Islamabad, Pakistan

Less than a week after Pakistan Muslim League (PML-N) won the country's general elections, Muhammad Nawaz Sharif has extended an invitation to Indian Prime Minister Manmohan Singh to attend his oath-taking ceremony.

"I would like to invite the Indian Prime Minister to Pakistan to attend the oath taking ceremony," Sharif told media in Lahore.

Two-time Pakistani Premier Sharif's invitation came after Indian Prime Minister Singh congratulated him on his party's election victory. Singh also reportedly invited Sharif to visit India.

Speaking to Indian NDTV in Lahore earlier, PML-N head had said that he would visit India soon after becoming the Prime Minister whether or not New Delhi invites him.

He added that he would leave no stones unturned in reviving Pakistan's relations with India, recalling his days in 1999 when former army chief Pervez Musharraf had dismissed his elected government.

Sharif, who has twice served as Pakistani prime minister, also vowed to resolve all disputes with India diplomatically.

Sharif's party is discussing with close aides to form the government and is expected to elect the new government by June 2. Prime Minister Mir Hazar Khan Khoso has also vowed to immediately transfer power without any delay.

The Election Commission has not formally announced the complete results of May 11 elections but hope that the remaining results would be received soon.

United Nations Secretary General Ban Ki-moon, United States President Barack Obama and a host of world leaders congratulated Sharif, the government as well as people of Pakistan on successful conduct of elections. Ban described it as "a significant step forward for democracy in the country."

"This is the first ever transition from one civilian government to another and a significant step forward for democracy in the country," he added.

 

Lahore, Pakistan

On the frontline in the fight against dengue fever in Lahore, Pakistan's second largest city, the authorities have a sharp eye for spare car tires.

"When the police show up, we will throw all these tires into the basement," said Rohil Ayub, 18, who runs a downtown repair shop.

"The police fine us a lot, thousands of rupees every time," he said.

Every few days, police inspectors fine anyone who leaves tires outside - a nuisance, complain the owners of the hundreds of repair shops in the area but essential, health experts say, for combating dengue, a potentially fatal haemorrhagic fever without a vaccine.

Response

In a four-month outbreak in 2011, the mosquito-borne virus infected 21,000 in Pakistan, 85 percent of them in Lahore, leading to 352 deaths.

At the time, a range of rapidly deployed measures, including using smartphone technology, fumigation and the tracing of larvae breeding grounds, were set in motion by the provincial government to help prevent a worse crisis and keep deaths in the hundreds.

"No one expected this kind of political commitment," said Qutbuddin Kakar, who oversees programmes to combat malaria and dengue in Pakistan for the World Health Organization (WHO). "In this part of the world, at least, we had not seen this kind of response before."

The anticipated 1,000-plus deaths did not occur, and since then, dengue fever cases have dropped - 200 in the province (Punjab) last year, without any reported deaths.

So, what was done right, and what do the authorities need to do to make sure solutions are long-term?

The tactics developed to prevent another dengue outbreak were first developed in 2011: information campaigns, data-sharing, and destroying mosquito larvae sites.

Hundreds of government entomologists regularly visit cemeteries, public parks, and gardens, testing for aedes mosquitoes and larvae in any sources of water.

The results they collect are processed on site by specially-designed Android based applications on their smartphones, and uploaded to a centralized dengue prevention centre.

There, analysts match the entomological data with reports from hospitals showing where dengue patients are being treated. Based on the findings, a team is sent to fumigate areas where aedes mosquitos seem to be breeding and infecting people, or to identify and remove sources of standing water.

The key season for infections comes with monsoon rains, when the aedes aegyptus and aedes albopictus mosquitoes, which can carry the virus, begin to appear.

Chronology of an outbreak

In August 2011 heavy monsoon rain dumped 13 inches in a week, leaving parts of Lahore with large bodies of standing water, and raising immediate concerns about disease.

By mid-October, the provincial government in Punjab reported that more than 11,000 dengue cases were recorded by the provincial government.

