Medicines at the margins: Conflict, Sectarianism and health governance in Gilgit-Baltistan

By Emma Varley

My 2010 return to northern Pakistan for an additional four years of fieldwork coincided with the renewal of protracted hostilities and bloodshed. In ways which have further compounded the politics and practices of inter-sectarian dissenssion, in the spring and summer of 2012, upwards of 30 Shias, Sunnis and Ismailis were killed in targeted attacks in Gilgit Town, while an estimated 50 Shias and 5 Sunnis were massacred on three separate occasions on the Karakoram Highway and the Naran-Kaghan Route interconnecting Gilgit to Islamabad, Pakistan’s capital. In response, my recent research interrogates how sectarian enmities and recurrent violence shape, amplify and politically differentiate Sunni and Shia forms of identity and belonging, and underpin exclusionary forms of health governance and the post-2005 emergence of sectarian medical economies in particular. In striking ways, Gilgit’s health services now socially and spatially exemplify the institutionalization of sectarian difference.

In ways that the illustrate the interlacing of sectarian and state spaces, a 30 foot high Shia religious flag, emblazoned with the name of Hazrat Ali, the revered fourth Caliph and spiritual progenitor of Shia Islam, was erected overtop the fortified concrete Army bunker which stands at the DHQ’s main entrance. Not coincidentally, this is the same intersection where an estimated 15 Sunnis were killed immediately after Zia-u-din’s January assassination. Sunni physicians and patients remarked that the Army’s apparent inability to remove the flag or, at the very least, to prevent Shia rallies from being held at the hospital site evidence Sunnis’ ongoing logistical vulnerabilities at the DHQ. Nor is it only in-town Sunnis who face challenges accessing the hospital. Because the DHQ is Gilgit-Baltistan’s sole tertiary-care referral hospital, serving a patient base of over 1.5 million residents, Sunni patients from across Gilgit-Baltistan are profoundly affected by thehospital’s insecure spaces.

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