At first sight, the small, sun-baked town of Pir Koh in Balochistan’s Dera Bugti district appears to have jumped out of a low-budget Western movie. Except there are no cowboys here. And the taverns have been replaced by storefronts that sell groceries, vegetables and rolls of cloth, among other household items.

The weather is almost pleasant, especially compared to the district headquarter, Dera Bugti town, which lies a half-hour drive away. Pir Koh is located on a mountain top and the mercury here is a few degrees Celsius lower than its adjoining towns.

Perhaps it’s the weather that has kept attracting people to this sleepy town, where both time and employment opportunities seem to have stagnated a long time ago.

There isn’t much traffic on the high street which also serves as the main market. Men of all ages idle outside shops, engaged in deep conversation. There are no women in sight. A lone policeman stands guard at the far end of the road.

What is most conspicuous about this small town of 40,000 people are the water drums. They line the winding streets, in front of shops and homes across town. For the past three decades at least, bowsers mounted on old Bedford trucks and tractors have carried water up the single, winding road leading into the town before making the rounds to each home, delivering water to the drums, which is then used for cooking, cleaning as well as drinking purposes.

It is due to this water that the otherwise obscure Pir Koh has made it to national news in recent weeks. It is also why MNA Shahzain Bugti, along with an entourage of other “important” people, had to fly down from Islamabad for photo-op sessions in the area last week. And it is why the residents of Pir Koh are up in arms against the local administration and the provincial government.

The outbreak

On April 17, the district health authorities were alerted to a wave of gastroenteritis infections being reported to the District Headquarters Hospital in Dera Bugti. At least 19 cases were reported on the day, one of whom passed away. “Within two hours, we sent out surveillance teams to scope the area,” said District Health Officer Dr Azam Bugti, who spoke to Dawn.com in his office almost a month later. “That same night, we alerted the higher authorities that an outbreak of this nature had been reported from the area.”

Four days later, the health authorities collected samples from the area for testing, which were later sent to the National Institute of Health (NIH) in Islamabad. By April 28, the laboratory had verbally informed DHO Bugti’s team that the samples may contain the cholera bacterium. Another three days later, the NIH sent him an official letter, stating that the testing had confirmed their suspicions — this was a cholera outbreak.

By the time the confirmation had come, said Dr Bugti, almost 600 patients had reported to the DHQ, complaining of severe diarrhoea and vomiting — both classic symptoms of cholera. At this point, the health authorities jumped into action. “We appointed four doctors in three different shifts, besides 26 paramedics and even deputed three ambulances to the area.”

By May 20, over 3,300 patients had visited the Basic Health Unit (BHU) and the Oil and Gas Development Corporation Limited’s (OGDCL) dispensary in Pir Koh — the latter having been taken over by the district health authorities after the outbreak was reported. At least eight of them had died, said Dr Bugti, however adding that the number of patients being quoted here was the total number of patients who had visited the medical facilities for any ailment, not just cholera symptoms.

In fact, it is difficult for the health authorities to establish exactly how many people have been infected by cholera. They simply have no laboratory to conduct the tests, so with the exception of the 12 cases initially confirmed by the NIH laboratory in Islamabad, all other patients have been treated on the basis of clinical symptoms.

Local residents accuse the district health authorities of underreporting the numbers. “There have been over 6,000 cases and at least 26 deaths,” said Ghulam Sarwar, a trained lab technician and resident of Pir Koh, who started volunteering at the OGDCL dispensary after his eight-month old niece died due to the disease. “The government is hiding these deaths,” he said, showing the forwarded image of a list containing the names of all the deceased collected by the Pir Youth Organisation.

Asked about the discrepancy, DHO Azam explained that the number he was quoting was only the data collected from hospitals; they did not have data of patients who had died at home.

