Pakistan's doctors are regular targets of kidnappers (dpa German Press Agency)

Pakistan’s doctors, widely targeted by kidnappers, extremists and organized crime, are emigrating in droves for safer, more lucrative positions overseas.
Karachi (dpa) – Pakistani doctor Tipu Sultan said the ransom letter he received last month demanding 5 crores rupees (500,000 dollars) was nothing new in his 38-year career.
“Nearly all of the consulting doctors of all hospitals in this city have received these kind of extortion threats,” said the 69-year-old anaesthesiologist in Karachi, capital of the southern province of Sindh.
“We have received envelopes with bullets inside.”
The threats are not idle.
Since 2006, at least 160 Pakistani doctors have been killed, according to National Dental Medical Council, mostly in Karachi and Quetta, the capital of south-western province of Balochistan.
“They were shot inside their clinics, at the door of their hospitals, and on the road,” Sultan told dpa at Karachi’s public Civil Hospital.
The motives vary widely, and are not always clear.
Doctors are undoubtedly targeted by kidnappers for ransom and racketeering, as they are relatively wealthy and easy to find.
Hundreds have been kidnapped, and thousands of them have paid extortion money, security and medical officials say.
In Balochistan alone, more than 50 doctors and medical professors have been kidnapped since 2008, the local chapter of the Pakistan Medical Association said.
“The majority returned after paying huge amounts in ransom money,” said Aftab Kakad, a senior doctor in Quetta.
Physician RP Phulara said “most doctors have paid money at some point, either after being abducted or before, as bhattaa,” or extortion.
Sultan said he has never paid, but has stepped up his personal security measures, including hiring an armed guard.
Since last year, he does not answer calls from unknown numbers, and keeps an irregular schedule to evade ambushes, despite his punctual nature.
“I have asked by the police not to be on time, and not to tell anyone what time I will arrive or leave, not even my wife,” Sultan told dpa.
Authorities in the north-western province of Khyber-Pakhtunkhwa have recommended since 2013 that doctors carry guns.
Aside from criminal enterprise, individual doctors also fall afoul of the city’s religious or ethnic fault lines between Sunni, Shiite and Ahmadi Muslims and minority Hindus or Christians, or between the area’s indigenous Sindhi population and post-partition migrants from India, or Pashtuns from the north-west.
“In almost all the cases nobody knows the exact cause,” Sultan said, “But it is mostly due to ransom, religious belief or ethnicity.”
Fayaz Ansari, who survived a 2010 bomb attack at the emergency ward of Karachi’s largest hospital when he was a medical student, said there is often a political dimension.
“Some say these groups are related to the political parties, others say they are related to pure criminal gangs,” he said. “It’s hard to say. Many times it’s the political-criminal nexus.”
“Criminal gangs have political backing. Doctors have held many talks with the parties, but nothing has happened.”
Whatever the motives, the targeting of Pakistan’s doctors is “a unique phenomenon in the whole world,” Sultan said. “Nobody kills their own expertise.”
And with perpetrators seldom caught, doctors are now voting with their feet.
The Pakistan Higher Education Commission estimates that about 1,500 doctors leave the country each year for work or further studies, and 90 per cent do not return.
“I don’t blame them,” Sultan said. “They are trying to protect themselves and their families. They don’t want to live under the constant threat of being killed.”
Of around 175,000 doctors registered in the country of 182 million people, “only 30-40,000 are [still] in Pakistan, nearly all in cities and their peripheries,” he said.
There is no record of how many registered doctors remain practicing in the country or have left, but one figure from the national Young Doctors Association quantifies the impact of the exodus.
More than half of the specialist position in Pakistan’s district hospitals are vacant, while 40 per cent of teaching hospitals lack professors.
“This is not heading towards disaster, it’s already a disaster,” Sultan said.
Security is not the only reason to emigrate, with salaries up to 10 times higher overseas.
For 20 years, Pakistan has been a leading exporter of medical professionals to the Gulf, the United Kingdom and the United States.
There are more than 8,000 Pakistani doctors in Saudi Arabia alone, according to Pakistan’s medical council. Riyadh’s Health Ministry hired 1,000 in one go in 2001.
Sultan holds authorities responsible for not clamping down on the perpetrators, nor doing more to keep the country’s medical experts.
“We have had three dictators and three democratic governments in the past 60 years. None of them prioritized the health sector.”
Pakistan’s 2014-15 national budget allocated 265 million dollars, or 1.3 per cent of the total, to the health sector, compared to 7 billion dollars to defence, or 23.1 per cent.
“The respect for doctors is still there, because after God it’s the doctors who relieve the people of their immediate pain and miseries,” said Sultan.
“But who will help the doctors with their own miseries?”