wrong place at the wrong time. I need not write much about the huge dent in the morale of the team, and his wife left with two children to feed.

The third in Islamabad occurred today in my neighbourhood, all too close for comfort. We felt the blast through our upstairs windows and heard the sirens wailing past at full speed. It was the first time that I knew of something that wasn't yet on the BBC website, and our team crowded round the radio operator's desk to watch footage and listen to the local news.

Never before have I felt so close to danger than today, despite my being safe and not in much personal danger at all. During the rest of the afternoon I had difficulty concentrating, and my heart did beat a little faster than usual. The strikes continue, we expect explosions at any moment, but thankfully we are not considered a target.

However, business as usual for our team, while keeping our heads down we avoid taking any additional risk, and continue in our work as always.

How The Hail Took Us By Surprise

I cannot lie and say that it is not hot in Pakistan. It is more than hot, it is extremely humid. I am now used to sitting at my desk with both a manual and automatic fan simultaneously, still damp in my clothes. It is supposed to be the monsoon season here right now, but we haven't had any rain to cool us for about three weeks.

This Saturday we were forecasted rain. The sky appeared doubtful and I sat outside during the evening. Little by little, the temperature rose to a near-painful level. It was finally going to rain. It must have been about 35° but it felt like 50°. Suddenly the winds picked up; fresh air blew our way as we sat back to enjoy the storm. The rain fell down hard. And pounded harder still. Leaves and bins span around, the iron gates swung open and the noise on the roof became deafening. The air cooled but the wind and rain did not relent; only picking up momentum. Never have I seen anything like it before in my life. It began to hail. But not the hail I know. Huge golf-ball sized chunks of ice literally fell from the sky in their masses. The kind of snowball that could knock someone to death! Everyone blinked in amazement, at the strength of the elements. Impressively powerful, oh-so violent, and very refreshing...

The Soundtrack To My Mission

Aside from listening to the regular calls to prayer, I keep my ears pricked for sounds of danger, especially when on the field. Explosions can't be the prettiest of noises, and I already know that gun shots aren't. However, music really does come to my ears late at night when, after inspecting my mosquito net for any unwlecome buzzing guests, I get into bed, turn out the lights and listen.

An array of tunes, tweets and songs can be heard. I don't know what insects and birds are out there beyond my windowpane - they certainly don't exist in my home country, but together their choir produces a veritable melody. In the dark when I can't sleep I try to pick out the different calls one by one as they chant to each other. It is one of the calmest moments of my day, and I relish it quietly.

Budgeting For Our Projects

My predecessor has flown home. I have my computer and keys to the office and safe. I guess it is time to get working as that is what I have come here for. Essentially my job is to manage the finance teams in the field, ensuring that they have enough cash to do what they need to do and that for every rupee spent there is reasonable justification and a correct accounting record. My days are punctuated with cheque signing and authorising payments and a large part of my work is relationship management down at the local bank. Nothing new there then. Except that things do not quite work in the same way here in Pakistan as in Europe. It is quite a wonder to work mostly in cash. I have to deal with large physical transfers of money that literally burst out of my backpack there are so many bundles and wads.

In order to draw up the budget, it is crucial that I understand the project and our operations. We have eight different cost centres that fund several activites:

MSF France returned to Pakistan after a previous evacuation to act following the earthquake in 2008. Since then we currently have a project in the Masehra district, where we are treating patients for Cutaneous Leshmaniasis, a skin infection transmitted by sandflies. Due to increasing security risks, we have evacuated all expatriates from the town and are running this project by remote control from a large city several hours away called Abbottabad.

We have another activity in the North Western Frontier Province (NWFP). Here we are running a cholera treatment centre and have a presence in the in patient department and emergency room of a local hospital. We are very successful in this region as people are are travelling for miles passing public hospitals just to attend our basic clinics for accurate diagnosis and referral.

Coordinated from Peshawar we are running basic health units and mobile clinics to allow free access to health care to those in need, in addition to revamping operating theatres in local hospitals. Non-food item distribution is another activity that we are fond of, providing blankets, temporary housing and soaps to fleeing refugees. The area was home to many internally displaced persons (IDP) who fled the recent military operation in Swat Valley and previously we were running some IDP camps in the region. These camps closed for two reasons, firstly the army wanted to assist in their management whereas we do not condone any military or political associations, nor do we accept arms in our places of work, and secondly because most IDPs preferred to stay in local homes. The Pakistani culture of privacy for their women is such that life living in camps all in the same tent is not easily accepted, thus they choose to find shelter with other families in a house. This can mean many families under one roof, with hygiene conditions that encourage the spreading of disease.

We also have further activity in the Kurram Agency, in the Federally Administered Tribal Areas (FATA) bordering Afghanistan. Again managed by remote control, we have activities in a region that is plagued by sectarian Shiite-Sunni conflict. The road into FATA is too dangerous to cross with a high risk of kidnapping, even for locals, as the area is under Taliban control. Our medical activities support local hospitals, and are run out of two towns, one Shiite and one Sunni.

Our latest project is just in its birth stages. The focus of military attention has shifted from Swat to Warziristan where we expect bloody violence and consequently a new movement of refugees. We had originally intended to take over a disused hospital in the city of Dera Ismail Khan and had obtained permission from the local authorities to do so. During a meeting to finalise this permission, the District Police Officer received a phonecall and then informed us that we had 30 minutes to evacuate the region with a police escort. We are now in the process of setting up a trauma centre and operating theatre from a Punjabi town bordering the Dera Ismail Khan district. We will operate from there and will rely on ambulance shuttles to access the area bringing patients for treatment.

This makes for a lot rupees needed, and a lot of rupees spent. I plan to visit those fields that are accessible to meet the team and enhance my comprehension of the technical operations, as I don't have any medical background whatsoever. During my first week I was responsible for drawing up the budget. This is a task that should normally take about three weeks for one cost centre. In Pakistan we were responsible for producing budgets for eight cost centres in just one week. We worked fifteen hour days for ten days solid. However, this was a great way to understand exactly what we are doing and what it is costing. Not working for profit is very different to working for the private sector. I am used to deciding what can be spent based on an arbitrary budget allowance. Here we are deciding what to do then estimating how much it will cost and thus we have our budget. Completely the other way around but not altogether foolish.

Our cholera treatment centre and staff