Off the Grid

A journey into the world of Karachi’s neglected population of Afghan refugees

Afghan refugees, who crossed the Pakistani border, arrive in Shakirpur, Pakistan, on 13 October 2001. BULIT MARQUEZ / AP PHOTO
Afghan refugees, who crossed the Pakistani border, arrive in Shakirpur, Pakistan, on 13 October 2001. BULIT MARQUEZ / AP PHOTO
01 February, 2011

AS I DRIVE PAST the Pakistan Air Force dormitories, whizzing past the busy roads leading to Karachi’s Jinnah International Airport, airplanes hover above like bloated mosquitoes in the clear February morning; below them, crows and mynah birds also seem to float calmly in the colourless sky. The first sign that one has landed in Karachi is a giant fluorescent-yellow McDonald’s sign just outside the airport; here, it is the golden arches that greet newly arrived travellers—rather than a flag, a welcome sign or the gleaming visage of some ghastly local politician.

After passing the airport, leaving behind its security officers wearing bullet-proof vests and helmets, things begin to look desolate. Driving away from the hustle and bustle of Karachi proper, the roads begin to seem wider even though they’re not; there are just fewer cars on them. I pass a spate of schools, all in gaudy residential bungalows, their names painted across their gates and balconies: My Little World School, White House Grammar School, Middle East Middle School. On the left-hand side of the road, there is a wasteland; on the right, more learning centres, with names like ‘Little Hearts Grammar School (Parsi Administration).’

But the wasteland will not remain barren for long: a massive golf club, resort and spectacular getaway for the rich is being built on the recently levelled land. Billboards mark the boundaries of the luxury retreat, depicting Arab-looking businessmen grinning at Western-style houses, confident golfers resembling a pre-scandal Tiger Woods, and glittering glass lobbies staffed by legions of secretaries, all of whom will be stomping through this dry land, with its wild shrubs and rocky soil, soon enough.

I pass by Gulistan-e-Jauhar, by more army bases, by land that has reportedly been bought by the Aga Khan Foundation, and by even more army-owned land, which the businessmen-in-uniform plan to transform into extensions of the existing Defence Housing Authority schemes that have already expanded throughout the city.

At a toll plaza, I pay a small note to the man sitting in the window. Another man, in a gray shalwar kameez, strolls between the stalled cars selling oranges and small apples in plastic shopping bags, shouting out prices to the truck drivers. There are a lot of trucks now: this is Karachi’s transport hub, where violence had recently erupted between the Pathans who control the transport in the Sohrab Goth suburb that links Karachi to the rest of the country and the Urdu-speaking Muhajirs who seek to relieve them of their power—shootings and riots and killings. Today, it’s quiet.

I see a large truck, filled with timber and painted in the vibrant Pakistani style, with splashes of bright colour everywhere; bright green decals plastered across the mud flaps say “dekh magar payar se”—“look, but with love”—a popular transport vehicle flirt. This bus has unicorns dancing in a Kashimiri landscape, icy mountains and flowing rivers, with a portrait of General Musharraf posed in the middle. It takes me a minute to make out the general; he’s painted with such soft-focus adoration that he looks more like an aged Korean granny—smooth skin and bouffant hair, even with the epaulettes.

After a series of forks in the road—heading to Hyderabad, Lasbela and Hub in Balochistan—I continue on toward Sohrab Goth. But there is no way to know where I am really going. A map of Karachi, produced by Haqqi Brothers and bought at the city’s teeming Urdu Bazaar, is laid out on my desk at home. The map is a big mess of blue, pink, purple and orange districts and dots. It tells me that my destination, the Afghan Muhajir Refugee Camp, is not in Sohrab Goth—which is not even on the map—but in Gadap Town, somewhere near the Dreamworld Resort Hotel & Golf Club and the Cosy Water Park. (The map, however, also says, in small print at the bottom of the Arabian Sea, “Information at the map are [sic] not authentic.”) According to another map I’ve bought, which only confuses me further, the refugee camp appears to be either in Gulshan-e-Maymar or Gulshan-e-Mehran. It’s huddled between the crossfires of what the map identifies as a ‘principal road’ and a ‘main road.’ I’m not sure what the difference is, or if, in fact, there is any difference. It’s in North Karachi, no one disagrees there. But its actual location is unimportant: there are no buses that travel to the Afghan Muhajir Refugee Camp; for all intents and purposes, it is entirely off the grid. These are the sticks. This is not a town.

