Global Outpouring to Help Pakistani Schoolgirl

By Declan Walsh | The New York Times | Published: October 15, 2012 | Source

ISLAMABAD, Pakistan — When the time came to choose medical treatment for Malala Yousafzai, the 14-year-old Pakistani schoolgirl who defied the Taliban and then was gunned down by them, her family and doctors faced a world of possibilities after a global outpouring of advice and offers of assistance.

Whatever they chose, a medical jet from the United Arab Emirates was waiting to take her to hospitals abroad. Pakistani and American officials had talked about arranging treatment for her at the giant American military hospital at Landstuhl, Germany.

A well-developed offer came from former Representative Gabrielle Giffords and her husband, Mark E. Kelly, who had gone through their own treatment ordeal after she was shot in the head last year. They had gone as far as to line up a noted neurosurgeon and had even arranged a transportation option of their own to the United States — with a television celebrity offering to quietly foot the fuel bill.

Those were among dozens of offers from across the world. But when the time came to fly the wounded schoolgirl out of Pakistan, in the early hours of Monday, a deal from Britain to accept Malala at a specialized hospital in Birmingham proved hard to beat.

But first, to get her there.

Out of worry that the Taliban would fulfill their promise to take a second shot at the teenage activist, the dawn run from the military hospital in Rawalpindi, Pakistan, to the airport was shrouded in secrecy, said Rehman Malik, Pakistan’s interior minister.

“I directed the airport staff to remain incognito, because there was an alert, threats from the Taliban that they would kill her,” he said. “We were very careful.”

When the Emirati jet carrying her and a team of doctors landed in Birmingham on Monday afternoon, most agreed that the decision made both medical and diplomatic sense.

Britain and Pakistan have a long history stretching back to British rule on the subcontinent; doctors at the hospital, the Queen Elizabeth II Memorial Center, have treated hundreds of British soldiers wounded in fighting against the Taliban in southern Afghanistan.

“We do, unfortunately, have a considerable expertise in treating that sort of bullet injury,” Dr. David Rosser, the hospital’s medical director, told reporters.

Pakistani, British and American officials took pains on Monday to emphasize that the final decision about Ms. Yousafzai’s treatment had been based on medical grounds above all else.

“We never saw this in a political light,” one senior American official said on the condition of anonymity. “This was a humanitarian story, not a political one.”

Yet there was little doubt that each of the possibilities, especially given the diplomatic tensions between Pakistan and America, carried its own political risk.

Initially, Pakistani officials had approached the American Embassy for help, officials from both countries said.

Two options were discussed, Interior Minister Malik said: the possible use of an American military facility in Oman, and evacuation to the Landstuhl Regional Medical Center in Germany. “We scrambled like hell,” one American official said. “We were standing by, ready to do anything.”

There were also private American offers — from Ms. Giffords and Mr. Kelly, plus at least three other “serious” parties, the American official added. One came from an American businessman with ties to senior figures in the Pakistan government; another came from a constituent of Senator John Kerry, who has longstanding political ties to the country.

Meanwhile Ms. Giffords’s doctor, Dr. Dong Kim, the head of neurosurgery at the Memorial Hermann-Texas Medical Center, got ready to travel to Pakistan. Mr. Kelly, a former astronaut, said he had recruited an American celebrity, whom he declined to name, to finance the fuel costs of an emergency plane trip from Peshawar to Houston.

“We were just trying to offer the best help available, as we understand it from being down this road,” Mr. Kelly said.

Mr. Kelly also pressed political contacts in the White House, State Department and Pakistan to help push the offer through. He said that Johns Hopkins University made a similar offer.

But over the weekend, Mr. Kelly was told by a senior State Department official that “Pakistan has decided to solve this domestically.”

The British connection, however, had already been well established at that point through two doctors, both experts in trauma injuries and one of whom was of Pakistani descent, who happened to be visiting Pakistan at the time of the shooting last week.

The medics were quickly drafted into the effort to save Ms. Yousafzai’s life. They were flown to Peshawar to help with the initial diagnosis and then on to the hospital in Rawalpindi. They shared in decisions about how long to keep the patient in Pakistan, officials from Britain and Pakistan said, declining to name the two.

Early Monday morning, the medics accompanied a Pakistani brigadier in watching over Ms. Yousafzai during the flight to Britain. The air ambulance that ferried them had been offered by the United Arab Emirates, a country with close political ties to President Asif Ali Zardari.

By several accounts there were sound medical reasons why the American offers of help to Ms. Yousafzai were not accepted, including the lengthier flight to the United States.

But Britain may also have held other attractions. While the United States and Pakistan have engaged in diplomatic warfare in recent years — over the Osama bin Laden raid, drone strikes and the controversy surrounding a Central Intelligence Agency contractor, Raymond Davis — Britain has carefully cultivated a less adversarial relationship.

Britain has been a major aid donor to Pakistan for decades, and many high-ranking Pakistanis, in political life and in the country’s armed forces, have been educated or trained in Britain.

 “If we had an offer of British help and American help, all things being equal we would go with the British,” one senior Pakistani official said. “It makes more sense.”

Exact details of Ms. Yousafzai’s condition remain hazy. Doctors say she requires treatment for a serious skull fracture, caused by a bullet that passed through her head. Later, she may require long-term neurological rehabilitation.

Dr. Rosser, the hospital director, said his doctors would make a full assessment after carrying out a series of diagnostic tests, including neurosurgical imaging to determine the extent of the injury to her brain.

Ms. Yousafzai’s schoolmaster father, Ziauddin, who inspired her to start her high-profile campaign for girls’ education and women’s rights in 2009, did not travel with her to Birmingham yesterday, Pakistani officials said.

His passport had expired, and had to be renewed on an emergency basis. He and his wife are to arrive at their daughter’s bedside over the coming days.