Thursday, July 16, 2009

A frantic Al Qaeda appeal?

Al Jazeera reports that Ayman al-Zawahiri, al-Qaeda's second-in-command, has called upon the Pakistani people to rise up against the Americans who, he claims, have taken over the country.

The statement seems so farcical that one wonders how many Pakistanis will take it seriously.

He says, “the American crusader” is manipulating Pakistan’s destiny. Such language, "Crusader" and the like, will probably have less salience in Pakistan than in the Arab world from which Zawahiri comes, and to which he has addressed most of his public statements. There is no Crusader history in Pakistan.

"The Americans are today occupying Afghanistan and Pakistan,” he says. He is reaching here. True, the Americans are not popular in Pakistan, but how many Pakistani’s will believe that the Americans have occupied their country?

It is tempting to wonder if this is the voice of desperation. I don’t think we should underrate the Al Qaeda leadership, but this seems so fantastic as to seem frantic, even to Pakistanis who have their own grudges against the United States.

Saturday, July 11, 2009

Questions to ask executives of the health care industry

The more we know about the health care insurance industry the more we question how seriously they are committed to the task of servicing the people they take premiums from. There is reason for concern, not only because of what the executives themselves have said under oath but also what a former executive, Wendell Potter, says about the way the health insurance industry works. Here are questions I believe we should ask the executives of our insurance companies. RLC

Question: Do you hold the position, like other health insurance executives, that you can cancel policies for sick holders of an insurance policy? According to Wendell Potter:
• It is a common practice in the industry to purge accounts that become expensive because of health claims: “[W]hen that business is up for renewal, … they'll say, "We need to jack up the rates here …” [They’ll] [j]ack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. …” Or they will actually dump “employer groups from the rolls.”
• “They also dump small businesses whose employees’ medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year’s premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether. . . . The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association.”
• “The Energy and Commerce Committee’s investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.”
• Moreover: In a congressional hearing several health insurance executives refused to renounce the practice of canceling policies for sick clients, people who have been faithfully paying premiums for coverage.
How, then, can anyone be sure that any health insurance company will fulfill its commitment to provide medical care for its clients when they need it?

Question: What is your position on the proposal to develop a universal health insurance policy similar to the Medicare program?
• According to a statement on Bill Moyers Journal, and acknowledged by Wendell Potter, the industry has a “game plan” to "Highlight horror stories of government-run systems" in order to kill it.”
• In fact Potter indicates that the health insurance industry has no interest in allowing a universal health care plan to come into existence.
o “[J]ust about every time there has been significant legislation before Congress, the industry has been able to kill it. Yeah, the status quo works for them. … They don't want to have any competition from the federal government, or any additional regulation from the federal government. They say they will accept it. But the behavior is that they will not …”.
o “Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand — or even to obtain — information we need.”
o “The satisfaction ratings are higher in our Medicare program, a government-run program, than in private insurance. But they don't want you to remember that or to know that, and they want to scare you into thinking that through the anecdotes they tell you, that any government-run system, particularly those in Canada, and UK, and France that the people are very unhappy.”

Question: Isn’t the health insurance industry hostage to the demands of Wall Street? That is, to make large profits for investors? Again, Mr Potter’s statement:
• “[W]hat they want to do is enhance their profits. Enhance shareholder value. That's number one.”
• “Wall Street investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical "benefit ratio," as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.”
• “To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling.”
• “Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was spent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.”

Question: Doesn’t your dependence on Wall Street investors conflict with the interests of your insured clients?
• “[T]he more of my premium that goes to my health claims [and] pays for my medical coverage, the less money the company makes.” … [And so Wall Street thinks that] “this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls.”
• “They think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.”
• The profits: “a big chunk of it goes into shareholders' pockets. … It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses.”

Question: Is your company paying large sums to lobbyists in Washington to ensure that there will be no serious consideration of a universal health care bill? I presume that you are: How much is your company paying? According to the Washington Post, insurance companies are spending $1.4m a day to defeat the public option.

Obviously, I am now doubting that the health insurance industry has the interest of me and my family at heart.

