MUZAFFARABAD, 31 January (IRIN) - Mohammad Rafique, 38, a resident of Muzaffarabad, capital of Pakistani-administered Kashmir, prepares to walk down the hill to catch the bus into the city. At the end of the day, he takes the same route back, culminating in a 20-minute trek up the same dirt track – all on two new prosthetic legs.

Rafique lost both legs in the 8 October 2005 earthquake after a fallen roof beam trapped him for almost two days until help arrived.

"By then, it was too late," he said. "When doctors in Muzaffarabad saw my condition, they said they would have to amputate my legs from below the knees. I thought I would never walk again."

The 7.6 magnitude earthquake devastated much of Pakistani-administered Kashmir and the North West Frontier Province (NWFP), with its epicentre only 145km from Islamabad, the capital. Tremors were felt as far away as Multan, a southern city in the populous Punjab province, and more severely, in the eastern city of Lahore, the provincial capital more than 300km from Islamabad.

But it was in Muzaffarabad and in the hilly tracts of NWFP that the destruction was most obvious. Only one of Muzaffarabad's two hospitals was left standing, with the health infrastructure in earthquake-affected areas left virtually destroyed.

On the anniversary of the disaster, the Pakistani government estimated that 80 percent of reconstruction would be completed within three years.

However, aid agencies have said it could take up to eight years, while scores of homeless villagers had to make the difficult journey down the mountains for a second winter this year to stay in 'tented villages' - temporary shelters set up by the Pakistani government and local authorities.

More than 2,000 children are reportedly said to be waiting for prosthetics, with finances and funding scarce and private charities providing most donations to help in changing the lives of individuals such as Rafique.

For weeks after the earthquake, the Pakistani media carried a daily litany of suffering. Pictures of heavily bandaged survivors merged into even more stark images of children with amputated limbs staring blankly into space.

Almost a year-and-a-half later, with a second winter under way, rebuilding and reconstruction remains a daunting task - despite pledges of almost US$7 billion in aid.

Rafique was helped by Helping Hand For Relief and Development (HHRD), a US-based agency, which, apart from involving itself in much-needed relief activities, has spearheaded efforts to provide prosthetic limbs to survivors.

"We were the first NGO or charity to focus on providing prosthetic limbs to earthquake survivors," says Fazal-ur-Rehman, HHRD's general manager in Islamabad.

"Until October 2006, we had 796 patients who required prosthetic aids registered with our organisation and we've been able to provide artificial limbs, feet or hands to 500 of these patients through two centres we set up in Muzaffarabad and Mansehra [in the NWFP]," he added.

As part of the recovery effort, aid workers guided Rafique through the process that required prosthetic legs to exactly match his knees, and then lessons in how to put them on and take them off.

Soon Rafique found he could walk again and within a fortnight, discovered he could resume work as well.

Psycological worries and lack of funds

Still another challenge is the psychological trauma to earthquake victims who required amputations. While psychologists have played down worries that children might suffer more than adults, claiming that children are usually more resilient and require only dedicated counselling to alleviate and eventually overcome their fears, the risk remains that, given the nature of their injuries, they face nightmares, anxiety attacks and even social ostracism.

"I met - and eventually filmed - a young girl, barely in her early teens, in a hamlet near Muzaffarabad recently. She looked as pretty and innocent as most girls her age do - and then I saw that she had lost one leg and, like Rafique, also had an artificial replacement," Akmal Khan, an Islamabad-based film-maker, who has spent days filming the quake survivors, said.

"It was heart-breaking, therefore, to see her look so sad and wistful. She kept on repeating that no one would want to look at her because she was a cripple," he added.

But while prosthetic limbs have enabled many quake survivors slowly to rebuild their lives, they are far from cheap and remain largely out of reach for local residents.

"An entire prosthetic leg costs $750, while a limb that is required to be fitted from below the knee is worth $300," Rehman explained. A partial foot costs $233, a knee $100, an ankle $28 and a hand $33, he added.

Lack of funds means there are still almost 300 survivors registered with HHRD waiting to be fitted with prosthetic limbs, Rehman continued.

"We're trying to help everyone we can, but until we get enough funds, we can't hope to help these patients get their prosthetic limbs – and we know that there may be more such patients who need our help," he stressed.

"Again, because of not enough funds, we have only been able to treat about 2,200 [out of 3,500] for physiotherapy," he added.

The organisation is now "trying to approach government agencies" and looking to work with the International Organization for Migration so that a wider umbrella can cover the needs of such survivors, Rehman explained.

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