Last week, Médecins Sans Frontières (MSF), an international organisation also known as Doctors without Borders, was asked to pack up their work and leave the Kurram Agency -- bringing an end to their 14 years service in the tribal region.

The organisation was conveyed the message that it had been denied no-objection certificate on September 13, almost a week before the start of Muharram, a time when there is a lot of tension in Kurram Agency as well as many districts of the Khyber Pakhtunkhwa.

"MSF is saddened by the decision of the authorities responsible for NGOs working in Kurram Agency. The closure brings to end 14 years of MSF working with the FATA Health Services in Kurram Agency," Country Representative of MSF, Catherine Moody, said in a statement after the development. "We will continue to provide obstetric and newborn services to the women of FATA through the MSF Women’s Hospital located in Peshawar."

MSF had been working in Kurram Agency since 2004. It was functioning in the Tehsil Headquarter Hospitals in Sadda and Alizai towns since 2008.

MSF, alongside other NGO and INGOs, was helping locals access better health and education facilities in Khyber Pakhtunkhwa and Federally Administered Tribal Areas (Fata) till the government placed a condition on them of obtaining NOC (no objection certificate) from the KP and Fata administration to carry out any welfare activity in the area. This condition of acquiring NOC has forced many such organisations to stop operation in Khyber Pakhtunkhwa and Fata. A number of organisations were refused NOCs by the concerned departments as they did not meet the required criteria. They had to pack up from Fata and KP though a majority of them continue their operations in other provinces of the country.

In September 2016, the authorities ordered all NGOs and INGOs to inform the Health Department of Fata before starting any project for the welfare of the tribal people. The district administration in Shangla and a few other districts of KP had imposed a ban on NGOs working without an NOC soon after an earthquake in November 2015. Even last month, the district administration of Shangla had sealed the offices of six local NGOs for not having NOC.

The MSF authorities have informed its team in the Kurram Agency, the elders of Sadda and Alizai and the local community about the decision. The necessary measures to close the health services provided by MSF in the agency have almost been completed.

A number of districts of Khyber Pakhtunkhwa and almost all the tribal agencies and frontier regions lack basic health facilities and education -- the reason why many local and international organisations were working in these areas in different sectors till recent years.

"During the year 2016, in Sadda and Alizai, 36,498 and 6,416 out-patient consultations were conducted respectively. The Sadda hospital admitted 1,946 people and treated 414 patients for Cutaneous Leishmaniasis. A total of 736 children were admitted to the new born unit during 2016," said a MSF statement sent to TNS.

In Sadda hospital, MSF has been responsible for the out-patient department for children under five years and in-patient department for severely ill children up to 12 years of age. The newborn unit treated premature babies and those experiencing complications immediately after birth. In Alizai, MSF was responsible for the out-patient department and observation room for children under 12 years.

The organisation has been working with Pakistani communities who are affected by natural disasters, conflicts or lack of access to healthcare since 1986. Their teams are currently providing free emergency medical care in Kurram and Bajaur Agency (Fata), Khyber Pakhtunkhwa, Sindh and Balochistan provinces. "MSF relies solely on private financial contributions from individuals around the world and does not accept funding from any government, donor agency or military or politically-affiliated group for its activities in Pakistan," concluded the statement.

Spokesman Civil Secretariat Fata Abdul Salam Wazir says MSF and other NGOs and their NOCs are under scrutiny. "The agency administration has told me recently that they want MSF to stay."

He adds that the government has plans to make Parachinar a safe city to improve the law and order situation -- and "for that the NOCs of NGOs working in the area are also being scrutinised".

In June 2009, MSF had briefly stopped its operations in Sadda hospital after a mortal shell hit the tehsil hospital, injuring two children. The organisation has never stopped treating its patients in both the tehsil hospitals in Kurram since then.

Locals of Kurram Agency have appreciated the role of the MSF in both Sadda and Alizai tehsils and believe the organisation will return to provide medical facilities, especially to women and children.