Whatever the numbers may be, Deputy Commissioner Mumtaz Khetran said the government’s quick response had certainly saved a lot of lives. The first step was to procure emergency medicines from neighbouring districts, he explained, adding that this was one of the major reasons for the controlled death rate. Secondly, the district administration devised a strategy along the lines of the Rescue 1122 service, under which Frontier Constabulary and Levies personnel went to people’s homes and brought those suffering from diarrhoea-like symptoms to medical facilities for treatment.

“Another step,” said DC Khetran, “was that we upgraded the capacity and equipment at the District Headquarters Hospital [in Dera Bugti town], which also helped provide patients with the necessary treatment.”

Here too, the DC’s words rang hollow in the ears of Pir Koh’s residents. “These are all stop-gap arrangements,” said Noor Hussain, a resident of Pir Koh, who was also volunteering at the OGDCL dispensary. “The government and local administration are to blame for this whole episode,” he said flatly. “Before this outbreak, the one BHU in Pir Koh wasn’t even functional,” he claimed.

“What has the government ever provided us?” he questioned, adding that for the past 30 years, the OGDCL had been providing whatever little basic amenities the town was receiving, while the government had completely buried its head in the sand. “Is it not the government’s responsibility to provide us with these basic amenities?” he asked rhetorically.

Indeed, the cholera outbreak in Pir Koh has been traced to the water being supplied by the OGDCL, according to DHO Azam. The company laid a 30-kilometre pipeline around 32 years to bring water from a natural spring named Pathar Nala, located at the border of Dera Bugti and Marri Kohlu districts. The water was stored in a well near Pir Kohli, from where it was supplied to the homes in bowsers.

“The well itself had three-foot deep sludge, which had accumulated over the years,” said DHO Azam. “It’s as if it was never cleaned,” he added in exasperation. Further, he said, the pipe is so old it has rusted away in many places where animal waste was getting mixed in it, further contaminating it.”

For now, the district administration is paying private contractors Rs3,500 per trip to transport a cumulative 0.35 million litres of water from Dera Bugti town to Pir Koh from wells operated by the Public Health Engineering (PHE) department. The provincial government has released Rs10.2 million for the purpose.

Moreover, the World Health Organisation, whose country representative Dr Palitha Gunarathna Mahipala also accompanied MNA Shahzain Bugti on his trip, has pledged funds for the provision of another 0.4m litres of water per day for Pir Koh until a permanent solution is found.

In response to a query by Dawn.com, Dr Palitha said the WHO has also provided chlorine tablets for household water purification, necessary medicines, beds for the DHQ and an ambulance, among other items.

Meanwhile, Balochistan Chief Minister Mir Abdul Qudoos Bizenjo has approved additional funds of Rs300 million for emergency completion of the ongoing water supply project to Pir Koh, which had earlier been stalled due to inflation in rates of construction, said DC Khetran.

OGDCL’s dilemma

The OGDCL’s field manager Jahanzeb — who only gave his first name — believes, however, that it is unfair to blame the company for the government’s apathy. “We cannot provide water for 40,000 people,” he exclaimed. “That is the government’s job.”

According to Jahanzeb, the well DHO Azam was referring to was never meant to be used for drinking purposes. “But because there was no facility provided by the local administration, people and their livestock have been drinking from it for years,” he said, adding that since there were no rains this year, the water level decreased and contaminants surfaced, causing the outbreak.

The company's website claims it "continues to supply clean drinking water through water tankers and bowsers to the locals of Loti, Pirkoh ..."

Referring to allegations about the state of the pipeline, Jahanzeb said the company had been maintaining the 30km-long pipeline for the last three decades. “We recently replaced a 3km patch that had worn out,” he justified.

But why does this private limited company bear the cost of these amenities at all?

Rich land, poor people

Located at the convergence of three provinces — Balochistan, Punjab and Sindh — Dera Bugti district is spread over 10,160 square kilometres and is home to a population of 312,000, according to the latest census. The district is administratively divided into three sub-divisions — Sui, Dera Bugti and Phelawagh.