The more that is exposed about the industry, the more clear it is that the fundamental problem with American health care is the industry itself: it is committed to making money at the expense of those whom they charge for coverage. So they have every interest in ensuring that universal health coverage of any meaningful sort will never come into existence, because it would then become abundantly clear that the American people would prefer a universal care system. That public exposure would effectively put the industry out of business. I looked up the annual salary of the President of the company that provides insurance for me and my family: $1,135,538.00 [Forbes]. That money comes from the premiums of those who seek insurance from that company [including me]. And those premiums are providing the huge sums going into the lobbying effort to deprive the American people of a universal health care coverage system that they most obviously need. Those 47 million uninsured people could use some of that $1.4 million being spent every day by the insurance companies, and some of that executive salary. No wonder the insurance industry is frightened of universal health care. If there is no general public revulsion against the insurance companies the public are unlikely to ever have universal health care of any effective sort.


Tuesday, July 07, 2009

Uighur Uprising: continued signs of instability along the frontier

The street fighting in Urumqi and Kashgar indicate how much remains unresolved in the relations of power in Central Asia, that is, along the frontier of the former Soviet Union. And also the evident power of the new technology to enable collectivities to organize and coordinate in defiance of central power. The demonstrations in Iran have exposed the raw power that undergirds the system in place there. It is natural to wonder if the Uighur learned how to put it together by reading about the opposition movement in Iran. Could copy-cat movements develop elsewhere? We hear of tensions brewing elsewhere along the old Soviet border, that is, Bosnia, Kosovo, and Georgia. However it was done in Xinjiang, it is not over. Here is the NYTime report. RLC

July 8, 2009
New Protests in Western China After Deadly Clashes

URUMQI, China — Rival protesters took to the streets again on Tuesday, defying Chinese government efforts to lock down this regional capital of 2.3 million people and other cities across its western desert region after bloody clashes between Muslim Uighurs and Han Chinese.

The fighting, which erupted Sunday evening, left at least 156 people dead and more than 1,000 injured, according to the state news agency.

Police fired tear gas on Tuesday at Han Chinese protesters armed with clubs, lead pipes, shovels and hoes, news reports said. Earlier, in an attempt to contain China’s worst ethnic violence in decades, the authorities imposed curfews, cut off cellphone and Internet services and sent armed police officers into neighborhoods.

The official Xinhua news agency said an overnight curfew would again be imposed here on Tuesday night.

Despite the authorities efforts to bring the situation under control, hundreds of Uighur protesters defied the police, crashing a state-run tour of the riot scene for foreign and Chinese journalists.

A wailing crowd of women, joined later by scores of Uighur men, marched down a wide avenue Tuesday with raised fists and tearfully demanded that the police release Uighur men who they said had been seized from their homes after Sunday’s violence. Some women waved the identification cards of men who had been detained.

As journalists watched, the demonstrators smashed the windshield of a police car and several police officers drew their pistols before the entire crowd was encircled by officers and paramilitary troops in riot gear.

“A lot of ordinary people were taken away by the police,” a protester named Qimanguli, a 13-year-old girl clad in a white T-shirt and a black headscarf, said, crying. She said her 19-year-old brother had been detained on Monday, long after the riots had ended.

The initial confrontation later ebbed to a tense standoff between about 100 protesters, mostly women, some carrying infants, and riot police in black body armor and helmets, tear-gas launchers at the ready, in a Uighur neighborhood pocked with burned-out homes and an automobile sales lot torched during the Sunday riots.

But soon afterward, news reports said, hundreds of Han Chinese threw rocks and smashed shops owned by Uighurs, ignoring police who appealed to them over loudspeakers to disperse. At one point, some 300 Han Chinese marchers seemed to be heading toward a mosque, only to face clouds of tear gas, news reports said. And at one point, rival groups of protesters clashed until riot police moved in to set up a barrier between them, cheered on by Han Chinese protesters, Reuters reported.

The bloodshed here, along with the Tibetan uprising last year, shows the extent of racial hostility that still pervades much of western China, fueled partly by economic disparity and by government attempts to restrict religious and political activity by minority groups.

