Refugee Affected and Hosting Areas (RAHA)

Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014

District Lahore 1. Profile of District Lahore 1.1. Demography  Total Population (est. 2011) 8,739,000  Total Area 2014 square km  Annual growth rate 5.6%  Population density 8,200 persons/sq. km

1.2. Tehsil and Town wise Details

Lahore is comprised of two tehsils i.e. Lahore city and Lahore Cantt. While these tehsils are further divided into nine towns as under:

i. Nishtar Town; ii. Gulberg Town; iii. Aziz Bhatti Town; iv. Allama Iqbal Town; v. Ravi Town; vi. Shalamar Town; vii. Samanabad Town; viii. Wahgah Town; ix. Data GunjBakhsh Town.

Afghan Population in Lahore: 10,966 registered PoR cards holders Afghans Refugee reside in Lahore as per the Afghan National Registration database. However, since Lahore is the commercial hub of Punjab and center of business and industries, it attracts a lot of working and labor class, of both Pakistani and Afghan nationality, from around Punjab and other provinces of Pakistan. Hence the actual number of Afghans both registered and unregistered, mainly of young age, hosted by Lahore at any particular time is far more than the registered 10,966. Tehsil wise break down of Afghan population in Lahore is as under: Sr.No. Name of Tehsil Afghan Population 1 Lahore City 10,628 2 Lahore Cantt 338 TOTAL 10,966 Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014

2. RAHA targeted Area: 2.1. Rational: Out of the 10, 966 Afghans registered in district Lahore 10,628 (97% of the total) are registered in Lahore city. It is estimated that more than 80% of the Afghans, registered in Lahore city, live in Data Ganj Bakhsh town that is the center of the city and has most of the labor jobs. For the purpose of prioritization of RAHA intervention the UCs with large concentration of Afghan within Data Ganj Bakhsh Town shall be targeted.

2.2. Methodology Refugee Affected and Hosting Area (RAHA) programme was piloted in Punjab province in year 2012. In the first phase 4 refugee hosting districts i.e. Lahore, Rawalpindi, Attock and Mianwali were identified for the programme implementation however in the pilot phase 5 projects were implemented in Lahore and Mianwali district in year 2012. To implement the programme in a more comprehensive manner, a need identification and prioritization exercise has been launched. For the purpose of Comprehensive Needs Assessment (CNA) exercise for RAHA initiative within Punjab province a series of consultations were held with major stakeholders. Inputs relating to specific targeted areas and sectors were obtained from Govt. interlocutors, Line departments, NGO partners, community and UN sister agencies. Punjab is more than 55% of Pakistan, population wise, having almost 100 million population. Identification of targeted area within four RAHA districts was made by narrowing the target area to Tehsil and further to UC level. The mapping of Tehsils and UCs with high concentration of Afghans was made with the help of Afghan Nation Registration (ANR) and SCAC database and PPV data, where available. The area identification was further confirmed/ validated through field visits, consultation with CAR and respective district administration, partners working in the area and UNHCR field teams. Since RAHA initiative is relatively new to Punjab province hence the area of intervention is limited to four sectors i.e. Education, Health, WatSan and Livelihood however other sectors especially the cross cutting sectors i.e. Social Protection and Environmental protection remains part of the overall intervention under RAHA programme. Needs identification has been, primarily, based on secondary data available with Govt. line departments, other organizations and agencies. Secondary data has been secured from all possible sources within the targeted districts and analyzed to identify unmet needs. In some areas consultative discussions have also been conducted with the concerned line department authorities.

2. SECTOR WISE FINDINGS: 2.1 Health: The devolution process in 2004 brought a paradigm shift in the health sector in Pakistan where planning became a district responsibility. Planning focus changed from short term to medium term planning recognizing the flexibility /adaptability it provided. Government of Punjab adopted medium term plan .i.e. 3YRP to use health resources effectively and Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014 efficiently through adapting Minimum Service Delivery Standards (MSDS) as the strategy to achieve objectives of MDGs. Lahore like other districts in Punjab prepared their 3YRP (medium term plan) under the auspices/patronage of Department of Health (DoH) Government of Punjab through technical assistance of Punjab Devolved Program Social Services Programme (PDSSP). During year 2010-13 government of the Punjab through Health Sector Reforms Program (HSRP) with the technical assistance from a team of consultants (SP09) and wide consultations/inputs from all key stake holders established a bench mark in standardization of the format of 3YRP, where capacity building of the districts has been done on the standardized format.

