It's been a tough year for Pakistan-U.S. relations. Crucial NATO supply routes have been shuttered since November, there is tension over drone strikes and now the countries are at odds over the treason conviction of the Pakistani doctor who helped the U.S. locate Osama Bin Laden.
NOWSHERA, Pakistan -- There has been little change to the scenes at Jalozai refugee camp in recent years.
Lines of worn and weary wait to register for services, clutching the few belongings they brought with them. Food rations and hygiene packs are distributed inside large tents and makeshift shelters bearing the brands of various United Nations and non-governmental agencies. And children -- some barely toddlers -- are everywhere you turn: packed into temporary tent schools, running through the labyrinthian "streets" of shelters, and holding their parents' places in various lines.
But the thousands that crowd the camp and the area around it today are different from the masses relocated during Pakistan's military operations of 2008 and 2009 in the country's northwest. They are different than the throngs seeking shelter after the devastating floods of 2010 and 2011. The vast majority of the 300,000 the camp currently supports are all from Khyber Tribal Agency bordering Afghanistan, where ongoing fighting between Pakistan's military and militant groups forced them to flee their homes and seek safety elsewhere.
As attacks increase, aid workers say they must keep safety in mind at all times. NBC's Amna Nawaz reports.
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Unlike the previous groups of arrivals, this new group wasn't anticipated in such large numbers. At the height of the influx in mid-March, the camp was registering 5,000 new families a day. That number has slowed to 400 or 500 a day, but the arrivals continue. Resources the agencies thought would last for months, are now running out.
"Of course, everybody planned for an emergency," says Faiz Muhammed, chief coordinator of Jalozai camp. "But it was planned for, say 10,000 families, maybe for the rest of the year. We're now using up all those resources that were planned for nine months in just two months."
Aine Fay, chairperson of the Pakistan Humanitarian Forum (PHF)-- an informal network of 47 NGOs operating in Pakistan, says the funding situation is dire: less than 3 percent of the required budget to respond to the needs of internally displaced people is available.
"Agencies will run out of money by the end of June if the donor community don't respond," says Fay. "And we're facing into the monsoons of 2012. While we all hope that there will not be a repeat of the floods of 2011 or 2010, we have no guarantee and we have to be prepared for them."
Aid workers say they are concerned that the coming monsoon season may prove devastating for millions of people in Pakistan.
Robin Lodge, of the World Food Programme (WFP) -- the sole food provider for the Jalozai families -- says the agency has already had to cut back rations to deal with the funding shortage.
"Funding is not too good," says Lodge. "We're worried about the monsoon season because that will put an additional strain on resources."
As the need for their services grows, aid and relief workers are also having to contend with increased insecurity across the country, as they more frequently become targets for kidnapping -- a common means of fundraising for many militant and criminal groups.
Since 2009, according to numbers compiled by PHF, at least 23 aid and development workers -- foreign and Pakistani staff -- have been kidnapped. Eighteen have been killed.
In 2009, eight staff members of two humanitarian organizations in the northwest Khyber-Pakhtunkwa (KPK) province were shot dead in two separate targeted attacks on their office. In 2010, six staff members of one agency were killed in an attack in KPK, and four other staff members were abducted and one was murdered in Balochistan. In 2011, 14 staff from two different organizations were abducted in separate incidents in Balochistan.
So far this year, five humanitarian workers have been abducted and four have been murdered in Balochistan, Sindh and Punjab provinces.
Recently released video of American Warren Weinstein -- kidnapped from his Lahore home in August 2010 -- made headlines as the first sign of life since he was taken. The brutal April murder of Dr. Khalil Dale, a British aid worker with the International Committee of the Red Cross (ICRC) in Balochistan, again brought to the forefront the growing insecurity faced by relief workers in Pakistan.
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In response, the ICRC suspended its projects across much of the country as it reassesses its operations, placing local staffers on paid leave and bringing foreign staffers back from the field into Islamabad. This is the first time the agency has suspended operations in Pakistan since it began working here in 1947.
Local, national staff in particular are targeted here -- more visible and more frequently spending time on projects in their own communities than their foreign colleagues who visit sites from time to time. A fake vaccination program carried out by the CIA using local staff in the lead-up to the Osama bin Laden raid created additional problems for local humanitarian workers, leading to suspicion among communities as to aid organizations' true intentions.
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In February, InterAction -- the largest alliance of U.S.-based international NGOs -- sent a letter to CIA director David Petraeus expressing concern that activities like the vaccination program undermined humanitarian efforts in Pakistan and jeopardized the lives of their staff.
"The CIA's use of the cover of humanitarian activity casts doubt on the intentions and integrity of all humanitarian actors in Pakistan," wrote Samuel Worthington, InterAction's president. "It is imperative that independent, impartial humanitarian action be kept clearly distinct from intelligence-gathering activities. Any blurring of the two risks causing setbacks in decades-long global health and humanitarian efforts and endangers the lives of those working to make advances on the behalf of the global community."
Aid workers from multiple organizations told NBC News that security has always been a part of their planning in Pakistan, but re-assessments and operational re-adjustments have been necessary in recent years as the kidnappings and violence have increased.
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"I think for a lot of organizations, we would measure the vulnerability that communities are at -- the need for the services that we can provide -- versus the risk we think our staff are exposed to," says Fay. "If the risk is greater than the need on the ground, the answer is simple."
Muhammed Muheisen / AP
Images of daily life, political pursuits, religious rites and deadly violence.
Humanitarian workers in Pakistan with whom we spoke, most who wished to remain anonymous, all maintain that despite the risk and the resources they must now divert from aid delivery to security considerations, their priorities remain the same.
"We have had to look at things more carefully, scale up in certain areas of security, re-evaluate," says Stacey Winston, with the UN's office for Coordination of Humanitarian Affairs. "We try to keep security a priority and also to maintain operations as much as possible, because that is really the priority -- to reach as many people as quickly as possible in the humanitarian response."
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