The Humanitarian Crisis in Pakistan

Eric P. Schwartz
Assistant Secretary, Bureau of Population, Refugees, and Migration
Subcommittee on Near Eastern and South and Central Asian Affairs Senate Foreign Relations Committee
Washington, DC
July 29, 2009

Last week, I visited Pakistan with Ambassador Richard Holbrooke to assess the humanitarian crisis and the response of the Pakistani government and international community. I am grateful for this opportunity to share with you my perspectives on the humanitarian situation and to consider what more we and others can do to ameliorate the suffering of those displaced from their homes, as well as to create conditions for their return and the sustainable recovery of their communities.

Let me first acknowledge those on the ground who have responded so generously and effectively to this huge humanitarian challenge. Most of the more than two million internally displaced persons found refuge in homes of thousands of Pakistani families. Humanitarian workers from Pakistan and around the world are working tirelessly under difficult, and often dangerous, conditions to save lives. They have our admiration and our gratitude.

On the other side are extremists who bomb mosques and markets, destroy schools, murder teachers because they allow girls in classrooms, and kill aid workers. When extremists bombed the Pearl Continental Hotel in Peshawar in June, UNICEF Pakistan Chief of Education, Peseveranda So; UN High Commissioner for Refugees (UNHCR) employee Aleksandar Vorkapic; and three members of a UN Population Fund implementation team were among the 18 people killed; many other UN humanitarian workers were wounded, at least one seriously. This month at the Kacha Gari camp for displaced persons, gunmen killed a Pakistani employee of UNHCR, Mr. Zill-e-Usman, and Mr. Allauddin, a guard employed by the Office of the Commissioner for Afghan Refugees, an agency of the Pakistani government. Another UNHCR staff member and another guard were wounded. Mr. Usman had worked for UNCHR for 25 years. He left behind a wife and four children. He was one of three UNHCR employees killed in Pakistan this year.

Allow me now to offer background on the humanitarian crisis, describe and assess the current situation - including the U.S. and international response - and present my view of the near term challenges.


In response to the widespread abuses and lawlessness of the Pakistani Taliban, the government launched a military campaign in late April to break the Taliban’s hold on Buner, and soon thereafter, Swat in the North West Frontier Province (NWFP). Within a few weeks, the fighting caused about one and a half million people to flee. They joined more than half a million others who had fled fighting in the summer and fall of 2008 between the military and Pakistani Taliban in Bajaur and Mohmand Agencies in the Federally Administered Tribal Areas (FATA) and Lower Dir. By mid-June, more than two million displaced persons, or approximately 300,000 families, were living within an arc of 100 miles north and east of Peshawar.

In June, the displacement reached a plateau of more than two million people. About 15 percent were living in official camps; 85 percent were living in host communities: with families, in rental housing, or public buildings. Displaced persons have used nearly 4,000 schools as shelters.

People in both camps and host communities endured and continue to experience crowded conditions, lack of privacy, and often, poor sanitation and shortages of safe drinking water. Supplies of essential medicines and numbers of medical personnel, particularly female medical personnel, are insufficient. The main health problems are gastro-intestinal disorders, respiratory infections, and skin diseases. Camp management, which includes the NWFP government, UNHCR, and the Pakistani Red Crescent Society among others, keeps the camps in good order. While camps tend to be better served than host communities, there have been no major outbreaks of disease or instances of widespread hunger among the many displaced persons living within or outside the camps.

Humanitarian Response Structure

The Emergency Response Unit (ERU) of the NWFP government is responsible for overall coordination of relief activities. At the federal level, a Special Support Group (SSG), under the leadership of Lt. General Nadeem Ahmed, assists the NWFP government and coordinates operationally with international organizations and NGOs.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) ensures coordination and information-sharing among the various service providers through the mechanism of the UN cluster system. This system organizes UN agencies, NGOs, and government agencies into thematic groups (camp coordination and management; emergency shelter and non-food items; water, sanitation and hygiene; food security; health; protection; education; logistics; agriculture; and early recovery) to address needs in particular sectors more coherently and effectively. A representative from the appropriate government department and from a UN agency co-chair each cluster. The World Food Program (WFP), which leads the logistics cluster for the UN, manages most of the 36 humanitarian hubs to deliver supplies. UN agencies are operating from Peshawar with a reduced presence in the aftermath of the bombing of the Pearl Continental Hotel on June 9

Afghan Refugees

The current humanitarian crisis in the NWFP is not the only challenge of displacement in the region. Some 1.7 million registered Afghan refugees live in Pakistan, in addition to up to 500,000 unregistered Afghans. Most of them have lived in Pakistan for more than 20 years; many were born there. Like the displaced Pakistanis in the NWFP, they are principally ethnic Pashtuns, although they live in separate camps or communities throughout NWFP and in eastern Baluchistan.

