The pain etched on survivors' faces after they lost their family members, friends, homes, land and livelihoods is still as real today as it was six months ago. The nature of upheaval may be different as families face the task of rebuilding their lives, but it is no less daunting - or terrifying.

Resilient mountain farmers, hard-working urban dwellers, land-owners, tenants, mothers, fathers, boys and girls - survivors who herald from a human landscape as varied and intricate as the topography changed forever by Pakistan's most devastating earthquake.

Many rural families faced and overcame a bitter winter without their normal coping mechanisms in tents and temporary shelters, next to their damaged or destroyed mud and stone, well-insulated houses. Some are now reconstructing their homes with government housing compensation, while others are waiting for their houses to be assessed for damage in order to receive compensation. Families who rented homes prior to the earthquake wait for dwellings to be reconstructed or negotiate with landowners for new arrangements. Women and child-headed households are more vulnerable now than ever.

Those families who moved to relief camps after the quake now face the Herculean challenge of moving back to their places of origin to rebuild their homes and lives - or to different locations if they have no land or family to return to. For now, some vulnerable groups simply have no option of leaving the relative protection and provision afforded them in the camps.

Still thousands of other families displaced from urban areas have no home or land to return to. Some 600 hectares of the town of Balakot in the North West Frontier Province have been declared unfit for reconstruction. A whole town and its population will have to be relocated and rebuilt.

The 7.6 earthquake that struck northern Pakistan on the morning of Saturday 8 October dealt the greatest blow to children as they sat in their classrooms or helped their mothers with the daily chores at home. More than 19,000 were killed. Over 10,000 lost at least one parent and another 2.2 million children were affected.

She looked at me with one of those wanting stares that dives deep into any soul. It was my moment of understanding how much pain is here.

A young girl, appearing to be about nine years, lay on a cot with her right arm amputated. Her bandaged stump was oozing blood. She looked at me with one of those wanting stares that dives deep into any soul. It was my moment of understanding how much pain is here", said a World Vision aid worker days after the quake.

The destruction of homes, schools, hospitals and other infrastructure in some areas of the North West Frontier Province and Pakistan-administered Kashmir was absolute. Tens of thousands were killed and injured, some dreadfully, like this young girl. Millions were displaced from their homes and land. They faced a bitter Himalayan winter, many with only the clothes on their backs. The government and international community faced an unprecedented emergency and a race against time…

Official casualties - 73,338 (18,000 children) Official injured - 69,412 Area affected - 30,000 sq. km Population affected - 3.5 million people Population lost homes - 3.3 million people (400,000 dwellings) Food insecure - 2.3 million people Health facilities destroyed - 80% Educational facilities destroyed or damaged beyond repair - 10,000

Area:		803,940 sq km (slightly less than twice the size of California)
Location:		Southern Asia, bordering the Arabian Sea, between India on the east and Iran and Afghanistan on the west and China in the north
Major religion:		Islam
Natural hazards:		Frequent earthquakes, occasionally severe especially in north and west; flooding along the major rivers after heavy rains and melting snow (July and August)
Population:		152.53 million in 04 - 05 (Economic Survey 04 - 05)
Age of population:		0-14 years: 39.6% (male 33,104,311/female 31,244,297) 15-64 years: 56.3% (male 46,759,333/female 44,685,828) 65 years and over: 4.1% (male 3,189,122/female 3,437,055)
Form of governance:		Federal Republic
Human Development Index:		142 compared to India 118 & Uganda 146
GNP per capita:		US$470.00 compared to Angola US$740.00
Life expectancy at birth:		63
Under-five mortality rate:		103 per 1,000 live births, compared to 93 in Sudan and 87 in India
Infant mortality rate (under 1):		81 per 1,000 live births, compared to 63 in India & Lesotho
% of children in child marriage (total):		21%
Adult literacy rate (over 15):		43%
% of population living under US$1 a day (1992-2002):		13%
Net primary school enrolment/attendance:		56%
Unemployment:		8.3% plus substantial underemployment
% annual central government allocated to health*:		1%
% annual central government expenditure allocated to education*:		1%
% annual central government expenditure dedicated to defence*:		15% (3.1% of GDP- 05 & 06 budget)

Key achievements at a glance:

