March Issue 2015

Around 2,000 doctors, specialists, professors and consultants gathered at the Pakistan Medical Association (PMA) House in Karachi on February 2 to protest against the increasing number of targeted attacks on medical practitioners.

Outdoor patients departments (OPDs) of public hospitals, including the Jinnah Postgraduate Medical Centre and Civil Hospital, across Karachi and Hyderabad also remained shut.

Responding to the strike call given by the PMA Sindh chapter, practitioners at private facilities, such as the Aga Khan University Hospital (AKUH) and Liaquat National Hospital, also boycotted their duties, and expressed solidarity by staging rallies and wearing black armbands. This was part of their protest strategy against government in-action announced on January 22, which also includes sit-ins and hunger strikes at public places.

The January 18 killing of Dr Farooq Ahmed Shaikh was the third such incident in this lawless city of 20 million people in 2015. The total number of health practitioners targeted between 2010 and January 2015 is 57, according to data available from the PMA.

A diabetes specialist, 55-year-old Shaikh was on his way home from work at around 1:45 am when he was gunned down in Federal B Area. He was a Sunni. Earlier on January 10, Dr Yawar Hussain and Dr Ali Akbar were targeted by unidentified men at their clinics in Nazimabad and Paposh Nagar respectively. Both were Shia.

The figures show that 2014 was the most deadly for the medical community: 17 of their colleagues were murdered. Earlier, 14 doctors were killed in 2013; 11 in 2012; four in 2011 and eight in 2010. Excluding the years from 2005 to 2009, for which no data is available, Karachiites have lost 133 doctors since 1990. Nearly 20 practitioners survived attacks in 2013 and 2014.

The West Zone, which includes areas such as Nazimabad, Baldia Town, Orangi Town and Golimar, leads with 14 killings, while five doctors were targeted in the East Zone and one in the South Zone.

According to partial data compiled by the South Asian Terrorism Portal, at least 48 doctors were killed and another three injured in 44 attacks on medical practitioners across Pakistan since 2001. Earlier it was only Shia doctors who were being targeted but now, regardless of their sect, all doctors are in the line of fire. Seventeen of the dead were Shias, three were Ahmadis and 24 were Sunnis.

While the targeted killings of doctors caught in the sectarian conflict is an old phenomenon, their refusal to pay extortion money has led to the murder of thousands more. Gone are the days when extortion demands were restricted to businessmen alone.

“There are traces of sectarianism in many murders, but the recent increase in the numbers is because of non-payment of extortion money,” says Dr Tipu Sultan, former president and executive committee member of PMA.

The extortionists initially call, send emails and messages to their targets, and if they do not get a satisfactory response, they open fire or hurl hand grenades at their houses or clinics. If the demand is still not met, it ends up with the murder of the doctor.

“The extortion culture is relatively new, and the demands are being made by some ‘Mirza of South Africa’,” adds Dr Sultan. “Almost four to five groups are demanding money in the name of Mirza.”

“Doctor, listen carefully. I’m Mirza from South Africa; send three lakhs to South Africa. I killed Dr Rubina, Dr Asad, Dr Mayani and Dr Javed. It’s either money or your death. The police is of no help to you, my target killer is ready,” reads one of the threats sent to a doctors through an SMS.

Revealing further details, Dr Qazi Wasiq, general secretary of the city chapter of the PMA, explains that their fellow practitioners are under constant threat, and every day the Association receives several complaints of extortion. However, some doctors are so terrified that they do not report to the PMA: they cough up the money and settle the issue.

“We are like sitting ducks. Anyone can come and kill us,” says Dr Qazi. “It is easier reaching a doctor than any other professional nowadays.”

Not every clinic and private hospital can afford to install walk-through gates, metal detectors and CCTV cameras — these security measures cost huge amounts.

Moreover, in a city where policemen are under attack day after day, what hope do doctors have, anyway? One hundred and forty-two cops were targeted in Karachi in 2014 alone. “The killers are sending a chilling message to the doctors: when we can kill policemen, who are you? Non-entities,” says Dr Sultan.

