In southern Pakistan’s Sindh Province, on the edge of Karachi’s bustling fish harbour, sits Machar Colony, an informal settlement where life is harsh, often unkind, and plagued by overcrowding, poor sanitation, and limited access to basic services. The community’s struggles with health and well-being have long been exacerbated by these conditions, leaving residents vulnerable to a range of medical issues.
Médecins Sans Frontières/Doctors Without Borders (MSF) had been providing essential healthcare services in Machar Colony since 2012, offering emergency services, maternal health, and general health consultations. However, as the years progressed, MSF’s team noticed troubling patterns at their primary health clinic.
“As we investigated further, we found that a significant number of these cases were related to hepatitis C, a viral infection that affects the liver and can lead to severe health complications. Notably, during that time, Pakistan had the second-highest hepatitis C disease burden globally and had already initiated its national hepatitis control programme in 2005.”
Hepatitis C transmission in Pakistan is largely driven by inadequate sterilization of medical equipment and the improper reuse of needles and syringes. Contaminated blood transfusions also pose a significant risk. Common practices like barbering, tattooing, and piercing are contributing to the spread of the virus, as equipment is often not properly sterilized. In addition to these factors, the growing issue of intravenous drug use is also fuelling the transmission of Hepatitis C in Pakistan.
According to the World Health Organization (WHO), as of April 2024, Pakistan has the highest number of viral hepatitis C infections in the world, with around 8.8 million cases, accounting for 44 per cent of all new hepatitis C infections attributed to unsafe medical injections. Commonly, people are screened for hepatitis C only when they start showing signs of liver disease, which is often too late. If left untreated for too long, hepatitis C can progress to severe liver disease and even liver cancer.
‘’Many people in Machar Colony were unaware that they were infected because the virus can remain dormant for years without showing symptoms,’’ adds Dr Khawar. ‘’Even those who recognised their condition, either elsewhere or at our clinic, often faced obstacles to treatment, including high costs and the challenge of travelling to distant hospitals. Residents have limited income sources, primarily relying on fishing, daily wage work, or small-scale businesses, which barely cover their daily needs. Additionally, upon referrals to other hospitals, identity cards were required for hepatitis C care; however, most of the community in Machar Colony was undocumented, so they were refused treatment.’’
Recognising the urgent need for action, in 2015 MSF started a comprehensive programme to provide free testing and treatment directly to residents. The hepatitis C services were integrated into the existing primary healthcare facility, allowing MSF to reach people who would otherwise remain unaware of their condition. In 2018, MSF closed its primary healthcare services and shifted its focus solely to the treatment of hepatitis C patients.
To effectively address the crisis, MSF implemented a proactive strategy focused on community engagement. In a primary healthcare setup, free-of-charge hepatitis C services including screening, diagnosis, treatment, health education, and patient support were provided under one roof. Between 2022 and 2024, MSF teams conducted widespread testing, going door-to-door and using mobile vans to offer in-home testing for residents aged 12 and older. This approach, named “bending the curve,” ensured that no one was overlooked and that those who tested positive were quickly referred for treatment, helping to bend the curve of hepatitis C in the community.
Dr Khawar Aslam explains, “By offering free services in one location, we made it easier for people to access care. Our goal was to reduce infections and stop the disease from spreading. We’ve reached nearly 100 per cent of the community, spreading awareness and facilitating immediate treatment for those in need.”
Additionally, MSF collaborated with the Ministry of Health to bring hepatitis C care closer to the community by establishing a treatment facility in August 2022 at the Baldia town Rural Health Centre, Kemari district, Karachi. In this initiative, patients referred from Baldia hospitals’ outpatient departments and those identified by community health workers were screened for hepatitis C.
The community health workers were trained to educate the community about hepatitis C risk factors and prevention. Patients diagnosed with chronic hepatitis C received treatment for 12 or 24 weeks, depending on the severity of their liver disease. Additionally, all patients were offered hepatitis B vaccination to prevent future infections. This centre, handed over to the Ministry of Health in August 2023, serves as a crucial hub for hepatitis C treatment in the region. It is equipped with modern diagnostic tools and is now recognised as a key site for hepatitis care in Sindh.
As MSF’s hepatitis C programme concludes, the results are clear: thousands of lives have been transformed, and the rate of new infections has significantly declined. While hepatitis C remains a challenge in Machar Colony, the alarming spread has been curtailed, thanks to widespread awareness and early detection.
MSF has achieved its target of mobilising nearly 100 per cent of the community for hepatitis C awareness, and screening more than 72 per cent of residents. Between 2015 and 2024, MSF screened over 129,922 individuals in its clinic and in the community, undertook 64,984 consultations for hepatitis C at the MSF clinic, performed 25,553 diagnostic polymerase chain reaction (PCR) tests, and provided treatment to over 9,398 patients. Among them, 6,909 completed their treatment.
Of the remaining people, 2,061 were lost to follow-up without completing treatment, 176 with completed treatment were lost to follow-up, 14 people died during this period, while for the remaining 50 people, either treatment was not completed or follow-up stopped. Of the 6,909 completed treatments, 6,755 got cured of hepatitis C, which is 93.3 per cent, while the remaining 459 failed treatment, which makes 6.3 percent. The success of MSF’s treatment initiatives will serve as a model for similar programmes in other underserved communities across Pakistan.
Médecins Sans Frontières (MSF) first began working in Pakistan in 1986 and currently provides a range of health services across all four provinces of the country, including maternal and child healthcare, primary healthcare, treatment for cutaneous leishmaniasis (CL), drug-resistant tuberculosis (DR-TB), and ongoing emergency responses.