Despite its strategic location, the district only came into prominence in the early 1950s with the discovery of gas. Today, the district is home to three of Pakistan’s largest gas fields — the Sui, Pir Koh and Loti Gas fields — making it one of the richest in terms of natural resources. "The Sui Gas Field still remains one of the largest natural gas producing fields in Pakistan, contributing substantially to the country’s requirements with daily production of around 359 MMscfd,” according to Pakistan Petroleum Limited (PPL), which operates the gas fields in Sui.

These riches appear to have gone amiss on the people, however, with the district faring miserably in terms of the human development index with respect to other parts of the country. In Sui, for example, many residents still use firewood to cook food, despite the town providing substantial gas to other parts of the country.

Another indicator are the health facilities available to the public. The entire district has two tertiary care hospitals, one of which is the DHQ in Dera Bugti town and the other was recently completed by the PPL in Sui, according to DHO Azam. Residents complain both establishments lack even basic facilities and they must rush to adjoining districts for even routine medical needs such as childbirth. Besides, there are 37 basic health units and another 26 dispensaries, where the situation is even worse, say residents.

Origin of Pir Koh

When the OGDCL initially started drilling for gas in Pir Koh in 1975, the town barely had a few dozen households. Over the years, as the company grew its operations, a whole economy mushroomed around it and the town grew both in size and population. It employed locals in accordance with an agreement between the federal government, the companies and Nawab Akbar Bugti — the head of the Bugti tribe at the time — and paid them handsome salaries, besides pledging to provide gas, electricity and water to all households within a five-kilometre radius of its gas fields. Locals complain many of these promises were never fulfilled — which remained a constant source of tension between the Bugti tribe and the companies.

In recent years, however, the company’s operations have seen a steady decline due to the gas wells running dry. “We have been operating at a loss for the last five years,” said Jahanzeb, adding that of the 59 wells dug by OGDCL over the years, only two are currently operational.

The company currently employs 335 workers, including 300 locals.

But with the gas wells running dry, the company doesn’t have much incentive to stay in the area for much longer. And once the company leaves, so do its CSR activities, and more importantly, the security forces maintaining peace in the area.

Security woes

In his book, Love in the Time of Cholera, Colombian Nobel prize winning author Gabriel García Márquez narrates the story of a love triangle between a woman and two men. In Dera Bugti too, a love triangle exists between the oil and gas exploration companies, the sardars of the Bugti tribe and the people of the region. As the former two vie for control over its resources, it is the latter that suffer.

And yet, Nawab Akbar Bugti is still a household name in Dera Bugti. Demonised by the state as a fiend and an enemy in his last days, he is still remembered fondly by the residents of this district. “The man was a visionary,” said one government official, who asked not to be named for fear of reprisal. “You may have heard how he amassed wealth for himself and didn’t do anything for his people, but that is all propaganda,” he said, waving his hands as if to brush off the allegations aside.

“Yes, he may have made money but he twisted these companies’ arms to give the people of this district their due rights,” he explained his argument. “For example, while Nawab Bugti was alive, the company provided free air travel to residents of the district and their guests,” he said, adding that regular flights used to operate twice a week between Sui and all major cities of Pakistan. Besides, there were special chartered flights made available for medical emergencies.

“I would go to Karachi to get a haircut and fly back on the next flight,” he chuckled, reminiscing about the “good old days”.

“Today, we have no gas in our homes even as we provide gas to the whole country, there is no water and there is hardly any electricity.”

Others who spoke to Dawn.com also declined to speak on the record about Nawab Akbar Bugti, who was killed in an operation by security forces in 2006. That fateful year, the area was overshadowed by dark clouds that have yet to pass even after all this time.

Thousands of residents, including the Nawab’s family, fled the area to escape from the fighting. Most have been unable to return for a variety of reasons.

Today, perhaps the threat to the area comes from the infighting within the Nawab’s own family. Mir Ali Bugti, the eldest son of Nawab Akbar Bugti’s eldest son, Saleem Bugti, has declared himself sardar of the tribe. Meanwhile, Brahmdagh Bugti, one of the sons of the Nawab’s youngest son, has declared war on both the state and his cousin, Mir Ali, warning people against pledging fealty to the latter.

