PESHAWAR, Feb 20: A United Nations field mission has urged the UNHCR to devise a long-term health policy in collaboration with the Pakistan government and implementing partners for the Afghan refugees who want to stay in Pakistan for prolonged period.

The mission has compiled a report "Joint Evaluation of Health and Health Programme for the Afghan Refugees Living in Pakistan" after a visit of Afghan refugees camps in the NWFP and Balochistan last year.

Some 2.19 million refugees living in Pakistan are faced with a legal limbo and cannot return soon as the UNHCR repatriation programme has run out of steam.

The refugees agency in Pakistan is not facing any clear-cut refugee problem but a much more complex phenomenon of transmigration "in which political, environmental and human rights factors combine and lead to population movements". Traditional instruments and concepts of refugee crisis management are ill-equipped to deal with the situation.

The report suggests to improve the performance of the project director health, which, according to the document, had been causing a yearly loss of $200,000 due to some irregularities.

It has warned the refugee agency against the frequent budget-cuts, saying that this was against the overall policy of the UNHCR. The report has also touched gender issue, saying that there was a major inequality within the refugee population, that affected the basic rights of women, and called for innovative and sensitive programmes aimed at addressing this issue.

It adds that health-related protection issues concern mainly sexual and gender-based violence, rape and forced under-age marriages. The document suggests that a formal performance monitoring and evaluation system be established in consultation with the implementing partners.

New objectives must be formulated at a strategic level in view of the prolongation (perhaps indefinitely) of the refugee problem. According to the report, the UNHCR has spent over $1 billion on 2.19 million Afghan refugees in Pakistan between 1979-1997. The health care of the refugee is the UNHCR's exclusive responsibility, with bulk of its budget spent on this aspect.

The programme is aimed at the refugee camps housing at present 1.2 million persons. The primary health care and secondary health programmes are implemented through 117 basic health units operated by 15 partners.

The performance of the implementing partners was good, but the health information system has been unable to deliver since its establishment five years ago.

Shortcoming with regard to coordination between UNHCR offices, its partners and Ministry of Health had led to at times to service overlapping or gaps. It has also pointed that there is a dearth of standard protocols for the management of common diseases at the BHUs.