KARACHI, 24 May 2009 (IRIN) - Some 4,375 internally displaced women in northwest Pakistan are due to give birth in June with very few trained medics available and meagre facilities, according to the United Nations Population Fund (UNFPA). They are among about 6,000 pregnant women who are displaced as a result of clashes between the Pakistan security forces and Taliban militants in the northwestern Swat region.

"But there is no plan for these women," said Dr Mohammad Ali, a Mardan District programme officer who is supervising UNFPA's emergency services.

The UN Refugee Agency (UNHCR) said some 1.7 million people had fled the conflict areas of Buner, Dir and Swat, in the North West Frontier Province (NWFP) since the beginning of May, when the Pakistani army began its operations. A further 550,000 had already left over the past eight to nine months.

About 200,000 of the recently displaced are living in 16 camps set up by the NWFP government in conjunction with UNHCR.

Doctors are concerned about a lack of emergency obstetric and neonatal care in the camps.

"If, God forbid, there is an obstetric emergency in the camp after seven in the evening, there are no female medical officers or paramedic staff, such as skilled birth attendants, or lady health visitors to provide assistance," said Dr Aurang Zeb, executive director of Health Society, an NGO working in IDP camps in Mardan.

Complications, malaria and anaemia

Dr Khalid Khan, a UNFPA district project officer working with IDPs, said about 15 percent of women giving birth would develop complications and might require blood transfusions or surgery. He said that in any conflict situation, pregnancy-related complications increase.

"There is a rise in the number of malaria cases," said Salma Naheed, programme officer with HS. "This poses a threat to these pregnant women, who may be pre-disposed to abortion." She said medicated mosquito nets were badly needed as those supplied so far were not enough.

Fouzia Bakht Sher, a health worker in a camp in Swabi, said that three out of every five women she attended to was anaemic, adding to the potential risk of a childbirth complication.

However, while there is sufficient medicine - including iron and vitamin supplements – in the camps, there are no labour rooms or mid-wives. "Either the deliveries have to be conducted in tents, or the women have to be shifted to hospitals," said Bakht Sher.

With current temperature highs of 39 degrees Celsius in NWFP, displaced people have said being inside their tents is like being in an oven and giving birth there would be a test endurance for mothers and medics.

UNFPA mobile units

In response to this problem, UNFPA has begun bringing in to the camps specially designed mobile service units (MSU) that are equipped with a labour/operation room and skilled staff.

"There will be a five-member team in each MSU including a female medical officer, a lady health visitor, a skilled birth attendant, a driver and a helper," explained UNFPA's Ali.

Ali said the main purpose of the MSUs was to turn rural health centres into 24-hour Emergency Obstetric Care facilities.

"The rural health centre in Takht Bhai is 3 kms away from Jalala camp in Mardan, and it takes just five minutes to get to the facility," said Ali.

"Because providing safe and secure accommodation for our female staff is paramount, we are proposing that the MSUs should operate in the day time and by night they can provide their services at the health centres," he said.

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