• A total of approximately 142,932 people or 31,030 households benefited from World Vision relief supplies and food in the six months after the earthquake.
• World Vision reached more than 450 villages after the earthquake.
• A total of 15 airlifts transported vital relief supplies.
• Non-food items benefited 140,978 people or 30,056 households – exceeding the initial target by more than 15,000 households.
• World Vision distributed 36,296 blankets, 16,158 tarpaulins and 4,519 winterised tents.
• More than 77,000 people (12,342 households) have received food supplies (3,502 MT) since 28 November, when food distributions commenced.
• World Vision's medical team from Korea treated some 1,550 people during a nine-day mission directly after the quake. Dozens of these would have lost their lives or limbs if not for the rapid response of the team.
• Approximately 1,500 children participated in creative activities conducted in 15 Child Friendly Spaces (CFS) over their period of operation in the last five months.

The district of Mansehra in Pakistan's North West Frontier Province (NWFP), where World Vision had been working on disaster preparedness with local partners prior to the quake, sustained massive damages on 8 October. World Vision established a sub-office in Mansehra and in cooperation with local and international agencies, focused its emergency relief response in and around the district of Mansehra, particularly the remote and mountainous Siran and Kaghan valleys.

From its relief activities to the current transition to recovery and reconstruction, World Vision aims to work with partners and integrate its education, child protection, food security and livelihoods projects wherever it works, to develop long term sustainable relationships with communities.

With some 3.5 million rendered homeless in the earthquake and total destruction reported in various areas of the North West Frontier Province, the need for emergency relief items after the earthquake was enormous. World Vision first distributed burial shrouds, quilts and water, followed by water purification tablets, medicines, hygiene kits and other basic household supplies.

Tents and shelter materials were procured both externally and locally and distributed primarily to families living near their damaged or destroyed homes.

I am happy to receive these clothes and shoes as I have never had new clothes and I feel warm in these.

"I am happy to receive these clothes and shoes as I have never had new clothes and I feel warm in these. My father had been getting second-hand clothes and shoes for us from the second-hand clothes market in Mansehra and Shinkiari. I shall wear them when I go to school," said nine-year-old Manda Gucha second grade student Saadia in January.

Key achievements

• A rapid and thorough relief distribution of shelter and insulation materials before and during the winter meant many families in rural mountain areas could remain with their homes and land and not be forced to move down the mountain to relief camps.
• Non-food items benefited 140,978 people or 30,056 households - exceeding the initial target by more than 15,000 households.
• Cooperation with local partners enabled greater effectiveness of distributions and benefit to families.

Current activities

• World Vision is providing relief supplies including blankets, rehabilitation material kits and warm clothing for distribution by local partner ODC in the Black Mountain area of the Kala Dhaka tribal area to 6,000 households.

Future plans

• A 'return package' for families who have returned from relief camps to places of origin will be distributed to 500 households. The package will contain tarpaulins, rehabilitation kits and warm clothing.
• World Vision will identify outstanding needs for supplies, including shelter materials, in locations where it is working in the areas of education and livelihoods.

Prior to the earthquake, many of the quake-affected areas, particular difficult-to-reach areas with small landholdings and low literacy rates, struggled to access enough food. The North West Frontier Province receives assistance through market interventions and pre-positioning of food stocks for places cut-off by snow during winter months. The October earthquake disrupted this assistance and had a huge impact on food availability, access and utilization. Agricultural and livestock losses also had a devastating impact.

World Vision, in partnership with the United Nations World Food Programme, began distributing food supplies, including wheat flour, vegetable oil and pulses, at the end of November, targeting families who remained with their homes in rural areas.

"We had lost our grain stocks under the debris of the house and were in dire need of food to survive. We are grateful to World Vision for providing us with wheat flour, vegetable oil and other goods," said Aadil Shah from a village in the Siran valley.

We had lost our grain stocks under the debris of the house and were in dire need of food to survive

Key achievements

• Food supplies sustained more than 77,000 people after the earthquake through the worst winter months, meaning that families could stay with their land and homes and salvage what they could of their belongings and livelihoods instead of moving to relief camps.
• Distributions of food supplies by agencies like World Vision helped avert a potential malnourishment crisis, particular during the harshest winter period.

Current activities

• World Vision is currently distributing wheat soybean porridge to approximately 4,500 children under three in the Siran valley.