Upon entering the camp, you are met by one-room mud stores, stacked high with empty glass bottles of Mirinda and 7-Up warming under the midday sun. They will be recycled for a pittance and then used again without being washed. The bottles are dirty as only glass can be, scratched and cloudy where repeated use has marked them. There are posters of Indian film actresses and health pamphlets from the UN High Commissioner for Refugees (UNHCR) on tuberculosis and polio taped to the walls, but again, there is something old and used about this decorative wallpaper.

I WAS BORN IN KABUL, and I am, if only through blood ties—not by love or the constancy of family—half-Afghan. Being Afghan in this way, Afghan-born or half-Afghan, as though it is a condition, has always felt complicated to me: it means that my interest in and attention to the country of my birth was not decided for me.

I have chosen to be connected to this particular condition in part because of the suffering I can see among the Afghan refugees all around me in my city, in my Karachi; because of the friendliness, because of something mountainous and something destroyed about all the Afghans whom I have met at conferences and textile bazaars and electronics markets and airport terminals. There is a pride, now somewhat fractured, that I gravitate toward; it is the same sort of wounded confidence that comes to the surface when I correct people who presume that I was born in Pakistan.

I have an open heart, I confess. I’m from a lot of places, and I leave myself in suitcases and airports and border places.

According to the UNHCR, for the past two decades Pakistan has been home to the largest refugee population in the world. Afghans who fled their homes after the Soviet invasion in 1979—and the American-and Saudi-backed civil war that quickly followed—settled in Pakistan and Iran. By 1988, according to a New York Times article written that year, some 3.3 million Afghans were living in Pakistan. Another two million had settled in Iran—perhaps an easier place to adjust to, given the connection between Dari and Persian, and yet a crueller host to its linguistically familiar refugees.

Afghans in Iran are forced to work below the radar, thanks to laws that make it difficult for them to legally hold jobs; and the country’s recent high levels of unemployment have made it increasingly hard to find labour even in the black market. Low-paid construction work and under-the-table odd-jobs are no longer a safe bet for those without identity cards—and the refugees will never get identity cards; they are treated like ghosts, as shadows of people. When I was in Tehran three years ago, the only Afghans I noticed were little boys selling chewing gum and hard candy for pennies off wooden slabs tied around their necks.

After 11 September 2001 and the American invasion of Afghanistan, another wave of refugees fled from the rubble. The number of Afghans in Pakistan swelled to five million—including those who had been born here to refugees who came after 1979.

The refugees in Pakistan live in camps—in actual camps.  Before it was closed in 2002, the Jalozai camp in the North- West Frontier Province (NWFP), one of the largest in the country, resembled a plastic city: tens of thousands of Afghans lived in tents made from garbage bin liners or thin plastic sheets. Jemima Khan, the author and journalist who brought the world’s attention to the squalor of Jalozai, wrote this about her first visit to the camp: “At first sight, the camp resembles a vast dumping ground. Thousands of aimless people are wandering between endless rows of miniature makeshift plastic tents, one next to the other with no space between them…children barefoot and in rags are everywhere…the few latrines that do exist have not been dug deep enough and are overflowing, running in filthy streams through the camp and into tents.” Jalozai, a UNHCR official told Khan, was “fast turning into a death camp,” so dire was the condition of its refugees.

