Pakistan was convulsed by intense violence throughout 2009. Conflict between the Pakistani army and armed opposition groups in the North-West Frontier Province (NWFP) and in the Federally Administered Tribal Areas (FATA) displaced more than two million people, while numerous bombings in major Pakistani cities killed hundreds and injured thousands.

In Swat Valley, hospitals were struck by mortar fire and two MSF workers were killed where MSF ultimately suspended its operations due to the violence there.

As civilians continued to flee Swat and Buner and pour into other parts of NWFP, most settled with resident families. Providing assistance was extremely challenging because of difficulties in accessing insecure areas and identifying those who sought refuge in the major cities. Many patients in Lower Dir suffered from serious war-related injuries, among them children with gunshot- and explosive-related wounds.

Fighting in FATA's Kurram Agency has led to the near-collapse of the health system there. Since December there has been an acute intensification of fighting, leading thousands to be displaced. A daily curfew only allows the population to reach the hospital in a couple of hours a day, greatly reducing access to treatment

Conflict and suffering also continued in the province of Balochistan, where residents have long been neglected and marginalized. The eastern region's health-care capacity is minimal at best; infant and maternal mortality rates are very high.

In Pakistan, MSF does not accept funding from any government, relying solely on private donations from the general public.

An MSF doctor checks a malnourished baby admitted at the MSF ward set up at the Mardan Medical Complex, Mardan. [Pakistan 2009 ? Marta Ramoneda/MSF]

An infant dozes on a stretcher in a fan-cooled tent at the MSF run cholera treatment centre at the Mardan Medical Complex. [Pakistan 2009 ? Jobi Bieber/MSF]