2.1.1 Existing Health Facilities Health infrastructure in district Lahore is very well established and equipped. Lahore district has three teaching/ tertiary care hospital, two district Head Quarter hospitals and two Tehsil Head Quarter hospitals. Moreover a wide spread network of basic health units and rural health care centers are providing basic health facilities at far-flung areas. Details of the health facilities are provided in the table below.

Besides the Govt. health facilities District Rawalpindi has 100s of different private hospitals including very sophisticated and high tech private surgical hospitals.

Govt. Health Facilities Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014

No. of Bed Facility Type Name of Facility Functional Remarks Strength Beds

DHQ Hospital Government Mian Munshi DHQ Hospital- DHQ-I 150 150 Hospitals required to Government Kot Khawaja 149 149 be up Saeed Hospital- DHQ-II -graded

THQ Hospital Said Mutha Hosptal -THQ-I- 50 50 Mozang Hospital-THQ-II 20 20

RHCs 6 RHC’S 120 120 -----

BHUs 37 74 74 ------

MCH Centers 23 ------

Sub Health 2 ------Centers

TB Clinics Government infectious diseases hospital

Health houses 1856 ------

Besides the above health facilities that are run under the supervision of the EDO health, there are three main teaching hospitals that are autonomous and work under the overall supervision on provincial secretary health and the Director General health Punjab.

2.1.2 Private Health Facilities Private sector is also contributing in provision of health services in the district. In absence of any registration and regulatory mechanism, actual situation of private sector is not known. With the passage of time, role of private health care providers has expanded and there is a need to develop an effective coordination between public and private sector. It is not possible to annex at all the lists of private providers working in mega city of Lahore.

2.1.3. Identified needs The district is highly populated however one of the better planned city. The health facilities available are availed by both local and Afghan population. In Pakistan, generally, Afghans are able to receive the Govt. provided free health care. Due to having good health services a large population from adjacent districts also come to Lahore for treatment and admission to Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014 hospitals. The need is rather greater than what can be quantified. Apart from the medicine and equipment; there is need to rehabilitate and reconstruct some smaller units that could help reduce burden on the city health services. Furthermore better health facilities available at village level could help in early response especially in case of delivery and child-mother care. One of the most pressing needs identified in most of the BHUs, RHCs, TQHs and even at the DHQ and teaching hospitals’ level is that of equipment. The blood banks need supplies and new machinery. Diagnosis and treatment of infections can only be ensured through efficiently running laboratories and health facilities. Malnutrition needs to be addressed through Provision/Distribution of micro-nutrient supplements especially for children and women. The need to improve health was also identified through Health promotion campaigns. The staff needs capacity building trainings e.g. Integrated Management of Childhood Illnesses (IMCI) and similar ones. One of the most important factors of Lahore health sector is that it provides tertiary health care in most of the complicated health problems to patients from all over Pakistan. Lahore’s specialized health care in referred to from all over by both Pakistani and Afghan patients. One of the examples is the Oral & Maxillofacial Surgery Center at Mayo Hospital Lahore, that provides state of the art Oral cancer treatment and care to the patients of not only district Lahore but from across Punjab/ Pakistan. The Oral & Maxillofacial Surgery treatment benefits both local and Afghan refugee’s community due to excessive use of ‘Naswar’ and ‘Tobacco’ by Pakistani and Afghan refugees causing oral diseases. The Department of Oral and Maxillofacial Surgery is an integral part of emergency services of Mayo Hospital providing 24 hours emergency cover and catering the load and need of emergency department because of an ever-increasing incidence of high speed automobile trauma and increased number of Gunshot victims. The department is also a teaching and training department for post graduate students (both Fellowship and Master) from the whole Country.