In the summer of 2007, I visited one of the largest Afghan refugee camps in Peshawar, Kacha Garhi. At the time, the camp was home to more than 100,000 refugees—and it was a week away from being shut down. The Pakistani government, assisted by the UNHCR, had been pushing for repatriation since 2002, trying to uproot the refugees who had only just escaped a fresh round of war and occupation. In 2005, Pakistan began a registration process by which Proof of Registration (PoR) cards were issued to about 2.15 million refugees over the next two years. In Iran, meanwhile, the official number of Afghan refugees dwindled to under a million as repatriation programs were pursued in earnest, a move that caused the Afghan parliament to write an open letter to the Iranian state asking the government to halt their deportation drive until the worst of the winter had passed.

The mud homes in Kacha Garhi each housed an average of 20 people. I myself saw 11 people file out of one house myself, walking sideways in alleys that were too cramped to allow more than one person through their dusty corridors. Garbage and open, festering sewers were everywhere. Bulldozers were already in action, razing parts of the camp to the ground. Three years later, Kacha Garhi has come back into action as a refugee camp, but now it houses Pakistan’s own internally displaced, refugees from the army’s wars in Swat and Waziristan.

In 2007, Pakistan began seriously pursuing repatriation. According to the UNHCR, 350,000 Afghan refugees were repatriated between the spring and winter of that year, each armed with a generous 100-dollar stipend—though in Katcha Garhi, I was told the real figure was closer to 60 dollars. Many in Pakistan claim that that families took the money, crossed the border, gave the cash to friends or relatives still stuck in Afghanistan, and then turned around and returned to Pakistan. Or that they come and go between the two countries, leaving when danger strikes either soil and returning when safety is assured. The official numbers are dubious at best: according to the UNHCR, 80 percent of the Afghan refugees in the NWFP were repatriated in 2007—though only three percent of those in Sindh returned home—leaving two million refugees in Pakistan. As of March 2009, the UNHCR reported 1.7 million registered Afghan refugees in Pakistan, with the largest communities in Peshawar, Quetta and Karachi. But the number of unregistered remains unknown.

THERE IS NO SIGN OUTSIDE Is Islamia Public School: it is a plain cement building located near a monstrous garbage dump. As I walk toward the front door, I notice several children picking scraps of paper from the rubbish heap. There doesn’t seem to be anything worth recycling or reselling in the dump, and the children are simply scavenging for scraps of paper.

I find out later that the child garbage-sorters get 5,000 Pakistani rupees (around 2,600 Indian rupees) a month; Pakistanis feel such labour is beneath them, so the garbage dump bosses employ Afghan children. They are prized collectors: their nimble fingers and their small bodies allow them to crawl into the mounds of trash and return with the most valuable of the refuse. In addition to the money—I can’t decide if it’s surprisingly large or surprisingly small—the bosses give the children one meal each day and pay off the police to leave them alone.

Outside the school there are also three boys, each no more than five years old, tiny things playing cricket with a splintered log that wouldn’t even do for firewood. They are wearing finely woven skullcaps and shriek with delight every time they hit a run. I can hear the sound of the students inside the school chanting, repeating lessons out loud, but their voices are drowning out my knocks, and I haven’t been let inside. I see two girls walking barefoot between the cricketing boys, their hair streaked with blond wisps, a tell-tale sign of malnutrition, and matted together and as they stop to smile at me I start to make a tally in my notebook: Nine children not at school.

Eventually, the door is opened, and I meet Miss Naila, a young teacher who shares administrative duties with the school’s principal, a young man. They tell me that they thought I had forgotten about them since I last visited a month ago. This is how the principal greets me each time I come to the school; it used to send shivers of guilt all through me, but now it’s become a routine.

Hasan Islamia Public School is not a madrassa. It is a privately run school that offers 190 students education in Urdu and English mediums. Unlike the other schools in the Afghan Muhajir Refugee Camp, this school does not operate in Dari or Pashto. It is a conscious choice, Miss Naila tells me, in order to help the children assimilate into Pakistan. The principal agrees. “We are in Pakistan, we want to learn Pakistani languages—we have to learn them,” he says. “Plus, we already speak Dari.”

