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https://scmp.com/news/china/diplomacy/article/3021650/health-and-safety-chinese-medical-clinic-pakistan-belt-and
China/ Diplomacy

The Chinese medical clinic in Pakistan on the belt and road security front line

  • The first medical centre along the China-Pakistan Economic Corridor has helped build local goodwill, but also been caught in the crossfire as terrorists try to drive Chinese interests out of the province
  • The threats endured by the centre in the port city of Gwadar led to a decision not to use Chinese medical staff in future clinics
The Chinese Red Cross Clinic in Gwadar has been operating since 2017. Photo: CRCF

When the Chinese Red Cross Foundation (CRCF) started building a care centre in Gwadar, a Chinese-managed port in Pakistan, in 2017, it had a bigger vision than just providing medical services to the impoverished area.

The facility, equipped and staffed on a par with a community hospital in China, is the first stop of an envisioned China-Pakistan Life Rescue Corridor running along the China-Pakistan Economic Corridor (CPEC) from Gwadar to Kashgar, a Chinese border city in Xinjiang more than 2,000km (1,240 miles) away.

The CRCF is a fundraising arm of the Red Cross Society of China. It plans to build a total of seven medical care centres along the corridor, each centre to be outfitted with medical personnel, medical and communication equipment, and even an ambulance.

The objective is twofold: provide medical backup to investors, both Chinese and Pakistani, when economic activities increase along the corridor, and help build a positive Chinese image by offering those same services free to residents.

The Red Cross clinic in Gwadar is treating increasing numbers of residents. Photo: CRCF
The Red Cross clinic in Gwadar is treating increasing numbers of residents. Photo: CRCF

The CPEC is a pillar of China’s massive Belt and Road Initiative to build connectivity in Asia, Europe and Africa, a collection of infrastructure projects stretching from Gwadar, Pakistan’s southwestern port on the Gulf of Oman, across the length of the nation to Kashgar near Pakistan’s northeastern border.

While receiving staunch support from the Pakistani government, the corridor has been overshadowed by security threats as it runs through Pakistan’s restive Balochistan province, where numerous terrorist attacks – including some targeting Chinese – have occurred in recent years.

Liu Xuanguo, vice-chairman of CRCF, said that building medical facilities along the CPEC was an attempt to engage the local population in countries that have signed up to the belt and road plan.

The clinic in Gwadar, the China Pakistan Fraternity Emergency Care Centre, is jointly operated by CRCF and the Pakistan Red Crescent Society. It is co-funded by the Chinese government and donations CRCF raised from Chinese businesses.

“Combining social resources and government aides to provide humanitarian services in belt and road countries is a good attempt to build heart-to-heart connection between the peoples,” Liu told the South China Morning Post in an exclusive interview.

“The local people are the biggest beneficiaries of such projects. Therefore, local people can have a tangible feeling that they have gotten something [from the service]. It can effectively fill the gaps of government-aid projects and commercial exchanges.”

But two years after the first centre opened, the project’s successes and difficulties highlight the dilemma China faces as it aggressively expands its economic reach across different continents, especially in politically unstable regions.

On the one hand, the centre in Gwadar, with its medical equipment and professional services, has become highly popular among the people in the area.

On the other, the project constantly faces terrorist threats – a regional separatist group, the Balochistan Liberation Army (BLA), has vowed to drive Chinese out of the province – and the CRCF has accordingly adjusted its strategy.

For one thing, it will not send Chinese medical personnel to new centres to be built along the CPEC. Instead, CRCF now only provides hardware and training to the Pakistan Red Crescent Society for future medical centres in the corridor.

So far, of the seven medical centres for the economic corridor, Gwadar’s is the only one that has been built.

A low profile that grows

Since its inauguration in July 2017, three teams of Chinese medical personnel, ranging from 10 to 12 people, have served in the Gwadar centre. Each team of doctors and nurses – drawn from Fudan University’s Huashan Hospital in Shanghai and the Beijing Red Cross 999 Emergency Rescue Centre – was stationed there for six to nine months.

