Riots, target killings, bombs – Karachi has seen it all. Behind the scenes, responsible for damage control are the doctors and paramedical staff who work around the clock to keep up a semblance of normalcy in the city’s chaotic emergency wards.

Apart from the large number patients that flock the hospitals in a city teeming with over 18 million people, the emergency departments have a whole other problem to face: The constant danger and threats faced by the medical staff.

Security threat

The security threat is the common factor amongst the three major public hospitals in Karachi; the Jinnah Postgraduate Medical Centre (JPMC), the Abbasi Shaheed Hospital and the Civil Hospital. The nature of violence faced by them varies from militants to mobs, sometimes within the walls of the wards.

On February 5, 2010, a blast occurred right outside the emergency gates of the JPMC, killing 18 and injuring countless others. Though the whole emergency ward was eventually revamped by the administration, the ward’s Executive Director, Dr. Seemin Jamali says the threats have by no means disappeared.

“On our part, we have put up barriers and blockades to protect ourselves. But whenever the violence increases, the people accompanying patients or gunshot victims don’t listen and at times attack the staff,” she explains.

As of now, there’s extra but still-sparse security at the JPMC gates, including guards inducted by the hospital administration itself. Dr. Jamali adds that Rangers personnel are present at the gates and are “prompt in their response” in case of a security threat, but a video clipping of a recent incident shows something completely different.

The incident, which was caught on camera, captures an armed man killing an injured man on a stretcher right outside Dr. Jamali’s office. Narrating what happened, she says that an auto rickshaw drove inside the emergency ward, with a bearded man tightly holding onto a lifeless body. Apparently, a fight had broken out between two rival groups in Empress Market over extortion, which then made its way to the emergency ward of a public hospital.

In the CCTV footage of the incident, it is clear that the bearded man was not in the mood to talk or to listen to the ward staff, who repeatedly asked him to park the rickshaw outside. Dr. Jamali said that at this point, an injured man from the rival group was brought in, lying in a bloodied shirt on a stretcher. The CCTV footage then showed the bearded man rushing towards the man, hitting him with a stick. Seconds later, a man with his face covered with a scarf, came out of the opposite room with a Kalashnikov and fired a volley of shots, killing the injured man instantly.

The scenes right after the shooting show people rushing out of the emergency ward, while the hospital staff is seen ducking behind counters. It also shows both the men brazenly walking out of the emergency department, as around them people rush to save their lives.

Perhaps what is as shocking as the incident itself is the time it took for law enforcement officials, posted a few steps away from the ward, to enter the scene – a whole fifteen minutes.

Though Dr. Jamali gives a non-committal answer when asked about the promptness of the security officials posted, she did admit the hospital needs more security. “This is something that we go through everyday. We have repeatedly demanded security for our staff. We eventually got security but it is not enough, as it is a common sight to see people carrying armed weapons inside the emergency ward. The lack of proper security makes us a soft target.”

Meanwhile, the Abbasi Shaheed Hospital (ASH), located in a Muttahida Qaumi Movement (MQM) stronghold in Karachi’s Nazimabad area, received threats of a possible attack during elections, the deputy medical superintendent of the hospital says. “I have never seen the higher ups so serious,” he says, adding, “There were a number of meetings and a plan was chalked out, but it was not followed after elections.”

According to the plan, more security was to be provided to the hospital, which Mr. Anwar says was provided, but only for a few days. Secondly, a parking lot for the ASH was to be finished, as the cars parked inside created a traffic jam for incoming ambulances. Thirdly, Mr. Anwar points out that though security was provided, it was “not satisfactory.”

“The guards who were posted outside the gates were old and haggard. And they had to be told to be strict with people trying to get inside the hospital to create a ruckus, but to no avail,” he adds.

‘No-go hospitals’

But the ASH has other problems to deal with. Although the hospital has a strong reputation for providing efficient treatment for dengue, the hospital is also often alleged to have political links.

During the June-August 2011 ethnic killings in Karachi, which claimed the lives of around 400 people in just a month, Pakhtuns often refused to get treatment at ASH, although this issue received little attention from the media. Anwar responded to this by saying that a few of the “videos were circulated to damage the reputation of the hospital,” and rubbished the concern as ‘a mere perception’.

The deputy medical superintendent then quoted a recent incident in Mominabad, where the general secretary of the Awami National Party, Bashir Jan survived an attack. He said that most of the injured were treated at the ASH. “Bashir Jan was also quite happy with the treatment,” he says.

“If you come in the morning hours, you’d notice that there are more non-Urdu speaking people than otherwise. We don’t believe in discriminating against anyone,” he stresses.

Dr. Jamali, meanwhile, speaking about JPMC, says: “Our hospital is one of the most apolitical ones in the city. We don’t encourage discrimination on the basis of caste, creed, colour or gender.” Quoting an incident, she said that a member of the Khwaja Sarra community was once refused treatment at a known hospital and was then referred to JPMC.

She admitted, however, that removing a party flag from the hospital walls and electric poles outside becomes a huge problem.

Capacity to treat

If it isn’t political intimidation or security threats, it’s a lack of funding and resources.

Civil Hospital Karachi, with its small emergency ward, treats up to 900 incoming patients a day. It is the same number at JPMC (from 900-1,000), while ASH’s Anwar said that the total figure of incoming patients is around 2,500. With targeted killings occurring every other day in the city, the number of patients increases as well.

The Civil Hospital’s Dr. Saeed Qureshi had the same complaints about staff being abused by those who entered the ward – but added something positive: He is in the middle of finishing a grand project on the hospital premises. In 2006, Dr. Qureshi proposed a 12-storey building housing all the major departments, with two floors exclusively reserved for the emergency department.

The construction work has been going on since 2009, as there have been a few hiccups in terms of lack of funds which made the process quite slow. But Dr. Qureshi is adamant to go ahead with the process, adding: “My point is that people need an ambience to work in. Once we’ll create it for them, they’ll start working and hopefully will reduce the number of incidents occurring inside the emergency department.”

Budgetary issues are the main hurdle in terms of getting equipments for the hospital. With JPMC’s devolvement to the Sindh government, there have been a lot of problems in getting new resources for the department. While Dr. Jamali says that apart from the Sindh government, the emergency department gets most of its funds from “philanthropists who want to help,” the Project Director for the under-construction building at Civil Hospital, Engineer Hayat Kemal, explains that sporadic funding is the main hurdle in getting things done. “Since 2009, we get sporadic funding which comes with a gap of six months. We have got a lot of things in motion, but with lack of funding we’ll get nowhere.”

He also added, that the funding gets cleared online, “so, even if you have a document stating that you have funds, until it is certified online, we won’t get it.”

On paper, the plan for the new building looks ambitious, with a separate triage area, and 11 lifts for the whole building, but Mr. Kemal adds that with inconsistent funding, maintenance will be a bigger issue.

He elaborates, “It is something we have to live with: Lack of funding, safety issues, and so on. I still think the project wouldn’t have seen the light of the day if it were not for Dr. Saeed Qureshi’s devoted efforts. But the problem is, in any business, devoted people don’t stay for long.”

Anwar of ASH, however, has no such problem. With a centralised budget system handled by the Karachi Municipal Authority, he explains, the ASH receives funds in “crores and hardly has any problems related to lack of it thereof.”

At the end of the day, however, its security over budgetary concerns that is on top of the priority list for the administrative heads of all three public hospitals in Karachi.

Dr. Jamali adds, “Nobody knows how it feels to be trapped inside your office while there are mad men on the loose right outside your office. It is a new story every day, and we are marching ahead without actually knowing what’s in store for us.”