Future activities

• World Vision is exploring ways of supporting the World Food Programme's two-year recovery operation in the area of Food-for-work and school feeding, targeting families who lost their houses, livestock, agricultural land and those that lack remittance or family support.

"I'm not going back to school because schools fall down. "I like living in a tent. It is light. It can't fall down and kill anyone," said Saba, 5, to her father in a camp near Balakot in October.

Child survivors of the quake saw their schoolmates and family members dead and wounded and the world as they knew it turned upside down. The combination of grief, stress, chaos and displacement after disasters like the Pakistan earthquake leave children in a vulnerable state. One of World Vision's first Child Protection actions was to lead protection forums to advocate for community-based approaches as opposed to institutionalisation, to protect children from exploitation and for a common system of registration.

I like living in a tent. It is light. It can't fall down and kill anyone

World Vision carried out assessments on the situation of children and set up programmes to provide safe spaces and activities for them, and to provide support to vulnerable families as evidence emerged of threats to children's right to family based care.

"Almost all the children were afraid of going to school. But thanks to World Vision, which established a Child Friendly Space (CFS) near my school, the children are more at ease. Children play games, produce coloured drawings and make cartoons. They sing nursery rhymes and local songs. Activities in the CFS have helped to alleviate children's shock," said Mohammedan Public School Principal Seemi Gilani.

Awareness raising and advocating for the safe return of children and their families to their places of origin is ongoing, as is the monitoring of vulnerable children and families.

Key achievements

• Child Friendly Spaces enabled some 1,500 children to participate in creative activities and informal education over the five months after the quake.
• Feedback from teachers and parents on the positive change in behaviour and confidence levels of the children involved in creative activities was unanimous.
• Children communicated and demonstrated that they are no longer afraid of going to school thanks to participating in activities in World Vision's Child Friendly Spaces.
• Activities involving both boys and girls helped to increase their interaction and have given them an opportunity to play together.
• A child friendly booklet on the rights of children has been developed, translated, tested and will be published in April.
• World Vision identified and referred vulnerable children to partner agencies.

Current activities

• Child protection staff are identify vulnerable children and families, monitoring movements and helping to ensure they have access to a safe place to stay in the short-term, with full protection and access to basic facilities.
• Select Child Friendly Spaces are being relocated to places where families are returning in order to encourage access to education and identify out of school children.

Future plans

• World Vision's child protection team will continue advocating for the rights and protection of children, especially as they relate to children's right to education, (with a special focus on girls and children with disabilities), and family-based care.
• Ongoing psychological support will be provided to children and their families. Memorial services in Child Friendly Spaces and schools will take place as children near the one-year anniversary of the earthquake.
• Community based child protection programming will be developed through the CFS, which will provide support and children's voice in World Vision's rehabilitation phase programming.
• Creative activities and vocational training will focus on adolescents in select government boys and girls high schools and for out of school children in the CFS locations.

"Utter devastation", describes the impact the quake had on education in the district of Mansehra alone, with an estimated 80% of 2,749 public schools either completely destroyed or seriously damaged. Almost all the books and other instructional materials were lost or rendered unusable. The majority of schools were boys' schools with more boys enrolled in schools at all levels.

Recognising that schools are places of normality and stability, the international community, including World Vision, worked tirelessly to set up temporary schools in tents and equip schools with school kits containing materials for teachers and students immediately after the quake. Although school students would begin winter vacation in December, it was important for students to gain a sense of routine and overcome the fear of returning to school by starting off in tents where they at least felt a measure of security.

Many girls, who did not attend school before the quake, were given the opportunity to study and it is hoped that this trend will continue as new schools are constructed and information campaigns on education filter through to the village level.

Key achievements

• World Vision provided some 20 tents for schooling in the Siran valley and more than 3,528 school kits in different villages immediately after the earthquake.
• More girls now have the opportunity to attend school.
• Opportunities for education in places of origin will in many cases be greater than before the earthquake, after temporary schools and later permanent schools are established.

Current activities

• World Vision is working on establishing 10 temporary schools in the Saraash valley and 30 in the Siran valley, including 2 high schools.

Future plans

• In partnership with the government and other agencies, World Vision plans to construct some 50 permanent schools in the Siran valley.
• Advocacy, in partnership with child protection staff, for greater school attendance among boys and girls will continue at national and local level with a view to also curb high drop out rates at primary level, especially for girls.