The medical centre was built months after the Chinese Overseas Port Holding Company took control of the Gwadar port in 2016 from Singaporean investors. The acquisition of the strategic port, which enables China to circumvent the Strait of Malacca and gives China’s northwest much-needed port access, has raised eyebrows from China’s wary neighbours, especially India.

At the start, most of the patients at the care centre were Chinese employees hired during the port’s initial construction phase.

The Chinese Red Cross Clinic in Gwadar is treating residents and Chinese workers. Photo: CRCF
The Chinese Red Cross Clinic in Gwadar is treating residents and Chinese workers. Photo: CRCF

Yin Tao, CRCF’s liaison officer for the first team of medical staff, said there was little publicity about the medical centre when the team arrived in September 2017 because of the concern that it might attract terrorist attacks.

“But after the Lunar New Year [in February 2018] there was a radical surge in number … We have a gynaecologist and someone had told the villagers and suddenly the medical centre has become as crowded as a Chinese hospital,” Yin said, adding many Chinese staff have left since early 2018 after their construction work was completed.

“Lunar New Year in 2018 was a watershed. Before that the ratio of Chinese to Pakistan patients was 8:2, but afterwards it became 2:8.” 

The centre serves a population of 70,000-80,000, with the number of patients varying depending on the security situation. In the first two weeks in March 2019, it was treating about 290 cases.

In addition to the centre, there are two hospitals in the Gwadar area, but they are overcrowded and lack resources.

Jia Xin, head of CRCF’s primary health care service programme centre, said that over time, Gwadar residents were drawn to the medical centre. “It was word-of-mouth publicity … local people will tell others how good this medical centre is and they bring their wives and children,” he said.

Security as a matter of life or death

The success of the medical centre was, however, juxtaposed with terrorist threats in the region.

Three layers of security checks protect the Chinese companies in the Gwadar port. The medical centre is located beyond the first checkpoint, and local patients must pass through security and identification checks. Local people may pass the second checkpoint after presenting documents to prove they are port employees. The dormitories – for Chinese staff – are beyond the third checkpoint, which is heavily guarded by Pakistani soldiers. 

After passing the first checkpoint, which is guarded by the Pakistan Navy, patients must go through a second security check by the guards at the medical centre.

Liu said that with its strong security measures, the medical centre was safe.

“We have the support of the Pakistani military and the local government to ensure the safety of the medical practitioners and our own staff when they work there,” Liu said.

“When our doctors go out or go to the airport, they travel with an escort of armoured military vehicles, and we are grateful for the support of Pakistani military.”

But there have been times when the medical staff have had to withdraw behind the third line of fences, especially after a deadly terrorist attack on the Chinese consulate in Karachi last November. The attack killed two civilians and two police officers before the three militants were themselves killed.

A spokesman for the separatist Balochistan Liberation Army (BLA) took credit for the attack and said the consulate had been targeted because China had been “exploiting our resources”.

Shen Shuyu, another CRCF liaison officer, said terrorist alarms had been a feature of his eight months in the medical centre, from May 2018 to January 2019.

“When there were alarms, our medical centre had to close temporarily. That happened twice during my time there and we had to withdraw to the dormitory area.”

“It affected the development of our centre. Our doctors are now known for their skills and technical expertise, but because of the security threats, our centre had to close for two weeks every two months” during that period, Shen recalled.

Even before the consulate attack, Shen said, the medical team had received a security alert and “had already withdrawn to the dormitory area”.

“But when we saw the news that the consulate was attacked, we were shocked and were thinking whether the Gwadar port would be in danger too,” he said.

“Our team members were under pressure and they had to sleep with their [outdoor] clothes on. There were phone calls from home asking us when we could return home, but we insisted on staying.”