My first visit to Hasan Islamia Public School had been on a Friday in December. It was a public holiday—both Christmas and the birthday of Mohammad Ali Jinnah (said to have been moved to 25 December so as to give the Christian minority an easily explainable holiday)—but it was still a school day, and as I walked through the classrooms I counted only a handful of students present, about 30 or 40 of the 190 officially enrolled. But they hadn’t taken the day off for the holiday: it was a working Friday and there was big business at the nearby vegetable market, Sabzi Mandi. The children often skipped school to work for tips at the bazaar, carrying wicker baskets of people’s groceries for 50 rupees: small boys working as mazdoors haul baskets double their size and bodyweight for a pittance.

The school runs from nursery through grade eight; the lower classrooms, up to grade two, are crammed full of children. There are 12-year-old boys in kindergarten, sitting upright and heads taller than their peers. “They have to start from the beginning,” Naila explains. “Otherwise, how will they learn?” The older students, giants among their classmates, don’t seem to mind, or at least not to care.

Naila, who has a high-pitched voice and a sweet face that turns stern when she addresses her students, tells me that attendance is strongest in the lower classes, since many children are forced to drop out around the third grade to work and bring in extra income for their families, many of whom are unregistered refugees. The tuition fee at Hasan Islamia is only 200 Pakistani rupees, but it’s too much for most families to afford. The school doesn’t expel students who can’t pay the fees, but the teachers—there are 12 on staff—have to be paid somehow.

When I ask Naila and the principal how many people live in the Afghan Muhajir Refugee Camp, each mulls over the question for a little while. “Maybe 10,000,” Naila says, bobbing her head as if she’s calculating the answer. The principal disagrees. “No, no,” he says, “it’s more like 12,000 or 15,000.” I’m not sure whether these figures represent the actual number of refugees in the camp or only those who are registered. Naila tells me that most of the students’ parents are unregistered; one boy’s elder brother was recently held and beaten by the police when he was caught in the camp without the proper papers. I later find out that the real population of the camp is between 50,000 and 80,000.

I have visited a lot of schools—from Montessoris in slums to colleges in villages—but I’ve never seen anything like Hasan Islamia. The children are all wearing dirty uniforms—pale blue shirts with navy trousers. There is dirt under their fingernails and they have scabs and rashes on their faces. Green snot sniffles out of the younger boys noses and I can’t help but wonder about the last time they changed their uniforms. It’s cold in Karachi in December, by our standards at least, and there are no heaters here to provide protection from the passing cold. The children don’t have sweaters. Many of the classrooms don’t have thatched roofs, or doors—just empty frames where windows and doors should be.

The children are a mix of Afghans, Pashtuns and even Uzbeks. When I ask Naila how the Uzbeks ended up here, her plum-painted lips tighten. “It happens,” she replies noncommittally. Nobody wants to acknowledge the possibility that foreign fighters from Uzbekistan may have decided to quit their day jobs and settle permanently in Karachi. The Uzbek boy I meet in class is not yet 10 years old, and he is beautiful and shy. I do not ask him what his father does. When I tell people about the Uzbek children in the camp, their immediate response is to scream “terrorists” or “al- Qaeda” at me; others simply give a knowing look and smugly arch their eyebrows.

The children sit on old desks that look like discarded church pews. They huddle together, two or three children to a book, though Naila tells me there are enough books for everyone. The teachers are all young women, and none of them are Afghan. They all look tired and infinitely aware of their lack of power.

The principal proudly tells me they have built a tuck shop recently so that children need not go home for lunch, where they get stuck working around the house or are sent out to run errands for their overworked and underpaid parents. It’s really a tuck trolley, not a shop, not even a stand. They built it from old wood and stocked it with chips and soft drinks and Gluco Biscuits. There is a single water fountain for all the students to drink from with three metal taps and one cup that the boys and girls take turns drinking out of. The classes are co-ed, and the classroom walls are festooned with small Pakistani flags and maps of their new country drawn in chalk.