So Pakistan continues to lose some of its best doctors. Several doctors have left the country, and many more are preparing to follow in their footsteps. According to a 2008 report of the Higher Education Commission, greater security and higher salaries in western countries and the Middle East lure around 1,500 doctors from Pakistan every year. Although medics from all over Pakistan are leaving, most of them are from Karachi. “All the big posts at the Civil, Jinnah and Abbasi hospitals are lying vacant,” reveals Dr Sultan. “A number of departments have been shut down, as they don’t have professors and assistant professors.” According to Dr Wasiq, “This city does not have many good doctors left.” Dr Ghulam Mujtaba, President Sindh Doctors Welfare Association, disclosed that around 3,000 specialist doctors have left the country in the last three years.

And yet, until the recent shutdown of the OPDs, the Sindh government was not unduly concerned. Dr Wasiq laments that no government minister, chief minister or governor has issued a statement condemning the incidents or ever visited the PMA House to offer condolences. Neither has any compensation for the victims’ families ever been announced. “They have no sympathy for doctors. When a policeman is killed, a compensation of Rs 10 million is announced within two hours,” he says. “But aik doctor jo apne kaam ko ibaadat samajhta hai, uske liye kuch nahin hai.”

“The state has become irrelevant,” adds a former PMA president. “Even a banana republic would be better than Pakistan.”

The Karachi Police claims to have achieved some success vis-a-vis criminal elements in the city, but there appears to be no specific strategy to curb the killing of doctors in the metropolis. In any case, the total strength of the police is barely enough to meet the demands of a city like Karachi. There are 26,504 policemen and 8,070 of them are deployed on VVIP security duty, as reported by the Karachi Police Media Cell. The police to population ratio in Karachi is one policeman per 830 citizens.

“I cannot identify a single face in the police that would take up the issue of the doctors’ killings in earnest,” says Dr Wasiq. Interestingly, the former Additional IG, Shahid Hayat, and IG Shahid Nadeem Baloch were both working in tandem with the PMA, but Hayat was removed on ‘political grounds.’

On January 2, the PMA wrote a letter to the Sindh Chief Minister (CM), Syed Qaim Ali Shah, informing him of the ongoing slaughter of its members. Copies of it were also sent to the prime minister, the president, the army chief, the chief justice of Pakistan, the Sindh governor, the DG ISI and the Rangers DG. But the only response they received was from the DG Rangers, General Bilal Akbar, who then invited the PMA delegation for a meeting. “He is a true professional and has shown the intent to take up this issue seriously,” says Dr Wasiq. “Equipped with the latest technology, the Rangers have established an anti-extortion cell for doctors, and are handling such cases on a priority basis.” An SMS service, 1101, has also been started so as to help them register any complaints, he adds.

Incidentally, these decisions formed part of a high-level meeting between then DG Rangers, Major-General Rizwan Akhtar (now DG ISI), and the PMA delegation at the Rangers Headquarters in Karachi in March 2014. Training doctors in the use of weapons and facilitating them in the acquisition of arms licenses also formed part of the decisions taken at the meeting that was attended by the PMA President, Dr Idrees Adhi, and the CID DIG, Sultan Khawaja, among others.

Meanwhile, the medical associations called off their strike after meeting the Sindh chief minister at the CM House on February 4.  The CM assured them of providing adequate security and granting them permits to carry firearms within 24 hours of submitting an application. The meeting also decided to give compensation to the bereaved families, after approval from the Sindh Cabinet. But this is not the first time the authorities concerned have promised to redress these issues. The PMA has held meetings with delegations of political parties as well as law enforcers in the past, but to no avail. However, “now the government has shown interest, and things are moving in the right direction,” remarked Dr Qazi, after his meeting with the Sindh CM.

If nothing works, as a last resort the doctors plan to turn to military courts to bring the murderers of the doctors to justice, as “civilian courts hardly convict any terrorists due to lack of evidence and witnesses,” says a doctor.

“I have seen many culprits being released. In fact, I know of an accused target killer who, during interrogation, said that he was glad to have killed a doctor and that he would continue targeting medical professionals if he was released,” says Dr Wasiq.

If the killing of doctors by extortionists and extremists is not taken seriously, there may come a time when clinics will have to install walk-through security gates and doctors will have to wear bullet-proof jackets and carry guns in addition to stethoscopes in their jackets.

This article was originally published in Newsline’s March 2015 issue.