CARE is working in three districts of Pakistan's North West Frontier Province, with a focus on the remote Allai Valley in Battagram due to the level of devastation and the lack of aid from other sources in this area.

CARE's response to the earthquake has followed a three-phase approach, addressing the immediate needs of the survivors, ensuring their security over the harsh winter and finally helping them rebuild their communities and regain their livelihoods once the snows had melted.

Emergency Response

The immediate goal of CARE's emergency response in Pakistan was to ensure that survivors had adequate shelter and sanitation facilities to ensure their safety in the direct aftermath of the quake and its aftershocks.

Emergency Supplies

During the initial emergency relief phase from October to November, CARE provided nearly 75,000 survivors in Pakistan with:

• 4,500 tents
• 8,000 blankets
• 4,000 plastic mats and sheets
• 14,600 shawls
• 8,500 water bottles
• 6,500 hygiene kits
• 75,000 water purification kits

With the onset of winter just weeks away, CARE developed and distributed winterization packages for some 50,000 people without adequate shelter. To help families survive the bitter winter, CARE provided them the materials and knowledge to completely winterize their existing shelters and establish at least one insulated "warm room" for sleeping. We also helped form village committees that identified the most vulnerable members of each village, usually women and children, and ensured that they received their emergency relief quickly. This collaboration earned CARE the respect and acceptance of local communities.

Health and Trauma Care

CARE also established community-based emergency health and trauma centers for psychological and physical rehabilitation. Patients were provided with medical assistance and shelter for as long as necessary to complete emergency treatment. In all, CARE-trained community volunteers delivered public health education and counseling to more than 13,000 survivors during the relief phase of our response.

Relief and Maintenance

As families began to return to their damaged homes in the spring, CARE revived its shelter distribution activities to ensure these returnees had a safe, sturdy living environment during the reconstruction process.

Rebuilding Infrastructure and Livelihoods

To help people begin rebuilding their homes and communities, CARE provided iron sheeting, tools and other household items to approximately 1,800 people. We also repaired major water and sanitation systems, and helped 30 communities to build latrines and washing facilities. CARE used cash-for-work programs and livelihood training to allow people to earn money while working on projects to rebuild their communities, including:

• Providing seeds, tools and training for farmers
• Planting trees to prevent landslides and replenish the lumber supply
• Employing people from local communities to clear roads and footpaths

Health Care

Even before the earthquake, access to health care was a significant hurdle throughout the Allai Valley. Facilities were spread out over great distances, making it especially difficult for women and children to obtain regular treatment. With the destruction of those facilities, CARE began operating a series of village-based tent clinics. Each clinic is staffed with CARE-trained community volunteers who administer first aid, post-surgery follow-up, and treatment and identification of minor ailments. To date, CARE has trained a total of 200 volunteers, one-half women, who have treated nearly 18,000 patients, mostly women and children.

Education

Of the 215 schools in the Allai Valley, about 200 were badly damaged or destroyed by October's earthquake, and education came to a virtual standstill. CARE has been working to provide transitional schools where children can resume their studies as quickly and safely as possible. CARE is building sturdy transitional schools in communities throughout the Allai Valley and stocking them with furniture, equipment and other learning materials both for teachers and students. Permanent structures will be erected nearby, and the transitional buildings will be used as school offices or community centers. We have also organized sports tournaments and established playgrounds to help children to return emotionally to their normal lives.

Reconstruction and Rehabilitation

Although CARE's presence in the area began with emergency relief, there was a dire need for community development long before October's disaster. One key component to making a difference over the long term is the empowerment of individuals, communities and local partners in the decision making process.

Housing

Helping people build sturdy, permanent places to live is a key focus of CARE's reconstruction strategy. CARE is holding intensive 12-day workshops to train master craftsmen — masons, electricians, plumbers and metal workers — in quake-resistant construction techniques.

Gender Equity

Traditional beliefs in the Allai Valley prevent many women from leaving their homes or even interacting with other women. Emergency preparedness training has provided one way to address women's education. By teaching women how to safeguard their homes and families, we are now have an opportunity to introduce them to vocational training, savings and credit. When women come together, they begin to talk openly about common challenges and aspirations, working together and speaking with a stronger, more unified voice.

Nutrition

Simply put, poor people often lack the resources to maintain a healthy, balanced diet; when the earthquake destroyed most of the area's food crop, the problem of malnutrition intensified. But even when food is plentiful, most traditional diets rely heavily on bread and dairy products, with few nutrients from green vegetables or meat protein. CARE is monitoring the nutritional status of children, pregnant women and nursing mothers and training women's groups in food preparation and nutrition education.