“We need so much,” the principal tells me. I ask him what he needs, and realise it is a stupid question. Everything, they need everything. He and Naila start to make a list, counting on their fingers: “Furniture, fans, desks, a library, a small patch of garden for the children to play in, bags, uniforms.” What don’t they need?

As I am leaving the school one day, the principal stops me. Please come with me, he says; there is a girl who has just returned to school after being forced to drop out due to financial hardship. “You will motivate her,” he adds, as an instruction rather than an observation. Her name is Fatima, too. I meet a lot of also-Fatimas on my journeys around Karachi.

Fatima is in the sixth grade. She has a fair, moon-shaped face with light freckles that crowd her nose and forehead. She wears a white hijab, its edges trimmed with delicate lace. She is not bowled over by our common name and seems nervous about what the principal assumed would be a boisterously joyous and inspirational encounter. The principal tells me that Fatima’s father cannot afford the tuition fees and keeps taking her out of school. Her elder brothers keep persuading him to send her back. Go on, he tells me, motivate her.

I am on the spot. Everyone is waiting for me to say something fascinating—the students, the teacher, Naila, the principal, my friends who have come to visit the school with me. I ask Fatima what she wants to be when she grows up. A scientist, she says. I tell her I was never particularly great at science. She giggles. Stay in school, I say, your brothers are right. I can’t help feeling underwhelmed by my life lesson. There’s quiet. I hold Fatima’s hand and tell her that I’ll come back to check on her. I can hear the principal’s voice in my head, warning me not to forget this girl who shares my name, who I have been ordered to encourage. Fatima remains silent, nodding at me and stealing sideways glances at her friends. Tell me about science, I say, and she begins to talk.

My tally of children roaming the camp, picking garbage, playing cricket and out of school reaches 24 by the time I leave. I don’t know how many I missed when my head was down scratching numbers in my notebook.

SO FAR AS I CAN TELL, the Afghan Muhajir Refugee Camp has only one medical facility, run by the Marie Adelaide Leprosy Cenrer (MALC). There is a sign outside the clinic written in English and in Urdu, which says, “Operation Days: 1. Monday vaccinations, baby clinic. 2. Thursday eye clinic, baby clinic.” For Wednesday, the sign says “disable children,” though presumably on this day the doctors cater to disabled children rather than disabling them. Friday rounds off the week by dealing with tuberculosis and skin diseases and another baby clinic.

I duck inside the MALC clinic in the camp. There are two administrative coordinators, both Hazara. Dr.Abbas, one of the men, tells me that skin diseases are a major problem in the camp. Kharish, scabies, is rampant because of the filthy water. Women struggle with severe anemia because of poor diets and malnutrition. I see a woman in a long chador hold her pink-cheeked baby girl while she waits for the doctor to jab her arm with an anti-tetanus vaccine. Dr Abbas tells me the clinic treats 50 to 60 patients daily, but there are 20 people waiting for him already and it’s not even noon.

“How come there’s a clinic here?” I ask, given that the camp has no government facilities, no public schools, no hospitals, no water lines and no bus service. How did this leprosy non-governmental organization turn up here? Dr Abbas suggests that I should visit the MALC headquarters, in Saddar, for the answer.

The MALC was founded in 1956 by a group of gutsy foreign nuns who came to Karachi armed with their medical degrees and the three vows of their religious order, the Society of Daughters of the Heart of Mary: poverty, chastity and obedience. Dr Ruth Pfau was a 30-year-old German novice when she landed in Karachi on a flight from Paris, hoping to secure an Indian visa and cross the border to do charitable work. Not long after she arrived in Karachi, a fellow nun, Sister Bernice Vargas, a pharmacist from Mexico, invited Pfau to the McLeod Road Leper Colony, in Karachi’s commercial centre.

In 1960, McLeod Road was a filthy ghetto stacked to the brim with houses woven from straw, and had sewage that ran ankle deep; stray diseased dogs were the leper colony’s only visitors. Dr Pfau tells me that when she was first taken to McLeod Road by her “sister in religion” she met lepers who had their hands bitten to the bone by rats, indifferent to the maggots feeding on their open wounds because leprosy had rendered them numb, like living cadavers.