The rioting, which began as a peaceful protest calling for a full government inquiry into an earlier brawl between Uighurs and Han Chinese at a factory in southern China, took place in the heart of Xinjiang, an oil-rich desert region where Uighurs are the largest ethnic group but are ruled by the Han, the dominant ethnic group in the country.

Protests spread Monday to the heavily guarded town of Kashgar, on China’s western border, as 200 to 300 people chanting “God is great” and “Release the people” confronted riot police officers about 5:30 p.m. in front of the city’s yellow-walled Id Kah Mosque, the largest mosque in China. They quickly dispersed when officers began arresting people, one resident said.

Internet social platforms and chat programs appeared to have unified Uighurs in anger over the way Chinese officials had handled the earlier brawl, which took place in late June thousands of miles away in Shaoguan, Guangdong Province. There, Han workers rampaged through a Uighur dormitory, killing at least two Uighurs and injuring many others, according to the state news agency, Xinhua. Police officers later arrested a resentful former factory worker who had ignited the fight by spreading a rumor that six Uighur men had raped two Han women at the site, Xinhua reported.

But photographs that appeared online after the battle showed people standing around a pile of corpses, leading many Uighurs to believe that the government was playing down the number of dead Uighurs. One Uighur student said the photographs began showing up on many Web sites about one week ago. Government censors repeatedly tried to delete them, but to no avail, he said.

“Uighurs posted it again and again in order to let more people know the truth, because how painful is it that the government does bald-faced injustice to Uighur people?” said the student, who spoke on the condition of anonymity for fear of retribution from the government.

A call for protests spread on Web sites and QQ, the most popular instant-messaging program in China, despite government efforts to block online discussion of the feud.

By Tuesday morning, more than 36 hours after the start of the protest, the police had detained more than 1,400 suspects, according to Xinhua. More than 200 shops and 14 homes had been destroyed in Urumqi, and 261 motor vehicles, mostly buses, had been burned, Xinhua reported, citing Liu Yaohua, the regional police chief.

Police officers operated checkpoints on roads throughout Xinjiang on Monday. People at major hotels said they had no Internet access. Most people in the city could not use cellphones.

At the local airport, five scrawny, young men wearing black, bulletproof vests and helmets stood outside the terminal, holding batons. The roadways leading into the city center were empty early on Tuesday, except for parked squad cars and clusters of armored personnel carriers and olive military trucks brimming with paramilitary troops. An all-night curfew had been imposed.

Residents described the central bazaar in the Uighur enclave, where much of the rioting took place, as littered with the charred hulks of buses and cars. An American teacher in Urumqi, Adam Grode, and another foreigner said they had heard gunfire long after nightfall Sunday.

Xinhua did not give a breakdown of the 156 deaths, and it was unclear how many of them were protesters and how many were other civilians or police officers. There were no independent estimates of the number of the death toll. At least 1,000 people were described as having protested.

Photographs online and video on state television showed injured people lying in the streets, not far from overturned vehicles that had been set ablaze. Government officials gave journalists in Urumqi a disc with a video showing bodies strewn in the streets.

The officials also released a statement that laid the blame directly on Rebiya Kadeer, a Uighur businesswoman and human rights advocate who had been imprisoned in China and now lives in Washington. It said the World Uighur Congress, a group led by “the splittist” Ms. Kadeer, “directly ignited, plotted and directed the violence using the Shaoguan incident in Guangdong.” The statement said bloggers first began calling for the protest on Saturday night and also used QQ and online bulletin boards to organize a rally at People’s Square and South Gate in the Uighur quarter of Urumqi.

The World Uighur Congress rejected the accusations and said that it condemned “in the strongest possible terms the brutal crackdown of a peaceful protest of young Uighurs.” The group said in a statement on Monday that Uighurs had been subject to reprisals not only from Chinese security forces but also from Han Chinese civilians who attacked homes, workplaces or dormitories after the riots on Monday.

