by Dr Ghayur Ayub

Terrorism should be approached by the government as a clinician approaches a disease. Disease is managed in three integrated ways; preventive, curative, and follow-up. Each method is as important as the other. This approach in medical term is called total management. Is terrorism tackled in Pakistan with an approach of total management? Pakistan is 66 years old. During this time the leadership could not tackle the political system of the country how can one expect it tackling terrorism which is only 19 years old. So today, we see the preventive element to tackle terrorism is non-existent, curative operations are ill-managed and follow-ups are not visible. These failures led to unprecedented surge of the menace painting the streets of our country red with the blood of innocents.

I will concentrate on its preventive aspect.

In 1998 when terrorism was surfacing in Pakistan as a spillover from Afghanistan, the then government of Nawaz Sharif started to find ways how to tackle it. The health ministry, then, was involved in four health activities which had the potentials to help curb terrorism. How?

The ministry was running a project called Primary Health Care and Family Planning, (PHC & FP) which was basically involved in preventive care at community level. It had an important workforce of 44,000 Lady Health Workers with a capacity to increase it to 100,000 spread all over Pakistan. They were recruited from the communities they lived in. Primarily their duties comprised of preventive medical care by regularly visiting each and every household of the locality be that was in a village, town, or city. As a result, they became a rich source of medical information with authentic knowledge about individuals, their ages, employments and much more. While one section of the health ministry was dealing with this activity the other sections were involved in Health Management Information System (HMIS); Early Warning System (EWS-later its name was changed to Disease Early Warning System or DEWS); and Epidemic/Disaster Preparedness.

In a meeting an idea was put forward as to why not expand HMIS by linking it with EWS and EDP and make an integrated comprehensive data-bank with its base office in NIH at Islamabad and with branches in provincial capitals spreading to the districts and sub-districts. In this way a communication network would be created covering each nook and corner of the country from a remote village of Pakistan to its capital city Islamabad. Through this linkage, it would become possible to; create disease demographic picture of the country; have a storage of medical knowledge for research and academic activities; get an early alert on occurrence of contagious diseases; have early warning about natural disasters; have ever ready tool for population census. To make the data more comprehensive it was proposed to add finger prints and blood samples of individuals to the data-bank. It was then the role of LHW as the major source of medical information came into discussion and it was decided to add that portion of PHC & FP in the scheme.

It happened that in those days the terrorist activities were gathering momentum. The terrorists were leaving their marks behind in the blast areas as finger prints and blood samples. By the time the result were made available it was too late to trace or catch them. It was thought that if the available data in the proposed data-bank could be used to promptly trace the terrorists, the health ministry would be doing a noble job reducing the menace of terrorism. All the investigators had to do was to electronically forward the prints or blood samples to the data-bank and within no time they would be matched and the culprits identified. In case the samples did not match it would have meant they were foreigners and such samples would be saved in the storage for future references.

As majority of the culprits at that time came from the tribal belt, it was decided to start the process from that region. A feasibility paper based on personnels, logistics and finance was prepared to put the process on the track. Except for a few computer experts, the ministry had sufficient human resource for which a few workshops were needed for trainers and master trainers. The major part of logistics included computers. And of course funds were required for the project.

By a coincidence, while the feasibility report was being prepared the health workers involved in Polio Immunisation drive in Baluchistan came across some perplexing facts. For example at places they found Pakistani villages which could only be reached by crossing the Pak-Iranian border and entering through roads from Iran. Also they found roads which were not mentioned on the official maps. Obviously these roads were used for smugglings etc. The team workers were told by the locals that such roads existed in the tribal belt along Pak-Afghan border also. The team came up with a detailed new map of communication of Baluchistan which was surprisingly different from the official map. In another meeting it was prosed to prepare similar maps of the tribal belt to see how many secret roads existed there which gave ‘porosity’ to the Pak-Afghan border and were used not only by the smugglers but by the terrorists too. It was decided to take up this task in the forthcoming Immunisation Days.

Meanwhile, on the first plan, it was decided to approach the foreign funding agencies for finances. Thus, a meeting was arranged with the concerned agencies and after four hours of deliberation, they appreciated the plan but showed reservation calling it “too ambitious”. Only if they knew that two years down the line, after the attacks of 9/11, it wouldn’t be looking that ambitious; in fact they would have called it ‘timely’ and ‘well deserving’. While the health ministry was looking for alternate venues of financing, the government of Nawaz Sharif was removed and this plan along with other innovative plans were discorded by the military government of Gen Musharaf.

If the plan was made operational, the database created as a result would have not only made the health demographic and population record of the country but helped in reducing terrorism by catching the culprits in time and assisting in preventing its further occurrences. Now that the PML-N government is in power it can retrieve the files and materialise both plans linked indirectly with curbing terrorism that has become 100 times more important than it was 14 years ago.