The sisters lived in nun’s quarters in the Guru Mandir area of Karachi, named for the neighbourhood’s Hindu temple and now functioning as a transport hub; they travelled to the leper colony twice daily to minister to the men and women there. “Once I knew what was here,” Dr Pfau says, in her still heavily German-accented English, “I stayed.”

Dr Pfau began her work at McLeod Road by building medical histories of the lepers banished to the colony; she organised proper registrations and detailed medical examinations and lab tests. She ran a dispensary in the ghetto, literally built of discarded cardboard, for three years, until enough funds had been raised to allow the plucky nuns to open the MALC, a modern hospital, in Saddar, Karachi’s central business district. After the hospital opened, Dr Pfau says, local residents came to pelt their offices with eggs and tomatoes: nobody wanted the lepers in their pristine neighbourhoods.

Anti-Christian allegations also began to swirl around the nuns, claiming that THE MALC was a centre for Christian conversion—sort of like the “stress test” offices run by Scientologists around the globe: you come in for a stress test, discover you’re beyond repair, and the next thing you know you’re buying home e-meters and reading up on Dianetics. (For the curious: there is a Scientology centre in Karachi. It’s well-hidden.) The rumours were dispelled by the new organisation’s many Muslim staffers and supporters—society begums with big hearts, philanthropic benefactors and those who received full patient care all came to the MALC’s defence. By 1968, Dr Pfau and her staff had managed to convince the Pakistani government to kick-start a national leprosy-control programme.

Dr Pfau has been here ever since. She has traveled to worked with lepers and tuberculosis patients from Swat and central Afghanistan. She has been feted by a succession of governments (even by those normally praise-stingy dictators) and given numerous national honours, including honorary citizenship, not an easy prize to come by. For her part, Dr Pfau has stuck it out: she lasted through all the India-Pakistan wars, refusing to evacuate and head home to Germany in 1965 even after her embassy told her it could not protect her if she stayed. “Pakistan, mere dil ka mulk” (Pakistan, my heart’s country),” she says.

With just about 200 sub-centres and 170 clinics across the country—even in Pakistan-controlled Kashmir, where they have had a presence since 1967—and a team of close to 1,000 NGO and government workers, the MALC is Pakistan’s only leprosy hospital. They offer completely free treatment, gratis reconstructive surgery and constant inpatient care, having now branched out from leprosy—which the MALC reduced to control limits devised by the World Health Organization in 1996, four years ahead of the millennium deadline—into the additional fields of tuberculosis and blindness.

Dr Zia Mutaher, the MALC national coordinator (medical) and the author of a biography of Dr Pfau, takes me around the leprosy wards when I visit the MALC’s bustling hospital. In the men’s ward, I see mostly white-haired patients in the middle of their lunch hour, chomping through saag, channa and rice. He then takes me to the women’s ward, and again I see no one remotely near childhood or adolescence. The patients are all elderly and will be on the MALC’s treatment course from six months to close to about two years. Dr Mutaher keeps pushing further into the rooms, and I am aware that I’m just about clinging to the door.

I recall that in high school, someone from the MALC came to give us a lecture on leprosy and the stigma attached to its sufferers. But at this point, all I can remember are stories of Mother Teresa drinking the lepers’ saliva, stories about how the disease is hard to contract, and other shards and shreds of information that led me to believe—Mother Teresa aside—that contagion levels were high. Basically, I remember nothing. I’m standing here in a leprosy ward years later, wondering if I’m going to go home and infect my family. I consider asking Dr Mutaher how exactly one gets leprosy, but I decide that we’re already way past that point. And before I know it, we’re on to the TB wards. Now I’m completely certain that I’m going home with something.