Detailed needs are listed in the annex A.

2.2 Education*: Education and Literacy

Literacy rate Overall Lahore Data Ganj Bakhsh District Town Overall District 78.5% 77.8%

In District Lahore there are 1219 Schools in government sector with a total number of 574,832 students enrolled. The Public Sector schools are administered and governed by the Provincial Education Department, imparting education to different standards starting from Primary School to Higher Secondary School. Bing the provincial capital, Lahore, receives big number of students from other areas of Lahore, especially, for higher education. Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014

Data Ganj Bakh Town is mostly comprised of old city areas and commercial markets hence the schools are congested and overcrowded. Due to the unavailability of space, in most of the schools, the % of children educated though Govt. schools is far lower than other districts in Punjab. There is, however, a major contribution of the private sector schools in the education sector maintaining the literacy rate at almost 80%.

2.2.1. Needs in the Education In Lahore the RAHA targeted areas including UC 69, 74, 80 and 83 of the Data Ganj Bakhsh Town. There are total 25 Govt. Schools of Primary, elementary and high/ higher secondary level, including both Girls and Boys schools, in the four targeted UCs of Data Ganj Bakhsh Town in Lahore. The needs in the schools include construction of additional class rooms, renovation of the existing building, boundary wall, construction / renovation of the toilet blocks and WASH facilities, electrification, provision of drinking water, furniture for students, teachers and other staff and teachers’ training. Furthermore while selecting targeted Schools particular attention shall be made to the special needs of Girls schools. Detailed needs are listed in the annex A.

2.3. Water and Sanitation 2.3.1 Water and Sanitation situation in RAHA targeted area The RAHA targeted UCs in district Lahore are mostly urban. The underground water level, in most of the targeted UCs, is very deep and water mostly is contaminated by sewerage lines, chemical/ industrial waste etc. The existing water supply schemes are not regularly maintained and most of the tube wells installed need maintenance. The data on amount of water consumed per person is not available however general observation suggests that it remains far lower than the minimum standard of 20 liters per person per day in most of the targeted UCs. The local as well as refugee population lack basic sanitation and hygiene facilities. Most of the areas are located near the city solid waste sites. The assessment demonstrated that the health status of individuals in communities was poor and that community members lacked basic knowledge of proper health and hygiene practices.

2.3.2 Water and Sanitation needs identified Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014

The water needs identified in the area include installation of tube wells and extension of water supply pipelines in the targeted UCs. In most of the cases, there is need for chlorinators and water treatment/ filtration plants to treat the water.

In the targeted UCs especially areas of Sagiyan the sanitation situation is particularly poor. There is need of pavement of streets and sanitation lines and construction of proper sewerage system.

Furthermore, to meet the needs of clean drinking water in the targeted UCs there is need to install water filtration plants that could help in meeting drinking water needs and prevention of many water borne diseases.

Detailed needs are listed in the annex A.

2.4 Livelihood The RAHA targeted UCs in district Lahore are mostly urban areas located near to the small industrial units and attracts a lot of skilled and unskilled workers including both Pakistanis and Afghan refugees. There are, however, prospective chances of increasing the livelihood opportunities with better earnings by providing specialized training according to the market demand. It is worth mentioning that Afghan refugees are mostly involved in unskilled labor including scavenging hence the need to provide skill training will not only enable both the communities to have better livelihood prospects but also provide the skills needed by the market hence support the local economy. The skills training could also be linked with the needs of the market in Afghanistan which shall enable the Afghan refugees have better livelihood opportunities upon return to Afghanistan and shall support solution strategy for Afghan Refugees and contribute to the regional stability. The skill and vocational trainings could be provided both through the already established Govt. of Punjab technical and vocational training centers offering different skills training according to the market needs and can also be through privately organized livelihood/ skills training with provision of tools required to ensure sustainability in the longer term. Detailed needs are listed in the annex A.

