Research concerning the inter-relationship between conflict, health and identity is urgently required (Varley 2010), particularly with regard to the effects of hostilities for clinical service provision and physician and patient security. Using qualitative and archival data collected over a period of four years (2004-2005, 2010-2011), this paper responds to this gap in the available literature by presenting an ethnographic overview of the impacts of sustained Shia-Sunni hostilities for patients’ uptake of biomedical service provision and, as importantly, health providers’ employment and economic security in Gilgit Town, capital of the Gilgit-Baltistan region of northern Pakistan.

Specifically, I will examine how Gilgit Town’s government health services are embedded in and affected by sectarian affiliation, politicking and violence in ways that have profoundly affected health care providers’ ability to work safely and effectively in clinical settings. The impoverished and federally-neglected Gilgit-Baltistan region has experienced dramatically intensifying levels of Shia-Sunni hostilities over the past 20 years. The apex of recent sectarian conflicts was marked by the January 2005 assassination of Gilgit’s leading Shia cleric by Sunni militants. Over the subsequent 10 months of Shia-Sunni hostilities and Army curfews, the targeted assassinations of Sunni physicians and the security risks posed by government hospitals located in Shia mohallas (neighbourhoods) resulted in an 80 per cent decrease in Sunni patients and the forced relocation of Sunni health service personnel to ‘safer’ clinical settings. Or, public sector physicians were compelled to shift their clinical practices from Gilgit to urban centres such as Islamabad and Karachi.

As the paper will explore, in the years following the 2005 ‘tension times’ the security-related exclusion of Sunni health service providers from the Gilgit Town District Headquarters Hospital has led to adverse health effects for patients from all sectarian communities (Sunni, Shia, Ismaili) due to significant gaps in service coverage and provision. In response, Gilgit-Baltistan’s regional administration has attempted to mediate the risks facing health service providers and their patients through the establishment of hospitals in ‘purely’ Shia or Sunni mohallas. Such phenomenon serves to exemplify the continuation of conflict and exclusionary practices into clinical spaces, and demonstrates that Gilgiti health providers’ livelihoods and issues related to patient coverage are predicated on the regional politics of difference and enmity. Ultimately, my research addresses how conflictive sectarianism in Gilgit-Baltistan has complicated the practice and provision of public sector health services in multiple ways, many of which remain under-examined.

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