May 27th, 2021
By Hamid Riaz
An aggressive launch of the COVID-19 vaccination drive began in early February this year, but even then, millions are expected to remain untargeted by the vaccines.
The government has claimed that it has doled out over five million doses already, and that over a million citizens have been fully vaccinated, while 2.8 million are partially vaccinated. But the bigger problem at hand is to reach the large chunk of population that does not have the requirements needed to register for vaccination.
Citizens can visit the government’s COVID-19 advisory website or the official website for the National Command and Operation Center (NCOC). A pop-up dialogue box greets the person entering the website directing all citizens of the appropriate age (which now includes all citizens over the age of 19) to either send their National Identity Card (NIC) number to the COVID-19 helpline (1166) or directly enter their NIC with a mobile number on the website.
The vaccination process seems simple enough – but only if you have and can readily produce an NIC number. Sadly, for too many people residing in Pakistan, an NIC number is a luxury unheard of. The number is possibly in millions, and so this means that far too many may be missing out on these necessary vaccinations.
But who are these people whose health can put themselves and others in danger?
Extensive research including talking to multiple sources has helped categorize the population missing out, in three distinct groups – despite their being eligible medically and age—wise. More to the point, all three of these groups belong to marginalized and excluded communities, and they cannot be expected to receive their vaccines through the private sector either, because of expenses. Even worse, these groups may become even further marginalized because of their vulnerability to the virus.
According to the Pakistan Medical Association (PMA) the condition for the NIC is ‘unnecessary and has been urging the government to scrap the requirement that will ends up excluding ‘millions’ from the vaccine net.
“All it will do is, it will end up putting all the benefits of such a large-scale vaccination program in tatters, and the relentless efforts of health professionals will go down the drain if at the end of the day, such a huge portion of the population is not even receiving vaccines only because they don’t have identity cards,” says Dr. Qaiser Sajjad, the
General Secretary of the PMA. “We must vaccinate every single adult. The government must remove this [identity card] condition and simply let everyone get vaccinated,” says Dr. Qaiser.
Pakistan has the second largest population of refugees in the world, next only to Turkey. Though the biggest refugee community residing in Pakistan is from Afghanistan distressed regional communities like the Rohingya and the Bengalis also have a significant presence in Pakistan.
“The Afghan refugees residing in Pakistan can broadly be divided into three categories. Over 1.4million Afghan refugees residing in the country have been issued Proof of Registration (POR) cards under a scheme which was initiated in the year 2006-2007 and are generally known as Registered Refugees,” explains Qaiser Khan Afridi, the spokesperson of the United Nationals High Commissioner for Refugees (UNHCR). “Recently, the government of Pakistan has announced that it will begin registrations for registered Afghan refugees so at least theoretically they have become eligible for the vaccine. In the second phase of registration for Afghans residing in Pakistan, the government issued Afghan Citizen Cards (ACC) cards, but almost 400,000 to 500,000 Afghans living in Pakistan remain unregistered or undocumented in any way whatsoever,” continues Qaiser.
Afghans holding the ACC are normally termed as economic migrants, not refugees, and remain excluded from the government’s scheme while the unregistered Afghans are not even included in UNHCR’s mandate and hence ‘cannot’ be accounted for let alone be vaccinated. Simply put by this logic over 2 million and two hundred thousand (2,200,000) Afghans in Pakistan have been outrightly excluded from the vaccination drive. But even those with POCs who can officially apply for the vaccine are largely being left out.
According to the latest official press release of the UNHCR out of the over 1.4 million eligible Afghan citizens, only 10 had received the vaccination so far.
“Over 6000 people are residing in the camp I live in. Out of these about 3000 people are eligible for the vaccine according to the criteria set out by the government. But to my knowledge not even one of these have been vaccinated so far,” says Hameed-Ur-Rehman Safi, an Afghan refugee residing in a camp in Charssadah. “The registration numbers on our POR cards are of 11 digits while the NIC numbers are 13 digits. When we go to the vaccination centers we are told that the application being used for vaccine registration is not built for 11-digit registration numbers and this is why we cannot be registered.”
Hameed also points out that to date no representative of the government or even the UNHCR has approached the camps to register or even spread awareness about the vaccination program.
After the Afghans, the Rohingya make up the biggest refugee population in Pakistan. According to figures reported in local and international news outlets, there are about 0.2 million Rohingya currently residing in Karachi. Most of them are forced to reside in informal slum-like settlements in the city and many of them have been denied citizenship status because they have not been able to produce the requisite documents rendering them stateless.
“Most of the Rohingya living here came during periods of unrest in Bangladesh in the 1960s and the’70s (then East Pakistan). The people who have been issued CNIC and have been formally recognized as Burmese Pakistani citizens are eligible for the vaccine. But those who do not have ID cards obviously cannot avail any government services including the vaccine,” explains Nur Hussain Arakani, the convener of the Pakistan chapter of the Islamist Rohingya Solidarity Organization, currently residing in Arakanabad, the biggest Rohngiya settlement in the country. “But of course we are working with the government to try and address the issue,” adds Nur without expounding upon what these efforts were and exactly how many out of the thousands of Rohngiya residing in Arakanabad have been vaccinated.