"All the water resources and trails are wiped out in the area. The livestock was destroyed. The greatest sorrow I have is the death of my buffalo that I bought for Rs. 55,000 (Approx US$917) just four days before the earthquake. She died as the barn collapsed," lamented former Saraash resident Bakht Akbar Moughal, husband and father of three children who all survived the earthquake.

Agriculture and livestock were dealt an enormous blow in the earthquake - and with it, the devastation of thousands of livelihoods. According to findings by the Food & Agriculture Organization (FAO), agriculture is not only the dominant occupation for rural families, it is a way of life throughout the area, and the livelihoods of many people depend more or less entirely on farm and related activities. The FAO estimated slightly more than 30% of the rice crop and nearly 75% of the maize crops were lost in quake-affected areas. A huge loss of livestock, particularly buffalo that were crushed in stone barns or by falling debris was especially devastating.

We need to get people back to work and resuming their normal lives

Massive depletion in the social, human, physical, natural and financial assets and capital that people need to help them earn a living is another enormous issue affecting all levels of society- but the poorest most severely.

"Rehabilitating livelihoods upon return is vital, not only for income generation but to begin healing individuals, families and communities. We need to get people back to work and resuming their normal lives," said a World Vision Programme Officer.

Since livelihoods across this diverse and complex region are built on both on-farm and off-farm activities, World Vision is exploring ways to re-start agricultural production and animal husbandry, cash-for-work and contract employment for off-farm plantation and other activities, as well as skills training for the informal sector, such as masonry.

Current activities

• Community members, termed 'mobilisers' are currently being recruited deep within remote areas to assess the needs and types of work undertaken in select areas, as well as what resources are needed in order for people to resume work. This approach aims to build trust, authenticity and rapport with the community and will help to ensure World Vision's work is driven by informed voices on the local level.

Future plans

• The livelihoods team will work with communities on the construction of animal barns, seed distribution and replenishment of livestock, veterinary care, animal husbandry, irrigation of channels and other skills training as required and requested by the communities themselves.

Adults and children became vulnerable due to displacement and loss of family members and property following the earthquake. Among them, widows, orphans, the elderly and people with disabilities will face increased vulnerability during the return, recovery and reconstruction phase.

Vulnerable groups faced additional difficulties in accessing relief goods and increased insecurity in camp situations and will continue to face difficulties in rebuilding their homes, accessing limited community resources and resettling in deteriorated communities. Securing their basics rights, particularly their legal rights is also a challenge, such as realising their entitlements to compensation and additional relief supplies. Women and children who have lost a male member of the family remain particularly vulnerable, as rehabilitation support will be granted on national identity cards. Without a male family member, they cannot access assistance. World Vision's protection team will assist these extremely vulnerable groups through a variety of initiatives.

Since the Siran valley, where the majority of World Vision's work is focused, is a male dominated society, women face extremely limited mobility and freedom. Women observe 'purdah', meaning that they cover their heads and faces and do not expose themselves to non-family male members. Under these traditional circumstances, women, particularly widows will face greater difficulties in rebuilding their lives.

Current activities

• World Vision was one of the first agencies to reach the internally displaced in relief camps with return messages. The messages aim to assist their right of informed, free choice of movement, reducing the uncertainties of the return process and of their life after the return.
• Female hygiene kits distributed in remote rural areas afforded women dignity after quake, which exacerbated their inability to access personal items.
• World Vision has been an active advocacy member of the Protection Network, consisting of six non-governmental organisations, and has also worked with local agencies to advocate for vulnerable groups both in the relief and return and reconstruction phase.

Current activities

• World Vision's information campaign to communicate key messages to families in the return process will continue and evolve as long as families leave the relief camps to return to their places of origin or other locations.
• Monitoring the return process against government policies and commitments will also continue while families vacate relief camps for more permanent locations.

Future plans

• Targeting women and adolescents in the areas of Jabouri and Balakot, World Vision will identify vocational training needs and will conduct training with a view to support income generation activities.
• Advocacy initiatives on just and fair compensation for shelter reconstruction will ensure vulnerable groups are afforded necessary assistance.
• World Vision's protection team will work with programme staff from education, livelihoods and food security sectors to raise protection awareness, particularly as it relates to the rights and needs of women.