UNHCR protects and assists Afghan refugees in Pakistan in cooperation with the Pakistani government and with NGOs funded directly by donors, including the United States. One effect of the fighting has been the temporary suspension of UNHCR’s program of voluntary repatriation from Peshawar because of the security risks. While more than 275,000 Afghans were repatriated from Pakistan in 2008, the number so far this year has been only 44,000. UNHCR’s Afghanistan repatriation and reintegration program is still able to receive those willing to return, but we remain concerned that recent events in Pakistan have disrupted returns at a key point in Afghanistan’s own reconstruction. We look forward to seeing the resumption of the repatriation program in NWFP when security permits.

New Phase

Pakistan’s internal displacement crisis has now entered a new phase in two respects. First, as the military retakes territory from militants, people are returning to their home districts in large numbers. As is typical in cases of large and ongoing population movements, estimates have a margin of uncertainty. The government reports that, in all, well over 700,000 displaced persons have returned home to the FATA Agencies and NWFP. Also according to the government, some 100,000 people have returned to Bajaur Agency in the FATA; limited areas within the region remain unsafe and are still producing displacement. More than 300,000 people - about two thirds of the district’s population - have returned to Buner.

Earlier this month, the government announced the completion of its offensive in Swat. On July 13, Pakistani authorities launched an operation to provide transport, security and, with the assistance of humanitarian organizations, essential supplies to returnees. The operation began with camp populations and then expanded to assist displaced people in host communities. Two camps in Mardan district have closed as their inhabitants returned home. At least 300,000 people have returned to the more secure, less damaged areas of Lower Swat. The vast majority of returnees have traveled in private vehicles rather than in government-provided transport. The government has stated that it plans to complete its operation of assisted returns by the third week in August.

U.S. government personnel have conducted assessments in Buner District and report light to moderate damage, although police stations and some schools have suffered severe damage. Electricity and telecommunications are largely restored, but the water supply infrastructure requires repair.

Early reports indicate that damage to infrastructure in Swat is more severe than in Buner, although varied by location. USAID teams that entered Swat on July 16 observed little damage south of Mingora, but heavier destruction in the city itself, home to more than 200,000 people, particularly to buildings targeted or occupied by the Taliban. Areas north of Mingora are inaccessible and insecure.

Uncertainty about security, basic services, and prospects for restoring their incomes are deterring some people from returning home. Humanitarian agencies report that some individual family members are making trips to gather information for a decision on whether to bring their families back. This is typical in such situations - we call them “go and see visits.” Another factor slowing returns is that many families are waiting to receive their $300 debit card from the government. As of July 25, the Pakistani government had distributed about 220,000 debit cards to eligible families. The Pakistani government is allocating $100 million to fund this program. The military has committed to staying in the Malakand Division, which includes Swat, Buner, and Lower Dir, for 12 months to provide security.

On July 11, the Provincial Relief Commissioner, on behalf of the Chief Secretary of the NWFP, and a representative of UNHCR, on behalf of the humanitarian community, signed an official statement that sets out a policy framework for returns. The core of the return policy framework is that the return of displaced persons should be voluntary, informed, dignified, safe and sustainable, which we strongly endorse. During my visit, government officials told me they are committed to act in accordance with these principles. I discussed with officials reports that some displaced persons may have felt undue pressure to return (for example, as a result of the reduction or elimination of services in some camps), and this issue will remain an important part of our bilateral dialogue. However, it is encouraging that the Pakistani authorities have made clear their willingness to take seriously and investigate concerns about the repatriation process and other issues affecting displaced persons.

A second development is the increase in displacement from South Waziristan and neighboring areas of the FATA. Sporadic fighting on the ground and air attacks in South Waziristan, Kurram, Orakzai, and Bannu have displaced about 60,000 people, and this number will increase with the expected main offensive against the Tehrik-i-Taliban Pakistan (TTP) group headed by Baitullah Mehsud. Although international humanitarian organizations are prepositioning supplies in Bhakkar in nearby Punjab, they have no direct access to Tank and D.I. Khan, the areas receiving most of the displaced people. Pakistani authorities are responsible for registering them and providing assistance. The authorities do not intend to establish camps, and we believe that the displaced have no interest in going to camps. They are staying with host families, in second homes, in rented accommodations, or in schools.


Nearly three months into this humanitarian crisis, one can draw some conclusions about the response and the situation more broadly. First, the initial conditions presented huge challenges: a large and rapidly developing displacement in an area of heavy fighting between the Pakistani military and well-armed groups, as well as several deadly terrorist attacks beyond the area of military of operations. Many of the affected areas, while rural, were densely populated. The outflow of people represented one of the heaviest displacements in recent history.