"It was an exponential increase in number, and it really frightened the government," said Faran Naru, a consultant hired by the provincial government to tackle the problem. "And the issue was resonating in the media... so it created a panic in the public which had to be contained."

Most people infected with dengue recovered on their own, said Naru, but once media outlets began reporting on the extent of the outbreak, thousands showed up at hospitals and laboratories to get tested.

An initial team of 70 entomologists conducted 12,000 spot-checks to track where aedes mosquitos were present. By mid-October, this data had been mapped, along with the locations of 11,000 reported dengue patients.

The results surprised the scientists. The worst affected areas were some of the wealthiest neighbourhoods of Lahore: Model Town, Race Course, Mozang, and Gulberg.

"I saw that in Model Town there is a big park, and in Race Course there are two of Lahore's biggest parks… and I believe lots of breeding was happening there and mosquitoes were leaving from there and infecting people," said Naru.

The mosquitoes need fresh water to lay their eggs, and the large puddles in Lahore's biggest public parks proved to be ideal homes.

Another hotspot was the Mozang neighbourhood, home to one of Pakistan's largest graveyards. The 150-acre area was found to be a major breeding ground for mosquitos. Gravediggers had dug large pits to hold water, which they used to soften the dirt when digging.

"It's fresh water," said Naur, "from the tap, and there were 70 pits, and all of those were infected, full of larvae."

Back in the hospital, dengue patients were separated into special areas for treatment. The home of each dengue patient was fumigated, along with 12 surrounding houses, three in each direction.

Sanitation workers unclogged sewers and drains in an effort to clear areas of rainwater; and parks, gardens, and cemeteries were also sprayed. Thousands of Mosquitofish and Garden Carp - fish species known to attack mosquito larvae - were also released into ponds and ditch canals.

Within a few weeks, entomologists detected far fewer aedes mosquitoes, and the prevalence of dengue cases rapidly decreased.

A public awareness campaign also helped - with city residents encouraged to use mosquito repellent and bednets, and schoolchildren instructed to wear long-sleeved clothing, despite the monsoon heat.

Lessons learned?

There have only been two cases of dengue fever reported in the province so far this year, suggesting the anti-dengue measures have had an impact.

But the disease tends to come in 2-4 year cycles, and public health officials worry that if the lessons learned from the 2011 outbreak are not institutionalized, future governments might not handle subsequent outbreaks as well.

In March, an interim government took over in Pakistan to oversee national and provincial elections.

"We must see if the government is able to plan long-term for dengue. This was just a short-term response," said Kakar from WHO. He says the teams of entomologists and fumigators, and funding resources devoted to surveillance and data transmission, need to continue to work every season.

He also says Pakistan could devote the same kinds of resources to other mosquito-carried diseases like malaria.

Pakistan sees more than 300,000 cases of malaria every year according to WHO, a figure that would inevitably drop with a successful long-term anti-mosquito campaign.

"So far," he said, "a negligible amount is spent on malaria eradication in Pakistan. We should expect that all vector-borne diseases - malaria, dengue... should be brought together under one programme."

Kakar says malaria is mostly restricted to rural parts of Pakistan, where healthcare facilities are so bad that it is difficult to even get an accurate count of how many people are dying from the disease.

He said if the government provided good sources of water, in both cities and rural areas, he would expect a major impact on mosquitoes, whether they carry malaria or dengue.

- Provided by Integrated Regional Information Networks.

 

Islamabad, Pakistan

Delivering humanitarian aid in northwestern Pakistan has recently been hampered by attacks on schools , aid workers and polio vaccination teams , and bureaucratic procedures for aid projects are making matters worse.

International and national humanitarian agencies in Khyber Pakhtunkhwa Province (KP) and the Federally Administered Tribal Areas (FATA) often face long delays waiting for local officials to grant the relevant permits.

Since 2005, procedures to obtain No Objection Certificates (NOCs) for projects and travel have made it more difficult to deliver vital aid, and in at least one case, led directly to the cancellation of projects.

Relief and recovery projects in FATA and KP require project NOCs, while international staff, including UN workers, also require travel NOCs to move around.