The violence on Sunday dwarfed in scale assaults on security forces last year in Xinjiang. It was deadlier, too, than any of the bombings, riots and protests that swept through the region in the 1990s and that led to a government clampdown.

Uighurs make up about half of the 20 million people in Xinjiang but are a minority in Urumqi, where Han Chinese dominate. The Chinese government has encouraged Han migration to many parts of Xinjiang, and Uighurs say that the Han tend to get the better jobs in Urumqi. The government also maintains tight control on the practice of Islam, which many Uighurs cite as a source of frustration.

But an ethnic Han woman who lives in an apartment near the central bazaar said in a telephone interview that the government should show no sympathy toward the malcontents.

“What they should do is crack down with a lot of force at first, so the situation doesn’t get worse, so it doesn’t drag out like in Tibet,” she said after insisting on anonymity. “Their mind is very simple. If you crack down on one, you’ll scare all of them. The government should come down harder.”

Michael Wines, Jonathan Ansfield and Xiyun Yang contributed reporting from Beijing, and David Barboza from Shanghai. Huang Yuanxi contributed research from Beijing, and Chen Yang from Shanghai.

Friday, July 03, 2009

Pakistan Divided Against Itself

Recent reports by Jane Perlez and her colleagues at the New York Times reveal that Pakistan is still a divided house. The military and the civilian administration don’t trust each other, and indeed seem to have competing visions of the world; and the military itself seems divided. Whatever cooperation the Americans are getting with Pakistan is therefore likely to come unraveled. An unpromising future in a critically important neighborhood. RLC