2.5 Social Protection Capacity building support shall be provided to the Govt. Social protection sector though material and technical support. For the purpose of Social Protection support Govt. run institutions providing support to vulnerable individuals including, but not limited to, orphanages, shelter homes, Dar-ul-amaan, crises centers, shelters for SGBV survivors etc. The support could include capacity building initiatives for both the institution and the beneficiaries of the institutions. Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014

Detailed needs are listed in the annex A. Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014

Annex 1. Sector Wise NEEDS identified: District Lahore UC 69, 74, 80 and 83

Sr. Tota Remarks Sector Name Service Structure Needs identified Targeted area Needs’ Detail No l #

1. Construction of Data Gunj Additional Bakhash Town Construction of Rooms UC 69,74, 80 and 1. Construction of rooms in schools in target Additional rooms 83. 2. Construction of areas. is based on the indicator of Toilets 2. Construction of Toilet blocks. 05 Primary, 10 Middle and students per class 1 Education 11 High Schools for boys and 26 3. Repair of 3. Repair of existing schools buildings in rooms. The girls Building target areas. standard of 50 students per class 4. Drinking water 4. Electric Water Cooler in schools. room has been supply applied. 5. Student and office furniture in schools. 5. Electrification 6. Furniture 1. Extension and Construction of wards and 2 Health Mayo Hospital, Lahore. 1. Renovation / Mayo Hospital, duty rooms. construction Lahore. Maxillo Facial 2. Renovation of the existing building Surgery Deptt 3. Equipment: and provision Data Gunj of equipment Bakhash Town o Dengue Surveillance kits, 2. Construction of UC 67 – 86 o Refrigerators, o X-ray Machines, Health facilities in Data Gunj additional o ECG Machine, Bakhash Town UC 67 – 86 wards o Micro scope, there are a total of 34 health 3. Renovation of o Micro lab, facilities. building o Anastasia Machine, 4. Equipment o Ultrasound Machine, o Generator, o Hematology analyzer and Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014 Sr. Tota Remarks Sector Name Service Structure Needs identified Targeted area Needs’ Detail No l # o The blood banks.

Laying of different 1. Water 4000 rft 6 inch dia 6000 rft 4 inch dia pipe line. dia pipe line supply scheme in Rafaiabad. Laying of different UC 83 1500 rft 5 inch dia pipe line. dia pipe line 2. Water supply scheme in Sanat Nagar Tube well Laying of st 45 and 55. UC 80 different dia pipe line Tube well Water Supply 3. Water 5000 rft 6 inch dia 5000 rft 4 inch dia pipe line. supply scheme in Water and 3 Laying of Sewerage Shafiqueaba None. Sanitation pipe line Sewerage system d. UC 69 500 rft 12 inch dia pipe line. 1. Sewerage in Water filtration Sanat Nagar plants with st. 36 electrification connection Installation of Chlorinators at existing tube wells Comprehensive Needs Assessment Refugee Affected and Hosting Areas (RAHA) District Lahore, PUNJAB April-May 2014 Sr. Tota Remarks Sector Name Service Structure Needs identified Targeted area Needs’ Detail No l #

1. Trainings on District Protection and Lahore assistance of the survivors 2. Vocational trainings for the beneficiaries. 1. Construction of additional rooms to house the women and children. Social Govt. Shelter homes 3. Construction of additional 2. Repair and maintenance of the protection and Govt. Rehabilitation centers 4 services for rooms to house existing buildings. persons with Dar-ul-Aman additional number of 3. Water and sanitation improvements. specific needs Crises Centers beneficiaries. 4. Trainings regarding Protection and 4. Repair and vocation. maintenance of the existing buildings. 5. Furniture 6. Equipment

1. Vocational Data Gunj 1. Vocational trainings in different trades trainings in Bakhash for male and female. different trades. Town / Lahore 2. Income generation trades for Established Govt. / NGO 2. Income unemployed. 5 Livelihood vocational institutes generation trades. 3. Tool kits distribution amongst the trainees. 3. Kits distribution.