"We had applied for a project implementation NOC to begin a project in livestock in the Kurram Agency to the FATA Disaster Management Authority in February, and had planned the project in December last year, but have still had no response," said Anwar Shah, CEO of the Peshawar-based national NGO Shid, which works in livestock, livelihood and education.

"Now the local livestock authorities in Kurram say it is too late to start - so everyone suffers."

Hearing reports of delays, the UN Office for the Coordination of Humanitarian Affairs (OCHA) set about getting a more comprehensive picture by gathering data from agencies operating in the area.

"The problem is not a new one. It has been there for some time, but now rather than just anecdotal accounts, we are trying to properly monitor the situation and create a database to engage the authorities on this issue based on evidence," Christina Alfirev, OCHA humanitarian affairs officer in Islamabad, told IRIN.

Of the 18 humanitarian agencies who submitted data on NOC project requests in January and February, related to 27 projects, 21 were still being processed; only five had been approved and one had been rejected without explanation, as of early March.

Average processing time for project NOCs in KP as of the end of February was found to be 53 days and 66 days for FATA instead of the six weeks indicated by government authorities. One NGO had to wait 118 days for an NOC.

The OCHA bulletin published 4 April 2013 says the delays are "hampering the provision of critical services" and calls on local authorities to speed up the paperwork "to enable timely assistance to people in need in KP and FATA."

The bulletin says one emergency project had to be cancelled because of delays, while another had to be reduced in scope.

The paper trail

Humanitarian projects in KP need an NOC from the Provincial Disaster Management Authority (PDMA) , and must be requested at least six weeks in advance.

Expatriate staff also need an NOC for travel; and in February the Home Department in KP said applications should be made "at least 6-8 weeks prior to the visit", something one international humanitarian worker, who asked not to be named, told IRIN that if implemented, "means regular visits to projects are nearly impossible."

Donors have been expressing concern to the government about the delays these moves could create if implemented, and there are some indications the authorities may be prepared to revoke the policy.

Applications go to the home department of the provincial government in Peshawar, and then can often follow a trail of authorizations and approvals from various military units, as well as the Inter-Services Intelligence.

"A key reason for the new procedures is security concerns. The government is worried a foreign worker or local NGO worker may be harmed, and this brings it a bad name. I think recent events like attacks on polio workers are a factor in the decisions taken," said a PDMA official in KP who preferred anonymity because he was not authorized to speak with the press.

The delays witnessed by agencies in the last few months are also affecting relations with donors, some of whom do not transfer funds until project NOCs have been issued.

"The Project NOC is valid for six months. Then the same game starts again. At this time I have been waiting now more than six weeks for the extension of an NOC," said the aid worker, adding that donors usually extend a project's lifespan, though without increasing budgets, which means they are almost inevitably reduced in size, something donors do not always understand.

"Right now one of our donors is very unhappy," he said.

Permit mission creep

Alfirev said project implementation permits date back to the 2005 earthquake which killed 73,000 people in the north: "The procedure was put in place by the Earthquake Reconstruction and Rehabilitation Authority set up by the government after that disaster, and was really intended to coordinate the many agencies working in the quake zone and prevent duplication. The process worked smoothly then."

All organizations working on relief and early recovery activities in KP/FATA are required to either apply for Project NOCs for projects lasting up to six months, or apply for a Memorandum of Understanding for projects lasting more than six months.

Since 2005, there have been a series of additions to the list of documents and information needed when making NOC requests.

The latest came in February this year with the government's announcement of a 6-8 week requirement for travel NOCs, against the normal 5-7 working days.

The Home and Tribal Affairs Department issued new directives for travel NOCs for 10 (out of 25) KP districts - Malakand, Swat, Upper and Lower Dir, Buner, Shangla, Chitral, DI Khan, Tank and Hangu. The Law and Order Department issued a similar directive covering FATA.

Humanitarian agencies are hoping the new time-scale will be officially reduced to the previous 5-7 working days, and as yet it does not seem the 6-8 week policy is being applied on the ground.