World Vision's Phase 2 (18 months) aims to focus on education, livelihood recovery, food security, child protection and disaster preparedness and mitigation. Where possible, World Vision works with and strives to build the capacity of local partners. Harnessing the capacity of these partnerships, World Vision plans to:

• Distribute 'return' packages to 500 households to facilitate their resettlement and reintegration.
• Reconstruct 50 schools in the Siran valley.
• Operate 20 Child Friendly Spaces in relief camps and new locations where families are returning.
• Assist people to resume work through livelihoods projects by re-starting agricultural production and animal husbandry, cash-for-work and contract employment for off-farm plantation and other activities, as well as skills training.
• Work with the World Food Programme on Food-for-Work and Cash-for-work activities, as well as engage in school feeding projects.
• Phase 3 (36 months) aims to meet the longer-term needs of children, their families and communities primarily in select locations of the North West Frontier Province in the areas of:
  
  1. Humanitarian emergency assistance, disaster preparedness and mitigation
  2. Assistance to "children in crisis", including "street children", "runaway children", child trafficking, children in prison and in bonded labour and HIV/AIDS and STI awareness
  3. Support to selected communities in Afghan Refugee Impacted Areas of North West Frontier Province

• Q. How quickly was World Vision able to respond following October 8?
  
  A. World Vision was able to respond immediately as it was already working with an office in Pakistan and with local partners in the affected area. The call went out to World Vision's Emergency Response Team within 24 hours and specialist staff were on the ground in the affected areas 48 hours later.
  
  
• Q. How effective does World Vision think it has been in meeting the relief effort?
  
  A. The speed of response with a disaster of this scale was critical in allowing World Vision to play a major part in mobilising resources for quake affectees, saving lives and alleviating suffering. Over the initial six months its field operations staff, based in Mansehra, North West Frontier Province (NWFP) and support staff in the capital Islamabad, have worked tirelessly to deliver emergency aid to more than 30,000 households.
  
  
• Q. What have been the main areas of World Vision's work?
  
  A. The main areas of work have been emergency aid distribution, including shelter, food and clothing. World Vision's other focus has been to protect children, particularly vulnerable following the disaster. The organisation set up 15 Child Friendly Spaces, or safe havens for children, across the quake affected area of Mansehra District, NWFP, where child protection specialists worked with children, many deeply affected by the disaster, to create a pocket of safety and normality among the devastation.
  
  
• Q. How many people have been helped?
  
  A. More than 143,000 people have received aid, many on a regular basis, with support across all activities in Mansehra District totalling approximately US$12 million.
  
  
• Q. How have children been assisted?
  
  A. Children have been helped in different ways. Relief supplies met their basic needs along with their families and attendance at World Vision's Child Friendly Spaces ensured informal education by specialist staff created an escape from the devastation affecting their lives. Thousands of school kits have also been distributed and Child Protection Staff have advocated for children's rights to education as well as protection from exploitation and separation from their families in the emergency and return and recovery process. World Vision is also planning to engage in school rebuilding projects across Mansehra District.
  
  
• Q. What assistance has World Vision given to the people of the Black Mountain area of Kala Dhaka?
  
  A. World Vision launched a groundbreaking aid distribution into the forbidden tribal area of the Black Mountain after discovering 13,000 households had received little or no help - four months after the earthquake. In partnership with local agency ODC, World Vision has supplied more than 1,600 households with non-food items since February and plans to distribute to a further 6,000 families in the weeks ahead. Other support programmes are being planned with the consent of tribal leaders.
  
  
• Q. Now that people have been helped, is it not time for the international relief agencies to leave Pakistan?
  
  A. There is no quick fix solution following a disaster of this magnitude. The initial rescue and emergency relief phase may be over, but many communities still require aid and support to return to a semblance of normality. The entire infrastructure was destroyed across a wide area, stretching from Kashmir across the North West Frontier Province towards the Afghan border. The reconstruction phase of homes and basic amenities, including homes, gas, water and electricity supplies, is just beginning. Hospitals and schools also need to be rebuilt in partnership with local agencies.
  
  
• Q. How long will World Vision stay in Mansehra?
  
