Chaman; Safa and Marwa

Born in Afghanistan, 25-year-old Madeena moved with her family to Chaman, Pakistan, when she was 10 years old. One of 14 siblings, her parents couldn’t afford to send her to school. She was married off to her cousin (who had also migrated with his family at the same time) when she was only fourteen years old.

“I became pregnant as soon as I was married but due to a premature delivery I lost my first baby in my seventh month.”

Madeena’s body barely had time to recover when she fell pregnant again immediately after this trauma. Luckily, she delivered her first healthy baby at 16 years of age. Her next four children were born consecutively with no gap years.

By the time she was 20 she was a mother of five.


Her pregnancies did not stop there. At 22, Madeena delivered another baby who died due to premature birth. Three years later, she found herself at the MSF facility delivering twin daughters, both born with Down Syndrome.

Almost as a promise of protection and devotion to her new-borns, Madeena named her girls Safa and Marwa after the legendary hills (from Islamic History) in the deserts of Saudia Arabia that Bibi Hajra ran desperately between to find water for her thirsty son thousands of years ago. Allah rewarded her act of love towards her child when He created the most mysterious source of water known to mankind; The Well of ZamZam that lies between those two hills. Today it is known as one of the holiest places for Muslims who believe in the spiritual power of the Zam Zam water.

Madeena has to be strong for her girls because life will be very challenging when she takes them back home. She mentions that she doesn’t have cemented house or a fixed roof and they live in a ‘katcha’ place where there is no access to water. They have to rely on tankers which means extra expenses.

“My husband is jobless. Every day he tells us he will go and look for a job but he never does!” 


Safa and Marwa have been admitted to MSF due to severe malnutrition. Having been fed impure milk in the first 6 months of their lives, the twins developed a history of chronic diarrhea. They are now finally receiving the best kind of formula milk available at MSF to make them healthy again.

Dr. Muhammad Iqbal, a medical officer in the pediatric and nursery ward at MSF, describes this as one of the most common cases that he has dealt with since he arrived in Chaman 7 months ago.

“A good number of women do not know how to wean their children properly and that results in malnutrition. These women are extremely poor and have too many children at home who distract them from giving adequate attention to the new borns. They are simply too exhausted to give the care required.”


In Madeena’s case, the fact that she has twins (and that too with special needs) could mean she is overwhelmed.

“I live in a house with twenty five people and yet I have no help at home. My eldest daughter is only 9 years old. What can she possibly do to help me at that age?”


According to Dr. Iqbal, lack of family planning, poor economic means, poor hygiene, lack of health education and lack of early consultation are all factors that lead to malnutrition which is extremely difficult to overcome in the social fabric that is Balochistan.

Adnan Amir, a freelance journalist from Quetta in an article “Planning in Balochistan” (The News, 5thFeb 2017T) writes about how 160,000 pregnancies are unwanted in Balochistan every year which can be avoided if population control methods are effectively employed.

He mentions that according to Pakistan Social and Living Standards Measurement Survey (PSLM) of 2013-14, the literacy rate in Balochistan is 43 per cent (* dropped. to 41% in 2018 survey). According to estimates, 20-25 per cent population of the province is urbanised. In such a scenario, it’s natural that population control has not been effective in Balochistan.

He quotes Mehwish Quddus Alizai, who teaches Sociology in Balochistan University of Information Technology, Engineering and Management Sciences (BUITEMS) as Assistant Professor, who says “Cultural and contextual impediments, such as lack of education and awareness, male dominance and religious misinterpretation, restrict women’s choices to negotiate their family size and birth spacing.”

Photos and Text ©Khaula Jamil

On Assignment for Medicine Sans Frontiers / Doctors Without Borders



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