Local Pakistani kids await to be evacuated during the Pakistan flood Local Pakistani kids await to be evacuated during the Pakistan flood Photo credit: U.S. Army photo by Pfc. Joshua Kruger
‘We don’t trust that’: politicised assistance in North-West Pakistan
by Jonathan Whittall, MSF February 2011

Humanitarian aid in Pakistan is being held hostage to internal and external military and political objectives. This occurs through the control and blocking of humanitarian assistance by the Pakistani military, and through the use of aid by donor countries as a tool of ‘stabilisation’ in areas considered strategically important. These trends are reinforced by the approaches and policies of the aid community. The highly politicised delivery of aid is eroding the capacity of humanitarian principles to ensure a  cceptance and access.


The politics of flood relief

The rhetoric accompanying the international response to Pakistan’s recent floods played heavily on Western security concerns. Whilst the provision of international donor funding at times of disaster has never been driven solely by altruism, public declarations that the imperative to respond was underpinned by the need to prevent further destabilisation in Pakistan, thus helping to contain the spread of violent extremism, have never been more evident.

The rhetoric has exposed what has been happening in Pakistan for at least the past nine years. Counter-insurgency, counter-terrorism and stabilisation efforts have dominated international engagement with the country. Aid funding has duly followed. The primary focus has been the Federally Administered Tribal Areas (FATA), where since 2004 the Pakistani army has been engaged in a military campaign against the armed opposition, the Tehrik-i-Taliban-Pakistan (TTP). In 2009 the conflict intensified, with a large-scale offensive by the Pakistani military against the TTP in the Swat valley of Khyber Pakhtunkhwa Province (KP). Well-documented humanitarian consequences ensued, primarily in the form of large-scale displacement.


The role of the military

The Pakistani military has attempted to address the consequences of its broader military actions by registering the displaced, distributing food and establishing mobile medical camps. The military’s capacity to respond has been commendable, but significant gaps remain. In north-west Pakistan, relief for the displaced is allocated based on their area of origin as opposed to their needs: areas must be classified as ‘affected’ in order for internally displaced persons (IDPs) to be eligible for registration and assistance. Khyber Agency in FATA is an example of an area never officially recognised as ‘affected’ by conflict, and as such almost no assistance has been provided to IDPs coming from there.

As a humanitarian organisation, Médecins Sans Frontières (MSF) looks for those gaps, working to establish independently where the greatest needs lie. Mixed teams of international and national staff have been working for a number of years in volatile parts of KP and FATA, such as Timurgara, Hangu and Swat, providing secondary healthcare to conflict-affected people, host communities and IDPs. Yet there are other districts with high levels of need where access is conditional or denied. This is the case in Dera Ismael Khan and Tank districts, where the displaced from the recent South Waziristan offensive have gathered. MSF has tried for over a year to set up health facilities in the region, but the area remains off-limits. Space for MSF operations is only reopened when the government declares an area ‘cleared’ and begins ‘reconstruction’ and ‘rehabilitation’. However, this has not been the case in the south of Khyber Pakhtunkhwa or FATA. In ‘cleared’ areas such as Bajaur, access is still denied.


International political agendas

In contexts such as Pakistan, donors assume that, in the short term, the provision of relief will ‘win hearts and minds’, whilst medium- to long-term development support will help to lift people out of poverty and thus decrease their vulnerability to ‘radicalisation’. MSF’s concern is not that donors have these alternative agendas – we resolve that problem by not taking their funds for our work in Pakistan – but rather that these alternative agendas are increasingly associated with and part of humanitarian action. When the US and its allies went to war in Iraq and Afghanistan and referred to humanitarian organisations as ‘force multipliers’, ‘part of the combat team’ and elements of ‘soft power’, the very meaning and understanding of humanitarianism was fundamentally, perhaps irrevocably, compromised.

Whereas in conflicts such as Kosovo, military intervention was justified on humanitarian grounds, in Pakistan we are seeing an inverse trend: the humanitarian response is being justified on security grounds. This has understandably increased the suspicion felt towards foreign assistance by many Pakistanis. As one patient in an MSF health facility at a camp in Lower Dir put it: ‘America is paying the people who are fighting against us and destroying our homes [i.e. the Pakistani army] and then they are giving the relief. We don’t trust that’. 

This distrust is exacerbated by the conduct of the US military in carrying out reconstruction activities. In February 2010, a bomb blast hit a paramilitary Frontier Corps[1] convoy in Timurgara, Lower Dir, killing approximately 14 people and injuring over 126.[2] The convoy was on its way to inaugurate a girls’ school rehabilitated with US funding after it had been blown up by the TTP. Among the dead were two American soldiers. The US embassy’s initial explanation was that the pair were USAID workers. The embassy later admitted that they were actually military personnel. Later still it emerged that the soldiers were dressed in local clothing. This was a clear example of a misrepresentation of military personnel as civilian humanitarian workers – with what intention is uncertain, other than adding to the confusion and blurring the distinction between the military and humanitarian spheres, with potentially fatal consequences.