Second, Pakistani authorities, assisted by humanitarian organizations, responded rapidly and effectively to the emerging crisis. The NWFP government established an Emergency Response Unit (ERU) and declared that it would devote its entire development budget for 2009 for humanitarian relief. The federal government established the Special Support Group (SSG) and appointed Lt. General Nadeem Ahmad, who managed the relief effort for the 2005 earthquake, to head the operations of the Group and oversee on-the-ground coordination between the government and international humanitarian organizations.

At the request of the Pakistani government, the UN issued an emergency appeal for $542 million some three weeks after the Swat offensive began. International agencies such as UNHCR, the World Food Program (WFP), UNICEF, the World Health Organization (WHO), the International Committee of the Red Cross (ICRC), and Pakistani and international NGOs, set up camps, activated the humanitarian cluster system, helped the Pakistani government register displaced people, and distributed food and emergency supplies. It was helpful that several of these organizations already had a presence and emergency response capability in the area because of their participation in the relief effort for the Bajaur displacement in 2008, the earthquake in 2005, and their continuing support for Afghan refugees.

Third, in spite of massive displacement in one of the poorer areas of Pakistan, the humanitarian response has been effective in preventing dire outcomes, while providing shelter, protection, and critical medical attention to hundreds of thousands of people. There has been neither widespread hunger nor outbreak of epidemic disease. This is due in great part to the hospitality and generosity of the many ordinary Pakistani citizens who took in not only relatives but often complete strangers and shared what they had. But it is also due to a rapid response by humanitarian organizations – both international and Pakistani.

Fourth, despite its success, the humanitarian response lacks sufficient funding. As of July 27, the UN Appeal of $542 million was only 38 percent funded, at $203 million. Donors have also contributed $104 million to the government of Pakistan and to organizations outside of the UN Appeal. To date, the U.S. government has provided more than half of the total humanitarian assistance to Pakistan. Although we can take satisfaction in our support for the Pakistani people, other governments need to do more.

Fifth, the Taliban’s atrocities have turned many Pakistani citizens against them. A public opinion poll[1] conducted in May revealed that 81 percent of those surveyed considered the Taliban a critical threat to the vital interests of Pakistan, compared with 34 percent in September 2007. Asked whom they supported in the Swat conflict, 70 percent preferred the government compared to five percent for the Taliban. Where fighting raged in the NWFP, nearly every day we read in the Pakistani press of villagers and tribal militias turning against Taliban militants. In May, the government convened an All-Parties Conference that resulted in a declaration supporting military action against insurgents and extremists and condemning violent extremism and challenges to the state’s authority in any part of Pakistan

Further, following press reports in May that charities with links to extremist groups, such as Falah-e-Insaniat Foundation (FIF), were engaged in some IDP camps in NWFP, we raised this issue with the Government of Pakistan, which agreed to address it. We understand that in general terms, the GOP, through its security presence, is monitoring this kind of activity in camps and other IDP settings, and that due to government pressure specifically, FIF was made to restrict its activities with IDPs in the camps. The Pakistani government’s response to the crisis, including its close work with humanitarian organizations, has been an important factor in its ability to maintain public support for a strong response to the Taliban insurgency.

Humanitarian Assistance from the United States

In this crisis, the Administration, its agencies, and Congress have acted in concert to generate the resources and deliver them effectively to the people of Pakistan. The substantial U.S. response demonstrates our solidarity with the Pakistani people and support for the Pakistani government in these trying times. Early on, USAID deployed a DART team to assess conditions and recommend where to direct emergency assistance. By the time that the UN had issued its Appeal in May, Secretary Clinton had developed and announced a $110 million U.S. assistance package, nearly all of which was disbursed within a few weeks. The Secretary, Ambassador Holbrooke, and our embassies around the world urged other governments to meet the humanitarian challenge with additional resources. USAID, USDA, DOD, and my Bureau at the State Department have all mobilized to deliver vital assistance to our partners on the ground on a timely basis - shelter, protection, food, medical supplies and services, electric generators, and transport and logistics support.

Following Ambassador Holbrooke’s visit to Pakistan in early June, the President requested an additional $200 million in emergency assistance, and Congress passed a Supplemental appropriation shortly thereafter. Those funds are now beginning to flow. I thank you for appropriating these additional funds. Congressional support has been critical to our assistance efforts. We applaud the Senate’s passage by unanimous consent of the Enhanced Partnership with Pakistan Act (S.962), which authorizes $1.5 billion per year in non-military assistance for five years. Final passage of this legislation will be a powerful demonstration of our long-term commitment to helping the Pakistani people and reinforce our desire for a long-term partnership based on common interests.

