Early on October 29, an earthquake measuring a 6.4 on the Richter scale struck the district of Ziarat, Pakistan. MSF's closest team was in Quetta, a two hours drive away. An assessment team was dispatched followed by mobile and fixed clinics in the Ziarat district. Three days later I was there as well. The earthquake area is in the high mountains - it would normally be great to visit and live here. Around 120,000 people of different tribes, most of them reside in the widespread valleys where they make a living as apple farming communities and live together harmoniously. The houses here are mostly simple mud and wood constructions, with extended families. The earthquake destroyed a lot of houses here. My first feeling is overwhelming: kids, men and women are busy recovering what they can from their collapsed houses. Others are trying to collect relief items from the NGOs that have arrived. The Pakistan Military and Government have been ahead of all actors with huge logistical capacities. One thing also to mention: The public empathy and support has been extraordinary, goods and supplies were sent from all over the world. Our national staff have been impressive in their response; very experienced and highly motivated. The only part that is really difficult is the weather – it is the beginning of winter, and winter brings snow that closes the roads to these valleys, and at night the temperature already drops to 2 degrees and sometimes zero. Our tents are not winter designed, so to improvise we added layers of blankets inside along with gas heating at night. It makes me wonder how the earthquake survivors will continue through the winter, even though a substantial amount of tents, blanket, buckets and other basic items were distributed and more is coming. There has been a good response capacity from national and international actors, so MSF staff have focused our intervention on medical care and non-food items distribution in the remote areas deep in the mountains that did not receive assistance at early stages. We also increased our distribution of hygiene kits as well as promoting hygiene, since MSF is the only actor doing that. Along with the medical clinical activity we have observed that there is a high number of patients who suffer from post trauma and stress disorder (PTSD), such as anxiety or sleeplessness, so we have boosted this part of our activities, by offering mental health counseling to the affected victims as part of our psychosocial support. It is mainly one to one counseling and group discussions our teams offer. The people of this area are very warm and hospitable and deeply value their Islamic culture. Everywhere we have been, our routine visits have been met with warm cups of tea and sometimes with food that just adds to the connection I have with them. We try to show our respect to their values in our medical care by having separate consultation areas for men and women. My strongest memory will always be an old man whose house completely collapsed. We reached his village in the first days after the quake. He asked me where I am from and when he heard that I am an Arab and came to help the people here, he started crying and that made the tears also run out of my eyes. MSF activities at the Balochistan earthquake, Pakistan (until 21/11/2008) Ibrahim Younis, an MSF Emergency Coordinator, arrived three days after the earthquake October 29 earthquake in Ziarat District, Balochistan Province,Pakistan, and stayed two weeks in the Ziarat area as MSF Emergency Coordinator. He then went to Islamabad to coordinate from there, where he still is at the moment. The destruction from the earthquake has affected an area inhabited by about 150,000 people. The official death toll is approximately 300 people, with 35,000 injured and 40,000 homeless. MSF provided medical care and hundreds of blankets, tents and other basic items, like jerry cans and hygiene kits were distributed to 300 families. Immediately, MSF teams set up a clinic in the village of Khan Killi, offering 24-hour care. Two mobile clinics traveled daily to the more remote villages further away. In the first week, between 130 and 170 patients were seen each day, mainly for upper respiratory and skin diseases, diarrhoea and minor injuries. A total of 617 patients were treated in the first week. MSF has a team of more than 35 staff and plans to stay for another six weeks. � The majority of patients have psychological complaints, like sleeplessness, anxiety, increased heart rates, headaches and pains that need more than medication, combined with the loss of family, friends and homes due to the earthquake, this has left a massive need for mental healthcare. To provide for those in need of mental healthcare, MSF has sent international and Pakistani mental health counselors to the area around Ziarat to work in the local communities, not only providing counseling, but also training Pakistan Ministry of Health medical staff to do the same. Starting points are the communities where MSF started with fixed and mobile clinics. With a lot of agencies now coming into the area, MSF wants to focus on mental health care so it handed over its basic clinic activities. MSF is ready to respond to any emergency especially communicable diseases.