He tells me that TB is more common in Pakistan than leprosy, but that preventable blindness—largely due to poor nutrition, cataracts and the unhygienic, dry and dusty landscapes that are conducive to trachoma—is what brings in most of the MALC’s patients these days. I’m wafted by a wave of relief. “I’ve had trachoma,” I announce proudly to Dr Mutaher, imagining that he is as interested in my ability to contract one of the MALC’s diseases as I am. He nods sympathetically.

Now that its been acknowledged that I’ve had trachoma, I feel less susceptible to the leprosy and TB going around and am able to relax. Dr Mutaher takes me to meet the MALC’s CEO—Shakil Ahmad, a Muslim, it bears noting—who tells me that I’m in luck because Dr Pfau is here today and I will be lucky enough to secure an audience with her so that we can discuss the MALC clinic in the dispossessed Afghan Muhajir Refugee Camp.

It turns out that I’m very lucky indeed. Over milky chai, I get not only the organisation’s CEO, its founder, various staff and administrators, doctors, but also an Austrian volunteer named Claudia Villani, who wears round glasses and a colourful tunic and tells me she’s been here for several months but will leave before the city gets too hot.

Dr Pfau is smaller than her legend would suggest; she is crumpled by age but still wildly energetic and enthusiastic about her work. We sit next to each other on a comfortable sofa and begin to speak about the Afghan Muhajir Refugee Camp, which has brought me to the MALC’s doorstep. Dr Pfau, whose hair is clipped short and is ice white, wears a plain white shalwar kameez over a long white undershirt, the kind my Lebanese grandfather would wear. She looks austere and serious, like a doctor or a nun—appropriately enough given that she is both. The lines on her face are set permanently into a smile, and in her thick accent, she begins to tell me how the MALC set up its clinic, the only one of its kind, in the Afghan Muhajir Refugee Camp.

Dr Pfau tells me that she believes the camp’s population is now closer to 80,000. “Who knows?” Claudia adds. “Look at Karachi, no one knows if there are 14 million people living here or 20 million.” The MALC has determined that 40 mosques are operating in the camp, Claudia says, but after two months she only knows perhaps only 1 percent of the residents. “Dr Pfau said she wanted me to work in the camp,” Claudia tells me. “I asked her why and she replied because I was crazy enough to handle it.”

The MALC’s leprosy, preventable blindness and TB control centres are staffed and run by committed and enthusiastic doctors, the CEO tells me, so they decided to go further into community development, which is how they came to the Afghan Muhajir Refugee Camp. “We pick the most needy communities to focus primary healthcare and basic education facilities towards,” he says. “We worked with Hindu communities in Adam Goth, with bonded labourers in the interior of Sindh. Whenever we come across a marginalised group, we try to support them.” Dr Pfau is particularly distressed by what they found in the camp. “We haven’t seen so much misery as we see among those Afghans,” she says, clucking her tongue.

The MALC has been in the camp for a year. Its first job, Dr. Pfau says, was to convince the Tajiks and the Uzbeks and the Pashto-and Dari-speakers that they all shared the same difficulties and that it was in their interest to work together. “This took the whole year, to get these groups together,” she chuckles. The camp has no access to potable water; there are no waterlines set up to reach the homes of tens of thousands of people who depend on the state to care for them. The prevalence of dirty water is one reason why scabies is rampant among children in the camp; diarrhea is still a major killer here as well. Shakil Ahmad, MALC’s CEO, approached the city government of Karachi to ask for their help in securing water for the people of the Afghan Muhajir Refugee Camp. He was asked to send his plea in writing, which he did, but nothing happened. “We followed it up,” he tells me. “But you know the situation. You know how it is—they have no heart for these refugees.” Dr Pfau jumps in: “The mayor said to us, this settlement is illegal, the people are illegal.”

