Pakistan's military government is preventing aid groups from helping more than 80,000 people – many of them acutely malnourished children – who have been displaced by a widening civil war in remote southern Balochistan, say international aid workers and diplomats.
An internal assessment by the United Nations Children's Fund (UNICEF), shown to the Monitor, paints a disturbing portrait.
UNICEF and Pakistan provincial health officials, who surveyed the area in July and August, report that 59,000 of those suffering are women and children and that 28 percent of the children under 5 were "acutely malnourished." Six percent of the children were so underfed that they would die without immediate medical attention.
"I would say this now qualifies as a 'crimes against humanity' situation," says one foreign observer who has interviewed delegates from the region.
For six months, aid agencies and diplomats have been pressing Pakistan authorities to permit them to distribute aid packages, which include emergency rations, tents, and medicine. The UN won't deliver aid without permission from the host nation, says Robert van Dijk, the top UNICEF officer for Pakistan.
He and other aid workers say provincial officials have continued to assist his local staff in monitoring conditions in southern Balochistan, but more senior provincial and federal officials have simply refused his requests or derailed efforts with endless bureaucratic hurdles.
"We have tried everything to get our aid there," says Mr. van Dijk. "I even know of aid groups that tried to deliver relief without permits, but they got turned back on the road."
Meanwhile, reports from the region indicate the situation has grown even more wretched with the onset of winter.
Pakistani authorities have dismissed the UNICEF report as overblown, saying the majority of people in Balochistan were already dirt-poor and nomadic, and that most of those displaced by fighting returned home after an important rebel leader was killed in August.
"This report is untrue," said Maj. Gen. Shaukut Sultan, a spokesman for the military. "Almost all of those people have gone back."
Van Dijk agrees that some did return home in September, but says a recent UN assessment showed that other villagers have since been displaced.
"When we went back there recently, we found the same numbers of people," he says, "and even worse conditions – among the worst I've ever seen."
Villagers are caught in a conflict between the government and rebel tribesmen, who took up arms last year to demand greater autonomy for the Baloch people and a larger share of the resources in the gas-rich, sparsely populated province.
Vast Balochistan makes up 40 percent of Pakistan's land area, but is home to only 4 percent of its 170 million people. Because of federal formulas that dole out development funding for roads, schools, and hospitals based on population alone, the impoverished province lags far behind other parts of the country in development and social indicators.
The homelands of the rebel Bugti and Marri tribes sit atop rich oil and gas fields the government wants to exploit.
Their struggle has remained largely out of view of the global media, which focuses instead on Islamabad's wavering efforts to root out the Taliban and Al Qaeda along the Afghan border.
But it's grown into a major conflict – and a major challenge for President Pervez Musharraf, who has dispatched thousands of paramilitary troops to put down the rebellion. During 2006, the rebel tribesmen bombed civilian buses, rocketed military bases, and attacked gas pipelines.
In August, a Pakistani military operation killed one of the main rebel leaders, 79-year-old tribal chief Nawab Akbar Khan Bugti. On Tuesday, a former lieutenant of Mr. Bugti, who surrendered to the government in June in return for amnesty, was killed by a land mine.
President Musharraf says tribal chiefs like Bugti keep their people poor and backward in order to maintain control. He has repeatedly pledged to bring development and economic investment to the province.
But Bugti's death sparked widespread rioting among his supporters in the provincial capital of Quetta, and four months later, the insurgency shows no signs of abating.
Frustrated aid workers and diplomats are increasingly concerned about the widening humanitarian crisis – and furious they are being denied access to the area.
Six months since the UNICEF assessment, a Western diplomat says: "The UN is now desperate. They are literally begging us for help."
Just this week, the government abruptly canceled a planned tour to Balochistan by a visiting delegation from the European Commission.
There are aid-worker reports that military trucks rounded up displaced people and hid them ahead of earlier visits by local aid groups.
Why wouldn't Pakistani authorities let relief workers in to help? "The official logic is that they can't guarantee safety for the internationals, or even for local aid groups," says Samina Ahmed, head of the International Crisis Group's (ICG) office in Islamabad.
"The unofficial logic, I suspect, is basically neglect more than anything. This is just not a priority for the government, and they probably hope they will all go back home if everyone ignores them," she says.
Compounding the lack of aid access is the fact that the displaced families have decamped across wide, isolated areas.
"These are small groups – some as small as 10 or 50 people," says van Dijk. "And they roam around. They don't have permanent dwellings."
In the isolated districts of Naseerabad and Jafarabad, where the bulk of the displaced villagers have gathered, one eyewitness describes the refugees as "utterly desperate."
"It's very upsetting to see children in this state," says the local resident, who did not want to be named for fear he would be arrested. "They have no shelter, little clothing, and almost no food."
A climate of political oppression, in which more than 150 Baloch activists have been arrested and taken to undisclosed locations, only amplifies the crisis, say human rights workers and opposition politicians.
Some analysts wonder why the UN hasn't pushed Pakistan on the issue more publicly. "It's quite clear that quiet pressure is not working here," says one Pakistani political analyst. "This situation demands a strong, international condemnation."
Ms. Ahmed of the ICG says that, "The UN has a mandate and UN agencies have a responsibility to help people. My concern here is that if agencies don't meet their mandate they lose credibility."
The UN is not alone in being unable to provide aid. Other organizations, such as Oxfam, CARE, and the International Committee of the Red Cross, have also been trying to gain access to the region.
Baloch politicians meanwhile complain that millions of dollars in US military hardware, given to the Pakistan military to fight Islamic insurgents in the tribal belt, have been diverted to Balochistan and used against the rebel tribes.
"Are the American people aware of how their donations are being used?" asks a Baloch politician angrily.
As debate over the issue rages behind the scenes, van Dijk says supplies of medicine and food are sitting in Quetta warehouses, and could be distributed in as little as two weeks.
On Wednesday, an hour after the Monitor interviewed van Dijk about the crisis, his office suddenly received a letter from the Pakistani government giving permission to deliver some initial packages.
"This should have happened 10 months ago," he says. "If it would have happened then those children who died would still be alive. I don't know how many more have died by now."