Since May, the U.S. has pledged more than $320 million in humanitarian assistance to Pakistan to meet the needs of conflict-affected people. Last week in Islamabad, Ambassador Holbrooke outlined how we will spend $165 million of funds available (most from the FY 2009 Supplemental appropriation) to meet ongoing needs of displaced persons in camps and host communities, and also to address needs as people return to build their homes and communities.

The bureau I head, Population, Refugees, and Migration (PRM), has committed nearly $60 million for humanitarian relief efforts this fiscal year, $25 million of which has already been provided to humanitarian organizations and $35 million of which Ambassador Holbrooke announced last week in Pakistan. We are currently in the process of providing these new funds to our principal partners in Pakistan - UNHCR and the ICRC. Within the UN system for this emergency, UNHCR has lead responsibility for protection, camp coordination and management, emergency shelter, and provision of non-food items (which include blankets, cooking sets, mosquito nets and jerry cans) to people in camps and host communities

Protecting vulnerable populations is a global priority for PRM. In Pakistan, UNHCR’s protection function includes assisting the government to register displaced people and helping people with special needs, particularly the elderly, women, and children. UNHCR has set up child protection committees in camps to protect children from violence and abuse, and has reunited separated children with their parents.

Since the Bajaur crisis in August 2008, ICRC has provided assistance in insecure areas where most other providers, including UN agencies, have been unable to operate. ICRC was the first humanitarian organization to enter Swat in areas where fighting was still underway. In cooperation with its national partner, the Pakistan Red Crescent Society (PRCS), ICRC provides medical assistance, food, and other emergency assistance to people in camps, host communities and, where possible, people trapped by fighting. They also administer several camps, trace missing family members, and reunite families. The Department of State is proud to support UNHCR and ICRC on behalf of the American people.

Looking Ahead

Let me close by identifying the main challenges for the humanitarian effort over the next few months.

First, the humanitarian response is underfunded; other donor governments must do more to help. While about 700,000 people have returned home, there are still approximately 1.5 million displaced people. And we should not forget that Pakistan is still generously hosting 1.7 million registered Afghan refugees. Even with substantial returns of displaced persons, current operations require additional resources, and donors should support early recovery in areas of return. The long-term reconstruction needs are greater and will require coordinated and sustained engagement from international donors.

Second, the new and principal challenge is to create conditions to support voluntary and durable returns. These conditions include re-establishing security, utilities, and civil administration, providing food, and restoring livelihoods. The World Food Program (WFP) estimates that many returnees will need food assistance for six to 12 months to compensate for lost crops and income. While many people will continue to rely on food and other consumable relief supplies, resources will have to shift progressively to support interventions that restore normal daily life. In this respect, UNHCR is assisting Pakistani authorities by funding transportation for voluntary returns and supplying non-food items for returnees. It plans to provide protection and advocacy through an information and referral service for returnees.

The ICRC is helping 217,000 people in 31,000 households restore their livelihoods by distributing seeds and tools for the next planting season. USAID is providing assistance for debris removal, medical and agricultural programs, repair of infrastructure, and cash-for-work programs. These efforts at early recovery are absolutely essential, and you will hear more on this from my colleague Jon Brause.

Third, relief organizations must be prepared to meet the needs of those displaced persons who may not be able to return home promptly - especially as the monsoon season is beginning. Humanitarian organizations estimate that perhaps 30 to 50 percent of those displaced will not be able to return home before the onset of winter, and will need continuing assistance.

Fourth, the government and the humanitarian community must prepare for displacement from South Waziristan and possibly neighboring areas. This displacement may reach 150,000 people or more once full-scale military operations get underway. The relief effort will require a different supply chain from that established for NWFP. Humanitarian organizations have begun to pre-position supplies in Punjab, but the military has not authorized the set-up of delivery points closer to the areas of displacement. We will work with the Pakistani authorities and international assistance providers to promote ease of assistance to these populations.

Finally, the longer term task of rebuilding infrastructure must begin now. The World Bank and Asian Development Bank are preparing an assessment of damages that should be available at the beginning of September. Pakistan will need substantial support from donors to rebuild. Timely reconstruction is critical to ensuring our humanitarian, development, and security objectives.

It is clear that the people and government of Pakistan and their partners around the world have accomplished much. But much remains to be done. The Administration is committed to sustaining and strengthening our efforts to support recovery and development in Pakistan.

I welcome your questions.

[1]Ramsay, et al, Pakistani Public Opinion on the Swat Conflict, Afghanistan and the US, July 1, 2009,, a project managed by the Program on International Policy Attitudes at the University of Maryland.