The government has been particularly useless on this front: the whole city of Karachi runs on a desperate thirst for clean, potable water. The MALC had no choice but to turn to private water suppliers, as the majority of wealthy citizens have long been forced to do, and hire tankers to carry in water for the camp. They currently have three tankers, bringing in potable water in daily, but it’s not enough. They need at least ten, but can’t afford it. The government gives a token donation to the MALC, previously four million Pakistani rupees, which was and upped this year to ten million, though a MALC administrator who asks not to be named is quick to tell me that they have yet to receive the first cheque. The burden on raising funds during this shaky economic period falls to Dr Pfau, who travels to Germany every few months to lobby for donations. I ask her if she is still permanently based in Karachi. Don’t the demands of having to fly back and forth to Germany put a strain on her? “I don’t know where else I would be based if not here in Karachi!” Dr Pfau exclaims, amused by the very question.

Besides battling for water with the city government, the MALC works with young mothers in the camp. The clinic tries to enhance their nutrition to ensure they’re able to breastfeed, vaccinates women and children, and struggles with a plethora of languages through translators to bring the notion of family planning to the camp’s younger residents.

But there is a larger shadow that looms over the Afghan Muhajir Refugee Camp, a spectre that no one wants to talk about, though Dr Pfau is quick to offer her thoughts. “What frightens me is that these refugees came in the 1980s,” she says, shaking her head and wringing her hands in her lap. “We had 30 years to offer them alternatives. We still have a chance to do something for them in Karachi at least. We bred the Taliban in the Baloch refugee camps and in the northern ones. We still have a chance to change that here, but the Afghans are as miserable as they were when they arrived 30 years ago.”

Without amenities from the state or local governments the refugees have had to turn elsewhere for medical care, job opportunities and welfare. We’ve watched the power of fundamentalist and militant movements grow in Pakistan over the past few decades, not because their ideology has become more persuasive or their politics more nuanced, but simply because when a slum doesn’t have a school they come and build a madrassa. When northern Pakistan was hit by a devastating earthquake in 2005, measuring 8.2 on the Richter scale and killing more than 100,000, it was the Islamic parties, not the state that were first on the scene, setting up tent villages for the homeless—complete with dark green tent mosques.

“This is how one de-Talibanises,” Dr. Pfau says. I almost make a comment on her optimism, given how late to the game everyone seems to be. But then I remember that this is the woman who controlled leprosy—what’s fundamentalism? I ask if they feel afraid, though, working in the camp, knowing that they may be competing with the other groups seeking to exert influence over the needy refugees. “Never.” Claudia says the traffic on the lazy way to Sohrab Goth is more dangerous than anything they’ve seen in the field.

“The fact is there is so much need here,” Dr Pfau continues. “I go to Germany and think it’s beautiful because it’s a place of law, everyone is equal before the law, but then I am needed here.”

SO FAR, THE UNHCR has helped more than 150,000 Afghan refugees leave Karachi under its repatriation programme, though many eventually drift back. As of January 2010, there were an estimated 131,000 Afghan refugees in Karachi, just over half of whom were registered.

On another Sunday, I visit a flea market and out of my hyperactive sense of guilt, pick up small Afghan mazdoors as I go from stall to stall. I figure that the more I employ, the lighter their load, and the more money I can dole out for this month’s tuition fees. One of the boys, the one who wears a dusty turquoise shalwar kameez that is ripped at the side, does not appreciate my guilt. “Why so many of us?” he complains. “I can carry everything.” I assure him of my anxiously honourable intentions. He tells me he is from Kabul. I ask him where he lives now, and he says his family lives in a refugee camp. He adds that I would never know it—given that I’m a Sunday flea-market shopper, it’s not the kind of place I would frequent. I don’t say anything. I don’t think he’s going home anytime soon.

On the way out of the market, I spot some  small yellow melons and decide for the first time in my rather undomesticated shopping routine that I shall meander over to the fruit stalls and buy some fruit for the house. I discover that about two melons weigh a kilo. I need much more than that. I stand by the melons. Do I smell them? Or grope them? Should they be soft? Or hard? Yellow? Or greenish? My little Kabuli mazdoor interrupts my attempt to be convincing at melon purchasing and points his fingers at various melons, “Buy these ones, bhaji,” he says, nodding along as I follow his instructions without a word.