After the consulate attack, Shen said, Pakistan police raided a weapons depot 40km from the port and seized weapons, ammunition, torches, and fake government car plates. A number of those arrested said they had been planning for months to attack the Gwadar port.

Just this May, Gwadar’s only five-star hotel – popular among Chinese visitors – was attacked by three terrorists, who killed five before they were gunned down. The BLA also claimed responsibility for that attack.

Despite the terrorism in the area, Jia said, residents were generally quite welcoming to their Chinese visitors.

“The local people are actually very friendly to us. During my first trip there, once I had to wait at Karachi airport for eight hours for my departure flight. People would come and asked to take photos with us and told us ‘Chinese good’.”

Originally, CRCF planned to turn over operation of the centre to the Pakistan Red Crescent Society (PRC), their local partner, this year. However, the handover had been postponed because the Red Crescent failed to recruit enough medical staff to run it, Liu said.

Pakistani physicians command high salaries, and the PRC has limited funding available. As a result, the PRC has only managed to recruit one Pakistani doctor to work with the Chinese team.

Chinese Overseas Port Holding Company took control of the Gwadar port in 2016 from Singaporean investors. Photo: Xinhua
Chinese Overseas Port Holding Company took control of the Gwadar port in 2016 from Singaporean investors. Photo: Xinhua

Since a handover is not possible in the near-term, CRCF not only faces financial pressure to keep the centre running day to day, but also to maintain it in the longer run.

“An important mission for the third batch of medical staff [who are in Gwadar now] is to discuss with [the local partners] about how to train the local talents to ensure its long-term sustainability,” Liu said.

“This Gwadar medical emergency centre is not just for local Pakistan people, it is also serving our staff in the port area, including Chinese and Pakistani employees of Chinese companies. The port does not want us to withdraw and they particularly want us to stay there for the longer term.”

The handover delay and the security threats have prompted CRCF to adjust the development model for other centres planned for the corridor.

“The second centre was supposed to be launched in the second half of last year,” Liu said. “But we were told by the Chinese consulate not to go to Balochistan province after the consulate attack and the inspection [of the site] has been suspended.

“But we want to build the second centre in Quetta this year, as planned.”

China, though, will not send medical staff to the Quetta centre. Instead, it plans to work with the Red Crescent to revamp an existing hospital as the second project of the China-Pakistan Life Rescue Corridor.

Liu said that although the Gwadar centre was under strong protection and located in an enclosed area, there was no guarantee that the second centre would enjoy the same security.

Quetta, the capital of Balochistan province, is a hotbed for terrorist attacks, including some that have targeted Chinese. Last August, three Chinese nationals were among six people wounded in a suicide attack on a bus that was transporting Chinese engineers to Quetta.

Liu said the completion of the rescue corridor would depend on the funding available. But he hopes that the third centre – in the more peaceful city of Gilgit – could open this year.

“According to the original plan in 2017, we hoped to eventually build a command centre in Kashgar to help deploy aeroplanes and emergency teams,” Liu said.

Making a difference

Despite the challenges, he said the project had great significance, as CRCF was shouldering an important mission of civilian diplomacy.

“The companies in Gwadar told us that their employees felt their lives are protected and the local people are receiving help. While we are there, when someone get sick or if there is an emergency, we have people who can come to their aid and they feel safe.”

The Chinese consulate in Karachi was attacked in November last year. Photo: AP
The Chinese consulate in Karachi was attacked in November last year. Photo: AP

But he said that Beijing was only starting to involve charity organisations like the CRCF in long-term humanitarian projects abroad. The government has sent official medical teams to Africa, but the Gwadar centre is the first with a Chinese medical team in South Asia – and the only non-governmental medical team stationed abroad.

Liu said the CRCF would continue to expand other development projects in countries along the belt and road route, though the foundation would prefer to sponsor medical equipment, community development projects, and health programmes – like, for example, screening children for congenital heart defects – rather than send teams to manage medical centres on their own.