Abandonments, Solidarities and Logics of Care: Hospitals as Sites of Sectarian Conflict in Gilgit-Baltistan

Abstract

Using data collected over nearly three years of ethnographic fieldwork in the Gilgit-Baltistan region of northern Pakistan, my paper explores hospital spaces, clinical services and treatment encounters as conduits for the expression and propagation of conflictive Shia-Sunni sectarianism. Where my prior research has investigated the political etiologies (Hamdy in Am Ethnol 35(4):553-569, 2008) associated with Gilgiti women's experiences of childbirth during 'tensions', as Shia-Sunni hostilities are locally known, this paper focuses on healthcare providers' professional and personal navigations of an episode of conflict whose epicentre was at the District Headquarter Hospital, Gilgit-Baltistan's foremost government hospital. Through critical evaluation of the impacts of Shia-Sunni tensions on the social, administrative and clinical practices and consequences of medicine, my paper analyses the complex ways that clinics in crisis serve as zones of contact (Pratt in Profession 91:33-40, 1991) and abandonment (Biehl in Soc Text 68(19):131-149, 2001; Subjectivity: ethnographic investigations, 2007), in which neglect and harm are directed along lines of sectarian affiliation to produce vulnerability, spectacular violence and death for healthcare providers and patients.

Hospital Paperworlds: Medical (Mis)Reporting and Maternal Health in Northern Pakistan

“…The DHQ is the largest public sector hospital and tertiary‐level referral facility in the Gilgit‐Baltistan region, serving its capital city Gilgit's approximately 215,000 residents and a rural and semi‐rural catchment population of nearly two million. Though my research initially explored the impacts of conflict and humanitarian crises on the DHQ's maternity ward (see Varley 2016, 2019b), in trying to understand why the region has one of Pakistan's highest maternal mortality rates, 1 my fieldwork later pivoted to investigate the regularity and severity of iatrogenic (treatment‐linked) risk, injury, and loss in its labor room (Varley 2019a, 2022). There, delays in care and the failure to adequately monitor patient vitals contributed to frequent—even daily—stillbirths and newborn deaths.…”

“…Though more and more hospital ethnographers (see Smith‐Oka 2022; Towghi 2018; Varley 2019, 2022; Williamson 2021) explore what Saiba Varma and I describe as medicine's “shadowside” (2021)—when “medicine's soteriological foundations [become] manipulated, twisted, or mangled in everyday clinical practices, such that the lines between practice and malpractice can become exceptionally blurred” (Varma and Varley 2019: e198)—the ways that errancy and mismanagement are written into or out of hospital records are still only rarely attended to. In a clinically granular way, this article complements hospital ethnographers’ efforts to answer these gaps by addressing how “the medical record [serves] as an artefact of not‐knowing that both documents and performs uncertainty as a valuable resource” (Street 2011: 815; see also Sullivan 2017; Varma 2020).…”