In early May, a team of U.S.-supported health specialists in the Swat Valley received a curt message from the Taliban: Get out or expect to be beheaded. Meanwhile, the Pakistani military was advancing fast in an attempt to drive the extremist militants from the area once and for all.

Health specialists under USAID/Pakistan's Health, Population, and Nutrition program were at work on projects to deliver messages on maternal and child health awareness, improve access and quality of health services, and upgrade infrastructure in several adjacent district health systems. But they soon found themselves among the exodus of more than two million people from the valley. Some teams were able to bring their equipment, but others did not have time.

"We were IDPs too," said Amhed Nasir, a project officer with the USAID-supported initiative. "We had to leave our office with little notice. When we arrived in Mardan, our sister project was already operating in the area, so we just went to work too."

As the situation unfolded in the following days, USAID partners met to assess conditions and discovered that staff from as many as 11 local NGOs operating in four districts as part of the Pakistan Initiative for Mothers and Newborns, known as PAIMAN, were spread over the adjacent Mardan and Charsadda south of Swat and Buner districts, where the fighting was taking place.

Within five days, the new teams joined forces with three more partners already operating in Mardan and Charsadda under a two-pronged strategy to provide much needed relief to the overwhelmed healthcare system. The first priority they identified was to find a suitable place to care for the expectant mothers among the 300,000 camp dwellers.

"Women in labor were lying on the bare ground at the camp in Charsadda," said Dr. Shuiab Khan, a PAIMAN program director, who coordinated the effort. "We immediately brought in 100 mattresses and bedding for the women waiting to give birth."

Project staff coordinated with the government and other local and international aid agencies to augment the meager belongings of the displaced by supplying food, cooking pots and utensils, latrines, and clean water.

The government identified locations to set up four emergency birthing centers near the three camps in Mardan and one in Charsadda, including unlocking a disused sugar mill closed for 30 years, an abandoned health center, and a vacant house.

PAIMAN staff cleaned up and supplied the buildings, even installing air conditioners to ward off the oppressive heat. Soon the facilities were staffed by trained birth attendants, expectant mothers moved inside, and two daily shifts of project health specialists were hosting up to 400 patients on a 24-hour, seven-days-a-week basis.

The majority of displaced, about 1.7 million people, stayed with host families in the region. To reach this population, the network of NGOs organized two mobile medical camps per week, staying all day at each of 208 sites over ten weeks, ultimately treating nearly 52,000 patients to assist with births, conduct pre- and post-natal care, vaccinate children, and provide counseling on family planning. Availability of the services was publicized through the district health department and local mosques.

In the case of complications during delivery, the project supplied each NGO an ambulance to rush the mothers or babies to the closest hospital, about a half hour away from most of the camps.

Having undergone the trauma of delivery with little more than the clothes on their backs, new mothers were issued mother-and-baby kits, containing clean blankets to swaddle the newborns, nappies, and a set of fresh clothes for the mothers. Mothers requested this support during a camp visit by Dr. Nabeela Ali, chief of party for PAIMAN.

For children under five, life in the camps during the hottest part of the year was especially harsh. Skin ailments and dysentery were rampant; the medical camps supplied up to 60 intravenous drips a day for children to combat dehydration with oral rehydration salts.

Outside one birthing center in Mardan, PAIMAN staff noticed a young couple weeping over a three month old boy, certain he had died from the heat. They rushed baby and parents to the hospital, where doctors were able to resuscitate and rehydrate the boy. Within 20 minutes, the boy, named Haris, opened his eyes were and started to cry. Within two hours, they were on their way back to the camp. The next day, the parents returned to the center the best gift for the staff they could muster: two hen's eggs.

On the request of the Pakistani health director, Dr. Ali also assisted a district hospital in Buner, which continued to operate amidst fierce fighting. With the electrical grid knocked out by the Taliban, doctors had no alternative to conducting surgery by candlelight. With all the filling stations long closed, the hospital made an urgent appeal to PAIMAN for diesel to run their generators to assure a steady light and water supply. Eventually, staff was able to arrange to truck three large barrels a day for a month to the hospital under military escort.

By mid-August, Swat and Buner were again firmly under control of the government, and the displaced began to make its way back to their homes. Project staff members have begun to return to their workaday roles building capacity of the health systems in their respective districts.

"I think we made a real difference in the lives of a great number of people under difficult circumstances," Dr. Khan reflected. "The established presence of USAID in the districts was an important contributor to our success, but more important, when we came to them with our assessment of the situation, they immediately approved our plan. That saved a lot of lives."