"Since 2008, the humanitarian community has raised US$1.38 billion in funding for people affected by violence in northwestern Pakistan. In order to ensure that the assistance is delivered to the people in need, we depend on the government to facilitate humanitarian operations and ease bureaucratic hurdles," said Lynn Hastings, OCHA country director.

Aid workers say the delays are making it more difficult to deliver aid to KP and FATA. "People suffer when there are delays," said Shah of Shid NGO.

In Mingora, the principal town in KP's Swat District, Abdul Wali, 45, who lost his farm in the 2010 floods , told IRIN: "There is a desperate need for more projects, more development here. So many people are jobless, and need help."

- Provided by Integrated Regional Information Networks.

 

Content

Peshawar, Pakistan

Around 40,000 residents of Pakistan's Tirah Valley, close to the border with Afghanistan, have fled their homes after renewed fighting in the last few weeks, according to the Disaster Management Authority in the Federally Administered Tribal Areas (FDMA).

Most of the refugees from the Khyber Agency are heading towards Kohat, Hangu and Peshawar districts in Khyber Pakhtunkhwa (KP) Province or to the Kurram Agency in the tribal belt.

"My wife, my elderly mother and my two brothers walked for over- hours to reach safety," said Abdullah Khan, 30. He is now staying with relatives in Peshawar.

He said his wife, seven months pregnant, was "suffering severe stomach cramps." He and his brothers had carried their mother until they found a truck to give them a lift, as "she is quite frail and unable to walk for more than 30 minutes or so".

Aid agencies have given similarly harrowing accounts. The Norwegian Refugee Council (NRC) said many had walked for hours "without any access to basic services, such as shelter and water" .

The government provided some transport to those fleeing.

"People have suffered tremendously, escaping the violence and struggling for their lives. Most of them left their homes and their livelihood behind without being able to bring any belongings but the bare minimum to sustain the journey out of the valley," said Saeed Ullah Khan, country director of NRC.

Escalating hostilities

According to the Geneva-based Internal Displacement Monitoring Centre, some 750,000 persons are already internally displaced in Pakistan due to conflict and natural disasters .

The "escalation of hostilities in [the] Bagh Maidan area of Tirah Valley in Khyber Agency has resulted in the displacement of over 5,200 families (40,600 individuals). The displacements started mid-last week. Most of the IDPs [internally displaced people] are children (46 per cent) and women (32 per cent)," according to an update by the UN's Office for the Coordination of Humanitarian Affairs (OCHA), citing information from the FDMA.

Fighting between government soldiers and militants in Tirah Valley, which has strategically important routes into Afghanistan, has been underway for several months, but intensified recently with militants seizing control of key areas .

The conflict is a complicated one, involving at least three militant groups that also have internal divisions.

The humanitarian community is setting up operations to register the 40,000 IDPs and provide assistance at the New Durrani, Jalozai and Togh Sarai IDP camps, said Jean-Luc Siblot, the Acting Humanitarian Coordinator for aid agencies in Pakistan and the World Food Programme's country representative.

"Expectations are that the caseload is likely to grow and for tensions to continue. Agencies are monitoring the situation closely", he said.

Security concerns hamper aid

Those fleeing have not always ended up in safer places. A car bomb blast at a food distribution point at the Jalozai Camp last week left 17 dead and many others injured.

The district police officer, Muhammad Hussain, told IRIN, "We believe the blast may have been carried out by militants targeting tribespeople who opposed them and fled their villages as they moved in to capture these areas."

The security threat is making it more difficult for humanitarian groups to provide aid.

"The humanitarian community is monitoring the situation and stands ready to start humanitarian assistance to the IDPs as soon as the government puts in place the security mitigation measures," said the OCHA update.

IDPs, meanwhile, continue to struggle.

"We have received no help at all, and don't know what to do. We could bring nothing with us, and have no clothing, food, documents or cash," said Abdullah Khan, who is also trying to seek urgent medical attention for his ailing wife and work out what to do next.

- Provided by Integrated Regional Information Networks.

