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Doctors’ dilemma

November 20, 2013

IT was the end of a September day in Loralai, Balochistan. Dr Manaf Tareen, one of four trained cardiologists in the province, was finishing up at the hospital.

His afternoon had been spent treating a long line of patients who had come to see him from near and far. There were old patients and young patients, patients with diseased hearts that beat too fast or too slow or hearts with blocked veins or tired muscles that refused to pump blood.

Not far from the facility where Dr Tareen worked was the provincial police headquarters, the place responsible for the security of a province that sees a barrage of deaths with each dawn and dusk.

The day would not end well for Dr Tareen. Before he could leave, a group of armed men appeared at the hospital and kidnapped him at gunpoint. The road to the hospital is dotted with security and checkposts. They were not able to stop the kidnappers. The date was Sept 17, 2013. He has not been seen since.

The kidnapping of Dr Tareen is one in a series of kidnappings of doctors that other parts of the country have also witnessed. In Balochistan, disregarded by governments past and present, the danger is particularly pronounced.

The aftermath of Dr Tareen’s kidnapping, the 26th in Balochistan this year, drew only robotic condemnations from government officials before news cameras. Like always, they meant nothing. Those who can leave have left and more will likely continue to leave.

According to Dr Haqdad Tareen, the chairman of the Pakistan Medical Association’s Balochistan chapter, 18 doctors have died in targeted killings in the province. In Balochistan, everyone knows, saving lives takes lives.

The doctors left in Balochistan, those still committed to providing healthcare to patients who are some of the poorest in the world, face an ever-grimmer landscape of miserable choices.

Days have passed since that September evening but there’s been no word of the whereabouts or welfare of Dr Tareen, no real investigation into who’s taken him, no concerted attempt to improve the security available to doctors in Balochistan.

Faced with this ruthless set of circumstances, the doctors are desperate. In the lurid festival of fear that is each day in Pakistan, the disappearance of a doctor seemed unable to reach the level of catastrophe that merits concern.

Disappointed, the doctors convened meetings and wondered in frustration what they could do to make the government care, take notice, to initiate some action.

When nearly a month had passed and there was no word of Dr Tareen, no progress in discovering his whereabouts, the identity of his captors or the possibilities of his release, the doctors in Balochistan decided to go on strike.

They began first with a token hunger strike, establishing a camp outside the hospital building so they could register their protest against the disappeared doctor. They also began to hold three-hour token strikes at government-run hospitals where they refused care to outpatients.

While the doctors protested, the patients — having travelled hundreds of miles in lorries, carts and trucks, from remote parts of the province and from the even more distant recesses of southern Afghanistan — waited.

Their numbers grew as groups of families clutching bedrolls and children waited on the hospital grounds. It was, however, only a conversation between the hapless and those without hope; after weeks of token strikes and hunger strikes, there was still no action from the government.

It has been two months since the kidnapping of Dr Manaf Tareen. As a Balochistan autumn turns into winter, there’s still no word, no investigation, no security and no change in the situation confronting the doctors.

The strikes, press conferences and pleas have all failed to stir the government. The captivity of the disappeared cardiologist continues; the rest of the country lurches from one crisis to another: a bomb blast here, a drone attack there, a controversy over whether a mass murderer could be a martyr — all take their turns on Pakistan’s television screens and in opinion columns.

This week, the dejected doctors in Balochistan decided to employ the very last tactic available to them. After a year of having gunmen barge into emergency rooms, doctors kidnapped at gunpoint and medical staff killed, they did the last thing they could do. They stopped treating patients completely. Since Sunday, the outpatient departments at government hospitals in Balochistan have been shut down.

The situation in Balochistan, with one beleaguered community of professionals having turned its back on those it has sworn to save, is a crude representation of the circuitous routes through which both those who have no hope and the hapless become morally complicit in the persecution of one another.

The government of Balochistan seems to lack either the political will or the logistical capacity to provide any security to those who save lives.

In turn, the doctors, ignored and terrified — and witness to the thick, armed cordons that provide security to the province’s elected officials — resort to the only means of getting noticed. In turning away patients, they expand the wounds, underscore the discontent and try to expose the problem.

Their act of refusal hastens the deaths of many more, whose wounds fester and whose illnesses progress at the altar of a political protest that has stymied their only hope for cure.

Against this moral quagmire of illness and desperation, a government remains untouched and somewhere out there, in the depths of the country whose citizens he treated, waits Dr Manaf Tareen, a doctor hoping to be found.

The writer is an attorney teaching constitutional law and political philosophy.