A compromised humanitarian community

The approach of the UN in Pakistan has also represented a major challenge to independent humanitarian action. In the UN’s Pakistan Humanitarian Response Plan 2010, an introduction by the government of Pakistan explains its counter-insurgency activities in Khyber Pakhtunkhwa and FATA. Statements by UN officials have also proactively positioned the organisation in a way that has contributed to the politicisation of aid. In a statement that predates the floods, the UN special envoy for assistance to Pakistan, Jean-Maurice Ripert, appealed for more aid in order to ‘pacify some of the most volatile parts of Pakistan’.[3] Another statement from UNHCR claimed that ‘Making sure 20 million people are rehabilitated … is an international obligation: we are looking at a geopolitical situation where the stability of Pakistan we feel is in everybody’s interest’.[4]

Perhaps unsurprisingly, the UN in Pakistan is perceived as aligned with one side of the conflict and has become a target, notably in Balochistan, but also as evidenced by the bomb attack on the WFP office in Islamabad in October 2009 which killed five people. The inherent problem with this political alignment has been identified by OCHA in a recent cluster assessment report:

the United Nations and the wider humanitarian community need to enact and implement the basic principles of engagement in armed conflict while reconfiguring some of the relations with the government in order to demonstrate the independence of humanitarian aid since the government is party to the conflict, while also quickly agreeing on a modus operandi for engagement with the armed opposition in order to access civilians in need outside government controlled areas.[5]


The challenge of multiple mandates

International NGOs have not been bystanders to this confusion. In the case of Pakistan, there is recognition within the aid community that more principled engagement can bring with it improved security and community acceptance. Development activities are carried out under the guise of humanitarian principles. Thus, while the language of principles is used to describe the work of INGOs, the principles themselves are rarely applied in practice. For example, INGOs have used military assets to deliver flood assistance in conflict-affected areas, have allowed their lists of beneficiaries to be validated or corrected by the army and have accepted direct political involvement in the recruitment of staff and the distribution of aid.

Approaches to humanitarian aid are merging with longer-term processes of development and peace-building designed to build the legitimacy and capacity of the state and undermine support for the opposition. Secretary of State Hillary Clinton outlines the US approach to development as follows: ‘Our approach is not, however, development for development’s sake … We in the Obama Administration view development as a strategic, economic, and moral imperative. It is central to advancing American interests – as central as diplomacy and defense’. This is not the first time we have heard this kind of justification for development from the US and other donor countries. Indeed, this is not the problem per se, except that a lot of the money for this political development is channelled to INGOs, which then conduct their development activities in conflict areas such as Pakistan, Afghanistan and Iraq under the banner of humanitarian principles

INGOs must ask themselves whether it is possible to engage in activities funded by and contributing to the objectives of one party to the conflict without fundamentally undermining a simultaneous engagement in principled humanitarian action. This leaves multi-mandate INGOs working in north-west Pakistan with a dilemma: international engagement may represent an opportunity to improve development outcomes, while at the same time playing a part in the process is incompatible with principled humanitarian action.


An MSF perspective

While MSF does not confront this particular dilemma, due to our focus on medical humanitarian action, our desire to ensure that humanitarian principles remain central to our work has raised dilemmas of its own. For example, in some parts of north-west Pakistan where we have been unable to negotiate access, we may have been able to operate if we had agreed to work through national NGOs or only with members of our team from Pakistan. So far MSF has rejected this precondition, as in such a highly politicised and contested environment having mixed teams is essential because international staff can provide a buffer between national staff and community pressures, including pressures from armed groups. In other instances we would be allowed access if we used armed escorts. However, as these would be provided by a party to the conflict, this would contradict our neutral position and could make us a target.

We have had to question what role we may be unwillingly playing in counter-insurgency strategy, for example by working in an area that has just been declared as ‘cleared’ by the Pakistani military and prioritised for development and stabilisation. This was the case in Swat when MSF returned to the area to address the chronic lack of secondary healthcare immediately after the government offensive there had been declared a success.

We have also had to make uncomfortable compromises to enable us to operate in areas with massive medical needs. Not all of the health facilities that we work in are entirely gun-free, a working arrangement which is very important to us as a practical demonstration of non-militarised, neutral status. This is because we only work in a portion of a Ministry of Health (MoH) hospital, such as the emergency room – which reduces our ability to negotiate for the entire hospital to be free from guns – an issue often not seen as important for the MoH.



In the highly politicised aid environment of Pakistan – where both the national government and international donors seek to use aid in the service of political and military objectives – the aid community must resist attempts to co-opt and instrumentalise humanitarian action. There needs to be a clearer distinction between development activities that, however unwillingly, serve the objectives of the Pakistani government and the West, and a principled, humanitarian approach with an immediate, life-saving goal only. Both are legitimate forms of action, but they need to be distinct; in such an environment, a choice between them needs to be made. In the absence of such a choice, the value of humanitarian principles in gaining access and acceptance is rapidly being eroded. With the devaluation of the humanitarian ‘currency’, it is communities themselves that pay the heaviest price.


Jonathan Whittall is Humanitarian Advisor at MSF.


[1] The Frontier Corps is a paramilitary body under the federal Ministry of Interior. It is charged with maintaining control in KP, FATA and Balochistan.

[2] This represents the number treated in the MSF-supported emergency room in Timurgara.

[3] ‘Aid Must Follow Pakistan’s Military Gains: UN’, Dawn.com, 27 April 2010, http://news.dawn.com.

[4] ‘Pakistan Stability in Play with Flood Aid: UNHCR’, 5 October 2010, http://news.dawn.com.

[5] Humanitarian Coordination Support Section Mission to Pakistan 20–29 April 2009, oneresponse.info.