Bannu, Pakistan

Parents and officials are going to great lengths to immunize children after militants imposed a ban on polio vaccinations in Pakistan's restive North Waziristan Agency. Government officials are withholding money and identity documents from groups affiliated with the ban, and parents are travelling long distances to get their children vaccinated, in some cases smuggling the vaccine back home.

Abdul Hassan* emerged recently from the district hospital in Bannu, just outside North Waziristan, clutching his toddler son and niece. Their 100km bus ride from Miranshah, the administrative centre of North Waziristan, was well worth it, he said, because he was able to get the children vaccinated.

"The children have received polio drops, which they had not received for over a year, and that is a relief," he told IRIN.

Militants in the area banned all polio vaccinations in June 2012, to protest the killing of civilians by drones.

Around "200,000 children have been missed [by polio immunization drives] as a result of the ban in North and South Waziristan", said Mazhar Nisar, health education adviser at the Prime Minister's Polio Monitoring and Coordination Cell in Islamabad.

He said this "of course meant greater chances of the virus spreading and endangering more children."

Despite eradication efforts, polio remains endemic in Afghanistan, Pakistan and Nigeria.

Battling the ban

The government is trying a carrot-and-stick approach to get the ban reversed.

"We are making what efforts we can to bring [the ban] to an end, so the anti-polio campaign can resume," said Fawad Khan, health director at the Federally Administered Tribal Areas (FATA) Secretariat in Peshawar.

Nisar told IRIN that the Governor of Khyber Pakhtunkhwa (KP) Province, officials at the FATA Secretariat and the political agent - a representative of the federal government - in North Waziristan were "all attempting to talk to tribal elders and sort out matters so anti-polio drives could resume."

In addition to the negotiations, they are also using colonial-era legislation to impose collective punishment on the areas.

In December 2012, using powers available to him under the Frontier Crimes Regulation of'01 , the political agent for North Waziristan put in place measures that included denying tribal people of North Waziristan passports, national identity cards and other official documentation if community leaders don't overturn the ban.

A small honorarium to tribal elders was also stopped and development work in some areas has been suspended.

The steps were taken after the Wazir and Dawar tribes declined to back the anti-polio programme, Political Agent Siraj Ahmed Khan said.

Militants had also imposed a polio vaccination ban in South Waziristan but Nisar said this had since been "somewhat relaxed."

A doctor, who asked not to be identified, at the hospital in Wana, the administrative centre of South Waziristan, told IRIN, "Generally people are allowed to bring people into the hospital to receive anti-polio drops, but teams are not permitted to move in the field to deliver them."

So far, the government's tactics in North Wazirstan have not led to a relaxation of the unofficial community ban.

Parents act to protect their children

"Our children are still not receiving drops. We are scared for them," Amina Bibi*, from near Miranshah, told IRIN.

Bibi said she had seen "adults who had suffered polio," and "was scared of what could happen if the children are not protected."

Other parents with similar concerns are taking matters into their own hands.

Some "take their children to larger towns like Peshawar or Bannu to receive the polio drops", said journalist Ayesha Hasan. Peshawar is about 285km from Miranshah.

"My infant son is too young to travel, so I went to Bannu and brought back some vaccines. Doctors there put it in a plastic bottle, packed ice around it and I hid it in a tin of dried milk," Hazir Gul*, 30, told IRIN.

"They told me how to give the drops, and I also brought home enough for two neighbours with small children," he said. "I was really scared the militants would discover what I was doing."

Javed Khan, who works at a clinic in Peshawar, the capital of KP province, told IRIN, "At least a dozen or so families have come to me over the past six months or so and taken vaccine home."

Distrust, misinformation

An administrative official in Miranshah, who asked not to be named, said, "Yes we know parents are bringing in vaccine. They are desperate, and we try to help discreetly."

These actions take considerable courage as they expose the parents to potential violence from the anti-polio vaccine militants. The militants in North Waziristan have campaigned vigorously against the polio vaccine, and, according to Hasan, "planted in the minds of people the idea that it may be harmful for their children in some way."

She said that even people who had previously served as polio immunization workers have voiced suspicions that the vaccine could affect reproduction or be harmful in other ways.