  A. World Vision is planning and implementing programmes for the reconstruction phase, working in partnership with local, national and international agencies. World Vision will operate from Mansehra, offering support to local communities as long as communities seek help in rebuilding their shattered lives. World Vision Pakistan has a long-term objective to work with communities on disaster preparedness and mitigation, assist 'children in crisis' related to child labour and child trafficking, as well as support Afghan refugees in the country.
  
  
• Q. What work is there still to do in the quake area by World Vision?
  
  A. Immediate programmes in the weeks and months ahead focus on maintaining aid distribution where it is still needed, supporting the relocation of families back to their communities, child protection, women's welfare, supporting livelihood development and education. World Vision has supported dozens of temporary schools and is now seeking to construct some 50 permanent buildings in partnership with the Government of Pakistan.
  
  
• Q. How does World Vision view the future of those affected by the earthquake?
  
  A. The future is looking more positive but there is no room for complacency. There is still much work to do. Supporting communities during this difficult phase of returning hundreds of thousands to their homes is critical, working to rebuild communities in many cases completely reduced to rubble, is a giant task. The international aid partnership, working closely with the Pakistani authorities still has an important role to play. World Vision will focus on education, child protection, livelihood development and women's welfare, with aid distribution taking a lesser role in the months ahead as communities move closer to resuming a basic level of normality.
  
  
• Q. World Vision is a Christian organisation working in a Muslim world. Has this created any difficulties?
  
  A. World Vision is one of the largest international aid organisations, operating across more than 100 countries, embracing many faiths. The organisation's mandate is to deliver humanitarian aid where it is most needed, regardless of language, culture or religious boundaries. Wherever in the world it operates, World Vision respects the local customs and conditions, working in partnership with communities. In Mansehra, most of the 130 staff are in fact Pakistani nationals, many of whom had family members and friends affected by the earthquake.
  
  
• Q. What are the biggest challenges now facing people affected by the earthquake?
  
  A. The safe migration of those in temporary camps back to their home villages is a huge challenge. Many will need to reconstruct their homes, re-establish their livelihoods. In some cases entire communities will need to be rebuilt. Many families who remained with their devastated homes and land also need to start from zero.
  
  
• Q. What does World Vision see as the priorities for its work in Pakistan now?
  
  A. As a child-focused organisation, World Vision's focus is on the protection of children in the return, recovery and reconstruction phase, with emphasis on ensuring boys and girls have the opportunity to attend school. Supporting vulnerable families as they start from scratch through training and income generation activities is a priority, as is working with communities to identify common needs and making resources available to them to improve wellbeing, especially for children.
  
  
• Q. Does World Vision coordinate with other agencies/government/UN on the ground?
  
  A. Partnership with local relief and development organisations before and after the earthquake is key to World Vision Pakistan's strategic approach. Working with and through local and international partners has enabled World Vision to quickly and effectively meet the urgent needs of thousands of quake survivors in some of the most remote and difficult areas. Partnership with its Pakistani partner ODC is enabling World Vision to supply relief supplies in the Black Mountain area of Kala Dhaka (tribal area), which would be inaccessible without collaboration with ODC. Building the capacity of its local Pakistani partners, including ODC, as well as its own operational capacity is a key focus for World Vision and part of its long-term commitment to meet the needs of vulnerable children and their families.
  
  

World Vision has had programme activities in Pakistan since 1992 with a primary focus on smaller scale relief activities. Since 2003, World Vision has worked in the North West Frontier Province (NWFP) repairing more than 100 schools and 25 medical facilities following an earlier earthquake. It has also provided disaster preparedness and emergency first aid training to several hundred teachers in the disaster prone areas of NWFP. In February 2005, World Vision used airdrops and donkey trains to move relief supplies through implementing partners to many of the 100,000 people trapped by storms and avalanches in the remote, upper areas of NWFP.

• Rebecca Lyman, World Vision Pakistan Communications Manager
  Pakistan mobile: [+92] (0) 300 854 1262
  Email: rebecca_lyman@wvi.org
  
  
• Maia Woodward, World Vision Middle East & Eastern Europe Regional Communications Officer
  Cyprus mobile: [+357] 99 352 678
  Email: maia_woodward@wvi.org
  
  
• Rienk van Velzen, World Vision Middle East & Eastern Europe Regional Director
  Netherlands mobile: [+31] 6 5183 2040
  Email: rienk_van_Velzen@wvi.org
  
  

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