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The subtle art of compromise and reconciliation: a tale from Lower Dir
  1. Stefano Malinverni
  1. Emergency Department, Médecins Sans Frontières—Operational Centre Brussels, Timergara, Khyber Pakhtunkhwa, Pakistan
  1. Correspondence to Dr Stefano Malinverni, Rue d'Andenne n° 21, Saint Gilles, Bruxelles 1060, Belgium; stefano.malinverni{at}

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The sky above Timergara has an overwhelming tone of blue. The term ‘Kashmir blue’ was forged to describe the unique tone of colour of its skies. Timergara is not in Kashmir, just some hundreds of kilometres from it, but maybe skies, as clouds and winds, just ignore borders, unravelling their magnificent hues of blue over our heads. I have been asked to work there for an organisation that knows no borders as well, Médecins Sans Frontières (MSF), taking over the challenge of managing its emergency ward.

The 6-hour drive from Islamabad to our hospital is a journey through time. Tarmac highways give way to dirt roads. Toyota pickups and over-decorated trucks are slowly replaced by donkeys as we climb into the valley. Mountains populated by the ethnic minority of Pashtuns, whose millenary traditions are well alive today and whose pride goes unrivalled on Earth. Our hospital is a partnership, started during the 2009 refugee crisis, between MSF and the local government. When refugees from Swat valley poured into Timergara at an overwhelming pace, MSF took over the Emergency Room (ER), the blood bank and the urgent surgeries. Quickly a triage system based on the South African Triage System was implemented to improve the recognition and early management of critical …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.