NYTimes June 28, 2009
Taliban Losses Are No Sure Gain for Pakistanis
MARDAN, Pakistan — For the past month and a half, the Pakistani military has claimed success in retaking the Swat Valley from the Taliban, clawing back its own territory from insurgents who only a short time ago were extending their reach toward the heartland of the country.
Yet from a helicopter flying low over the valley last week, the low-rise buildings of Mingora, the largest city in Swat, now deserted and under a 24-hour curfew, appeared unscathed. In the surrounding countryside, farmers had harvested wheat and red onions on their unscarred land.
All that is testament to the fact that the Taliban mostly melted away without a major fight, possibly to return when the military withdraws or to fight elsewhere, military analysts say. About two million people have been displaced in Swat and the surrounding area as the military has carried out its campaign.
The reassertion of control over Swat has at least temporarily denied the militants a haven they coveted inside Pakistan proper. The offensive has also won strong support from the United States, which has urged Pakistan to engage the militants.
But the Taliban’s decision to scatter leaves the future of Swat, and Pakistan’s overall stability, under continued threat, military analysts and some politicians say.
The tentative results in Swat also do not bode well for the military’s new push in the far more treacherous terrain of South Waziristan, another insurgent stronghold, where officials have vowed to take on the leader of the Pakistani Taliban, Baitullah Mehsud, who remains Pakistan’s most wanted man.
Signs abound that the military’s campaign in Swat is less than decisive. The military extended its deadline for ending the campaign. Even in the areas where progress has been made, the military controls little more than urban centers and roads, say those who have fled the areas. The military has also failed to kill or capture even one top Taliban commander.
It was “very disappointing,” said Aftab Ahmed Sherpao, a senior politician from the region, that none of the commanders had been eliminated. It turned out, he said, that early reports of the capture of Ibn Amin, a particularly brutal commander from Matta, were incorrect.
Many Taliban fighters have infiltrated the camps set up for those displaced by the fighting and are likely to return with them to Swat, said Himayatullah Mayar, the mayor of Mardan, the city where many of the refugees are staying. “Most of the Taliban shaved their beards, and they are living here with their families,” he said.
As of two weeks ago, the police had arrested 150 people in the camps suspected of being members of the Taliban, Mr. Mayar said. This figure did not include suspects arrested by the Intelligence Bureau, Pakistan’s domestic intelligence outfit, and the Directorate for Inter-Services Intelligence, the country’s main spy agency, he said.
Meanwhile, the government, led by President Asif Ali Zardari, has yet to announce a full plan for how it will provide services like courts, policing and health care that will allow the refugees to return home and the government to fully assert control.
Those plans appear to be mired in conflict and mutual suspicion between the military and the civilian government, raising serious questions about whether the authorities can secure Swat and other areas and keep them from being taken back by the Taliban, military experts said.
“I’ve told the president and the prime minister and the chief of the army this is the time to act. Just take basic things and implement them,” said Gen. Nadeem Ahmad, the commander of the Special Support Group, an arm of the Pakistani military that is providing temporary buildings and some food for the displaced. “This is not talking rocket science.”
On a notepad, General Ahmad had drawn a chart of the four elements of what he called “lasting peace.” They were good government; improved delivery of services, including rebuilt schools; speedy justice (something the Taliban had provided); and social equity.
He appeared to be skeptical that those aspects could be delivered within what he called an essential one-year time frame. He said he had warned the leaders: “If you don’t deliver, it will be trouble. You will come back and do the operation again.”
Having witnessed past episodes of deal-making with the Taliban, the people of Swat say they want tangible proof that the military is serious this time and that they will be safe if they return home.
From the start, a rallying cry has been a demand that the army kill or capture Taliban leaders, a ruthless group of highly trained fighters, some with links to Al Qaeda. But the army has not been able to show any evidence that it killed any of the Taliban leaders.
The daily newspaper The News said in a recent editorial that unless Maulana Fazlullah, the Taliban’s main commander in Swat, and Mr. Mehsud, the country’s top enemy, were captured, “the Taliban are going to live to fight another day.”
Indeed, most of the damage from the recent fighting appears confined to small agricultural hamlets outside Mingora, according to interviews with displaced people. Some said they had heard from recent arrivals to the camps that areas 500 yards off the roads remained in control of the militants.
The “outlook was bleak” in Swat because the civilian government did not have the money or the skills to rebuild, said Shuja Nawaz, the author of a history of the Pakistani military and now the director of the South Asia Center at the Atlantic Council in Washington.
Most of the two million displaced people are still living in tent camps and cramped quarters with relatives and even strangers, in cities as far flung as the southern port of Karachi.
Many displaced people were fed up with the cruelties inflicted under Taliban rule and have backed the military campaign. But as the fighting drags on in places, the mood among them grows increasingly despondent.
Some displaced people said that they were angry at the army for indiscriminate shelling in civilian areas. Others said they were confused about why the military operation was even necessary.
“We had no problem with the Taliban,” Umar Ali, a poultry trader from Qambar in Swat, said as he sat on the veranda of a home in Swabi, a town filled with displaced people. “We’re here because of the military shelling. I’m a trader, and the thing that affects my life is the curfew.”
Earlier Pakistani campaigns against the Taliban do not offer an encouraging precedent. In Bajaur, a part of the tribal areas, two main economic centers, the market towns of Loe Sam and Inayat Kalay, remain in ruins nearly eight months after the army smashed them in pursuit of the Taliban and claimed victory.

“In Refugee Aid, Pakistan’s War Has New Front”

Published: July 1, 2009

QASIM PULA, Pakistan — Islamist charities and the United States are competing for the allegiance of the two million people displaced by the fight against the Taliban in Swat and other parts of Pakistan — and so far, the Islamists are in the lead.

Two million people have been displaced by the fight against the Taliban in Swat and other parts of Pakistan.

Although the United States is the largest contributor to a United Nations relief effort, Pakistani authorities have refused to allow American officials or planes to deliver the aid in the camps for displaced people. The Pakistanis do not want to be associated with their unpopular ally.

Meanwhile, in the absence of effective aid from the government, hard-line Islamist charities are using the refugee crisis to push their anti-Western agenda and to sour public opinion against the war and America.

Last week, a crowd of men, the heads of households uprooted from Swat, gathered in this village in northwestern Pakistan for handouts for their desperate families. But before they could even get a can of cooking oil, the aid director for a staunchly anti-Western Islamic charity took full advantage of having a captive audience, exhorting the men to jihad.