A polio vaccination centre in Bannu District, close to the border of North Waziristan, is a popular choice for parents hunting for the vaccine.

But, as Gul said, "It is not easy to move long distances with children, and the militants could find out where we are going." He added, "So far whatever measures the government is taking seem to have had no impact here."

*not real names

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Islamabad, Pakistan

Shielded by a protective bail over threats of his arrest upon arrival, former President Pervez Musharraf returned to Pakistan after spending more than fours years in exile.

Musharraf, 69, said that he is ready to confront any danger to contest for May 11 polls. The elections are the first democratic transition of power in the country's history.

Musharraf had taken power in 1999 through a violence-free coup and military-ruled the country until 2008.

Musharraf fled to Dubai in August 2008 following the assassination of former Premier Benazir Bhutto, wife of current president Asif Ali Zardari.

Talking to reporters before leaving Dubai, Musharraf said that he was not nervous but concerned about the unknown.

"I am feeling concerned about the unknown... there are a lot of unknown factors of terrorism and extremism, unknown factors of legal issue, unknown factors of how much I will be able to perform (in the elections)," he said.

He cancelled a public rally at the Karachi tomb of Pakistan's founding father Mohammad Ali Jinnah following his arrival amid threats from Pakistani Taliban to assassinate Musharraf.

He is likely to address his supporters at airport under high-security.

 

Islamabad, Pakistan

Residents escaping the latest round of fighting in Khyber in Pakistan's Federally Administered Tribal Areas (FATA) say they did not even have time to bury their dead before leaving their homes in the Tirah valley.

They are the latest of hundreds of thousands of people who have fled their homes in the tribal belt close to Pakistan's border with Afghanistan over the past five years of Pakistani military operations.

Conflict is not the only cause of displacement - natural disasters have also played a role, creating what humanitarians call a "complex emergency".

But despite the existence of camps set up for internally displaced persons (IDPs) where the government and humanitarian organizations provide assistance, most choose to flee elsewhere - creating a challenge for those wanting to help these vulnerable communities.

Over 75,000 people live in three established IDP camps (such as Jalozai, a half-hour drive from Peshawar) which house families in tents or makeshift structures, and provide food aid, medical facilities and drinking water. They also serve as a central registration point for families arriving from areas hit by conflict or natural disaster.

Large though these camps are, they only account for 10 percent of the three-quarters of a million IDPs, according to the UN's Office for the Coordination of Humanitarian Affairs (OCHA) .

Humanitarian agencies are increasingly being pushed to take care of those who prefer to live elsewhere; often in Peshawar, the capital of Pakistan's Khyber Pakhtunkhwa Province (KP), and elsewhere in KP.

NGOs and the UN working in Pakistan carry out so-called IDP vulnerability assessment and profiling (IVAP) surveys to gather information on where off-camp IDPs are, and the type of support they need - from shelter and food to health care and Water, Sanitation and Hygiene (WASH) assistance.

They also gather information about what IDPs say they will need on returning to their homes, generally in FATA - with housing, security and agriculture of particular concern to families.

IVAP findings are then passed to humanitarian partners in an effort to ensure that assistance is targeted where there is the greatest need.

The European Commission-funded IVAP project recommends that aid agencies prioritize assistance for off-camp families, 82 percent of whom have to pay rent and live in difficult, cramped conditions .

IDPs outside the camps

Providing humanitarian services outside of the camp environment can be challenging.

IDPs have direct access to facilities at camps, but tribal customs, perceptions of camp life and a preference to stay with relatives and friends, mean a large number of IDPs choose to live outside the camps, making it more difficult for the authorities and humanitarian organizations to keep track of them and offer assistance.

Those providing aid, and the IDPs receiving it, would be better served if distribution was decentralized, said Sobat Khan Afridi, chairman of the Tehreek-e-Mutasireen Khyber Agency, an NGO set up by different political parties to assist IDPs.

"It is easier for larger organizations, especially international NGOs, to operate from the camp as it is easier to manage for them. The problem is that it is still difficult for all the families not living at the camp to reach Jalozai and get aid," said Afridi.

