OVER the last decade and a bit, Pakistan, according to oft-quoted figures, has lost 40,000 people to the ‘war on terror’ directly and indirectly. This includes security personnel. The brunt though has been borne by the civilian population of the country. The numbers of those who have been injured are much higher. In addition, billions of dollars have also been lost in property damage and business losses. And the war is not over yet.

Whenever there is a bomb explosion we immediately hear of the initial estimates on the number of dead and injured. Often the initial estimates for fatalities are far fewer than what the final numbers are, as a number of the injured eventually succumb to their injuries.

Many a time in blasts in Fata, or even parts of Khyber-Pakhtunkhwa, Balochistan and southern Punjab, one hears that the injured have been transferred to the nearest district hospitals and sometimes to hospitals in the provincial capitals as the smaller hospitals, more often than not, do not have facilities for treating the kind of injuries that result from explosions.

But the war has been going on for many years now. Why have we not been able to develop trauma centres near places and in cities where a lot more of the explosions and fighting take place? Why are our hospitals not better equipped to handle the kind of injuries that occur in wars and explosions? Why have medical colleges of the country not introduced relevant changes to the curricula and to the training of nurses and doctors to better equip them to deal with such situations? It is not that better preparation would eliminate the tragic loss of life and limb that we have been seeing and are still living through. But it would have decreased the losses and some lives would have been saved and some limbs would not have been lost.

Malala was operated upon by doctors from the Pakistan Army, then had to be shifted to Rawalpindi and eventually even that was not enough. She had to be flown to England. The care she required could not be provided for her in Pakistan. Every person who has been injured in explosions or shot at has clearly not been treated as Malala. But leaving that debate aside, even if we wanted to, how many people can we fly to England? But we get trauma cases every day. Should we not have some of the more sophisticated treatment and services in Peshawar, Quetta and Karachi?

Let alone the more sophisticated treatment and services, friends who work in hospitals in some of these areas say that they do not even have basic services. Most ambulances are not fitted with needed lifesaving equipment; they are usually just vans with no seats so that stretchers can be loaded in and the injured transported to hospital.

Most of the paramedical staff is not trained in handling trauma victims. The emergency departments of most hospitals do not have trained staff and most of them do not have the needed equipment. In many places, they do not have the needed medicines either. The operation theatres of even the larger hospitals are not properly equipped and staffed.

Government functionaries keep quoting figures of the losses that we have suffered. But why have the provincial and federal governments not changed their policies to address some of the issues mentioned? Why have health-sector spending priorities not changed? Why have we not trained people especially to deal with trauma cases?

Even though we have had democratically elected governments in the centre as well as the provinces since 2008, there have not been any perceptible changes in policies or budgetary priorities. Do we explain this lack of change as a legacy of the non-elected governments and the weaknesses in our current democratic system where the elected representatives do not feel they are accountable to the people who voted for them and the people do not feel that even with the power of the vote they can hold their representatives accountable?

We probably spend a lot more protecting each of our very important persons in government in terms of the equipment needed (bullet-proof cars, protocol, entourage) and recurrent expenses (salaries of all the security staff, etc) than what it would take to set up some state-of-the-art trauma centres or equip and improve emergency rooms.

Even donors, including those hailing from countries that have been encouraging Pakistan to take on the war against terrorism as Pakistan’s war, have not focused on these questions. There has been plenty of talk of creating economic opportunities in areas that have borne the brunt of the war (though not much has been done there) and even exploring connections between lack of educational opportunities and the rise of extremism/terrorism (again not much has been done for education  either), but the health sector has been ignored.

Some of the donor countries have the expertise to deal with these issues: they could have helped educate and train Pakistanis, donated the relevant equipment and contributed some of the resources needed for addressing the variable cost requirements.

The last decade has been very traumatic for the people of Pakistan. The reported figure of 40,000 fatalities alone implies that some 200,000 plus individuals have lost family members over these years. Many more have seen their friends and relatives injured. And it does not seem that we are at the end. In fact we might be headed in the opposite direction.

Given what we have seen and what we are facing it seems very strange that we have not spent a lot more time and effort in ensuring that we develop systems, especially when it comes to dealing with blast and bullet-wound victims, to give the public as much of a chance of survival as possible.

The writer is senior adviser, Pakistan, at Open Society Foundations, associate professor of economics, LUMS, and a visiting fellow at IDEAS, Lahore.