Brahumdagh’s army of rebels, who call themselves the Baloch Republican Army — a proscribed outfit — have been accused of orchestrating scores of attacks on security forces and the installations of oil and gas companies.

A third cog in the wheel are the current lawmakers — MNA Shahzain Bugti and MPA Gohram Bugti — from the area, who are children of another of the Nawab’s sons, Talal Bugti. Though they too fled the area following the Nawab’s killing, they were finally allowed to return on the orders of the Supreme Court in 2014. Legend has it that both brothers stayed holed up in the Nawab’s ancestral home for four years before finally venturing out to canvass for the elections.

MNA Shahzain, who served as Special Assistant to Prime Minister on Reconciliation and Harmony in Balochistan under the PTI government between July 2021 till March 2022, when the Imran Khan-led government was ousted, currently serves as the Minister for Narcotics Control under the Shehbaz Sharif-led government.

Of these major players, it is Brahmdagh and his BRA that have posed the biggest challenge to security forces. After the Nawab’s death, Brahmdagh escaped to Switzerland via Afghanistan and has taken asylum there. He runs the BRA’s operations from there, said a government official, who asked not to be named. “People are scared of Brahmdagh. One reason is that the men he leads are ruthless, hardened fighters who live in the mountains and attack at will."

But people have had enough of violence. “What the people of Dera Bugti need is peace and development,” said a resident of Dera Bugti town, who again wished to remain anonymous.

The violence, according to DC Khetran, is one of the biggest impediments to development work in the region. “There are areas, particularly along the border of Kohlu district, where infrastructure is lacking,” he admitted, adding that the region had been marred by insurgency for the last several years. “The biggest issue in this area are the landmines,” he said, which he claimed were laid by insurgents to target security forces.

“The problem with landmines is that each time there are flash floods, these landmines flow further south with the water, “which makes it difficult and unsafe to access the region.”

The way forward?

If access to these far-flung areas is difficult for the authorities, access to the district is strictly regulated by the FC, which has a heavy presence in the region.

At least eight check posts line the highway leading into the district, where you must prove your identity and state your purpose of visit. The strictest vigilance is at the Zero-Point check post at Loti Mor, where we were stalled for three hours as the personnel manning the checkpost waited for “clearance from higher authorities” to allow journalists to enter.

Even if you aren’t a journalist, you must prove not only your identity but identify whom you are visiting in town. The latter must ensure they have secured access beforehand.

This regulation has become a source of great agitation among the local residents, who feel their freedom of movement has been curtailed due to these security measures.

For the district administration, however, the measures are vital for maintaining peace in the region. “They [FC] are keeping the area secure,” said DC Khetran, brushing aside the residents’ concerns. “Dera Bugti lies at the border of three provinces and is therefore a hotbed of criminal activity. We need the FC to ensure peace through strict vigilance,” he reasoned.

Besides security, the location also presents another puzzle for the authorities. “Dera Bugti is perhaps the only district in Pakistan that shares borders with eight districts. Moreover, the oil and gas companies operating here bring in employees from all over Pakistan, making it the perfect site for an outbreak to spread,” said a health department official, who asked to remain anonymous. “This is why it is all the more important to ensure the provision of health facilities in the district.”

Those facilities, for the most part, have been left to the oil and gas companies. But with gas running out, the companies are bound to leave. Once that happens, the FC will likely leave with them.

“Where does that leave us?” asked Noor Hussain. “The government has neither built any infrastructure of its own in the last several decades nor are they prepared for this exodus that is bound to happen sooner than later.”

The cholera outbreak appears to have been a rude awakening for both the provincial government and the local administration. No longer can citizens’ woes for help be brushed aside — social media and high speed internet have ensured that. If the state is indeed the mother — as it is often referred to in these parts of the world — Dera Bugti is that stepchild who is in dire need of love in this time of cholera.

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All photos by author