"It would be better if they set up distribution points across Peshawar in the areas where a lot of IDPs live. That would mean less stress for the authorities at Jalozai, and less problems for off-camp IDPs too."

Yar Mohammed, 29, arrived in Peshawar from Tirah in January after walking with his family for five days, much of the journey through heavy snow. He says going to Jalozai was not an option.

"I spoke to some people who told me the facilities at Jalozai are not enough. They were going to give just one tent to us, and that will not do for 10 people."

Instead, Mohammed stayed with his cousin until he found a three-room mud house in the Scheme Chowk area of Peshawar. He pays 4,000 Pakistan rupees (US$41) a month, and hopes to move his family to a better house soon.

"The movement of off-camp families, especially those from Khyber, is very volatile. Sometimes they are living with relatives. If they can afford it, they rent a house of their own. We try our best to register all of them, but it is a challenge," said Faiz Muhammad, the KP government's chief coordinator for IDPs.

Efforts are made to keep in touch with families who choose to live among relatives or rent property. The government uses mobile phone numbers to register families living off-camp, and officials try to reach families that are not registered in this way during monthly food distributions at designated points, he added.

"Even if they are not staying at camp, most of them visit the food distribution points and that allows us to get information from them, give them information and assess the situation."

Humanitarian organizations and the government have identified areas in and around Peshawar with a high concentration of IDPs, and some assistance, such as medical care, is also provided in those areas.

"Identifying off-camp families was a challenge because of the reluctance of many IDP families to register, as well as humanitarian organizations' own security concerns. That was overcome to some extent by mapping families initially based on information from IDPs living in camps, and then expanding the effort to surveys of off-camp families in host communities," said an aid worker with Save the Children in Pakistan who preferred anonymity.

Moving on

Khalid Shah from Khyber Agency lives in Sufaid Dheri, a Peshawar neighbourhood that is home to an estimated 250 displaced families. Two years ago, worried about the safety of his children as fighting escalated in the town of Bara, he boarded up his small shop and left home. His first stop was Jalozai.

"Everyone told me that going to the camp was the best idea. It was safe and there was food and shelter. But after a couple of months, I couldn't take it any more," Shah, 42, said.

He started commuting from Jalozai to Sufaid Dheri, where he would earn a daily wage loading and unloading goods in a market. Today, he lives in a two-room apartment in the same neighbourhood with his family. He remains registered with the Jalozai authorities, and often travels to the camp if he requires assistance.

"I have managed to move here, but my brother and his family are still in Jalozai. He works here with me but stays registered there. You never know," said Shah. The brothers also take turns visiting their land and their shop in Bara every month.

For many families, pessimistic about the prospects of peace in their villages and towns, the next step is to plan for a new life away from Khyber. Many have sold their land to buy property in and around Peshawar. Those with the money have set up businesses too.

"The day I am convinced Bara is peaceful, I am going back," said Shah.

However, those without even modest financial resources are the real challenge for policymakers in terms of a return strategy. The poorest of the IDPs have no option but to register and live in camps like Jalozai, where the services provided are far superior to what they could hope for back home.

"The ones in the camps are the most vulnerable. They have no other means or resources to set up something else for themselves. They get health, education and food at the camp," said Faiz Muhammad of the KP government.

"It's an obvious question: why would they go back?"

Security fears

Pakistani officials say return plans cannot be successful until peace is established in the affected areas.

"We can only begin working on a return programme for IDPs after the government and the military determine that the affected area is safe," said Faiz Muhammad.

In a refugee camp on the outskirts of Pakistan's capital Islamabad, home to many families displaced by the conflict on the border with Afghanistan, Sher Mohammed, from the Mohmand Agency in FATA, says the military has cleared his village, but his family members that visited still fear militant attacks.

"My cousins went back last summer and they had to come back because it was still dangerous there. I can't afford to go back unless it is absolutely safe. It costs 50,000 rupees to take my family back. If it's not safe, I'll have to spend another 50,000 rupees to come back here," said the 40-year-old. "I don't have that kind of money."

- Provided by Integrated Regional Information Networks.