“I do not have any information regarding the issue. Frankly, I have only learnt about this through this interview,” remarks the District Health Officer (DHO) Karachi-Korangi, where a portion of Arkanabad is concentrated, when asked about the vaccination of the Rohingya living under his jurisdiction. “It is not my job to make policy. I just execute instructions. It is the higher-ups in the federal and the Sindh should ponder on the issue,” asserts the DHO.
‘We have not thought about the issue’
“We have not thought about this issue so far. So there is no policy on it,” responds a senior official of the NCOC when asked about the vaccination of the Rohingya in particular and in general about other refugees. “When we figure it out I’ll let you know.”
“Even though un-registered refugees are not included in the mandate of the UNHCR, I cannot say anything officially,” says Qaiser Afridi. “But on a humanitarian level I think the government should seriously consider removing the PoC condition for the vaccine otherwise millions of undocumented human beings in the country’s territory will remain unvaccinated. The virus does not differentiate between documented and undocumented human beings.”
Citizens of rural and peripheral areas
Another large chunk of the population which is marginalized and has trouble producing their identity cards are those who reside in rural or remote areas, who either do not bother getting an NIC or are prevented from doing so due to a variety of social factors. Even though there are no credible figures available on exactly how many of these ‘non-existent’ citizens are currently residing in the country researchers who have been working on Pakistan’s identity managing crisis have been painted a shocking figure.
“During my fieldwork during the 2018 elections, we were able to identify that over 12 million women currently residing in the country do not have identity cards. We were able to make this estimation based on the gender gap in voter registration. You can see that this is a massive figure and even if we go by reserved estimates the chunk of the population is just too large to ignore during the vaccination drive,” explains Saud Sahah Lead Researcher at the Free and Fair Election Network (FAFEN), one of the organizations working on the registration crisis.
“Most of the people who do not have identity cards are women and it is not difficult to assess why considering our societal culture. Women in rural areas never come into contact with departments and institutions of the state because they are mostly confined to their homes,” says Saud. “They do not have jobs, they do not have bank accounts, they do not have driver’s licenses, they cannot access hospitals, and do not even go to educational institutions. Even when they work they work in the informal sector and for this reason, their men do not bother getting their ID cards made. Meanwhile NADRA’s approach is not proactive at all. They believe that setting up offices and sending vans will somehow resolve the issue but it won’t because these women cannot access these offices and vans at will because of gendered barriers,” Saud explains why such a large section of the population remains unregistered.
“Because of this lack of registration, a vast majority of them women are also left out of relief programs set-up by the government (while referring to the Ehsas program) even when they need it the most. And now when we are going through an emergency crisis – a pandemic – yet even now these women have been pushed aside and out of the vaccination program,” continues Saud.
Saud reiterates Qaiser Afridi’s demand that the “proof of identity” condition for the vaccine must be scrapped instantly because it is tantamount to “excluding the already excluded citizens of the country the government should try to break this cycle of exclusion at least in this emergency situation.”
Blocked ID cards
In 2016 the then Interior Minister of Pakistan ordered the “re-evaluation” of 100 million ID cards issued to the citizens after it was revealed that Afghan Taliban leader Mullah Mansour possessed two Pakistani ID cards at the time of his killing by a U.S drone. The purpose of this re-verification was to filter out the aliens and foreign nationals who had obtained ID cards through fraudulent means. As a result of the re-verification campaign over 3 lakh identity cards were blocked for further verification. Even though NADRA failed to make public how these fraudulent cards were issued in the first place or even the parameters of the re-verification.
In a report submitted to the parliament in February last year, the interior ministry admitted that NADRA has yet to decide cases of over 1,50,000 blocked computerized national identity cards. Out of these some 1,21,889 cards were declared to be “complex case” or “digitally impounded cases” while the rest were marked to be resolved soon. The revelation meant that thousands of “suspected citizens” still await the rehabilitation of their citizenship and consequently all the services that come with it including the current vaccination drive.
Dr. Faisal Sultan the Special Assistant to Prime Minister Imran Khan on Health has announced that by the end of this year the government of Pakistan will have vaccinated 70 million of its adult population to curtail the pandemic in its territories. But it is clear that even the government’s “free” vaccination is a privilege that millions residing in the country cannot afford.
Medical health workers, aid workers, and researchers are united in calling on the government to get rid of the POC and move towards vaccinating whoever wishes to be vaccinated. Otherwise, it will become almost impossible to break the chain of infection in the country.
“The middle classes are praising the government’s vaccination program because they cannot even conceive that there are people not being able to log into a website or enter their ID card numbers. But for millions, even this simple process is a luxury they cannot afford,” points out FAFEN’s Saud Shah