“The Western organizations have spent millions and billions on family planning to destroy the Muslim family system,” said the aid director, Mehmood ul-Hassan, who represented Al Khidmat, a powerful charity of the strongly anti-American political party Jamaat-e-Islami.

The Western effort had failed, he said, but Pakistanis should show their strength by joining the fight against the infidels.

The authorities’ insistence that the Americans remain nearly invisible reveals the deep strains that continue to underlie the American-Pakistani relationship, even as cooperation improves in the fight against the Taliban, and public support for the war grows in Pakistan.

Yet Islamist and jihadist groups openly work the camps.

“Because of the lack of international agencies, there is a vacuum filled by actors that are Islamist and more than that, jihadist,” said Kristele Younes, a senior advocate with Refugees International, a Washington group established in 1979.

One of the most prominent jihadist charity groups, Jamaat-ud-Dawa, had been barred from the camps, according to Lt. Gen. Nadeem Ahmad, the head of the Pakistani Army’s disaster management group. The group was designated as a terrorist organization by the United Nations Security Council in December.

Nonetheless, it set up operations in Mardan under a new name, Falah-e-Insaniyat, according to Himayatullah Mayar, the mayor of Mardan. After the order to leave the area, Falah-e-Insaniyat went underground but still appeared to be operating to some extent, Mr. Mayar said.

Signs of the organizational strength and robust coffers of Islamist charities were easy to see around the camps, often in contrast to the lack of services offered by the government.

For example, Al Khidmat, Mr. Hassan’s group, arranged to bring in eye surgeons from Punjab to staff a free eye clinic for the displaced, offering cataract operations and eyeglasses.

“Government hospitals are nonexistent here, and we are able to treat not only the displaced but the whole community,” said one of the surgeons, Dr. Khalid Jamal.

Meanwhile, Mr. Hassan was busy checking new temporary schools, health clinics and four ambulances on 24-hour service that Al Khidmat had set up.

Every day, he said, he personally supervised the distribution of food at three different places — sometimes at a home, sometimes in a camp. So far, he said, he had covered 400 of 450 villages near the city of Swabi. Always, he said, before the food is distributed, he delivers his exhortation to jihad.

By contrast, although much American aid gets through, it is not branded as American, and Pakistani authorities insist that it be delivered in a “subtle” manner, General Ahmad said.

The general said he had told American officials there would be an “extremely negative” reaction if Americans were seen to be distributing aid. “I said they couldn’t fly in Chinooks, no way,” General Ahmad said, referring to American military helicopters. The United States, he said, was seen as “part of the problem.”

That is not what American officials had hoped for. At first, the exodus of people from Swat, many of whom had suffered from the brutality of the Taliban, seemed to present a chance for Washington to improve its image in Pakistan.

“There is an opportunity actually to provide services, much as we did with the earthquake relief, which had a profound impact on the perception of America,” Senator John Kerry, the chairman of the Foreign Relations Committee, said at a hearing attended by the Obama administration’s special envoy, Richard C. Holbrooke, at the start of the exodus.

In an effort to highlight American concern for the refugees, Mr. Holbrooke visited the camps in June, sitting on the floor of a sweltering tent and talking to people about their plight. “President Obama has sent us to see how we can help you,” he said. One result of the trip was an effort to send Pakistani-American female doctors to assist women in the camps.

According to the State Department, the United States has pledged $110 million for food and logistical support. In late May, the Defense Department sent several flights to Islamabad carrying ready-to-eat meals, environmentally controlled tents and water trucks. But ideas of winning back popularity with a big show of airlifts of American assistance on the scale of American earthquake relief to Kashmir in 2005 were rebuffed, and not only by the Pakistanis.

American nongovernmental organizations in Pakistan discouraged high-profile deliveries of United States government aid because anti-American sentiment was too widespread and the security risk to Americans in the camps was too high, said the head of one of the groups, who spoke on condition of anonymity because of the sensitivity of the issue. There were many Taliban in the displaced camps, and they believed the Pakistani military was fighting against them in Swat on orders from Washington, the official said.

The restrictions on American assistance are clear in the camps and in villages like this one deep in the countryside around Mardan and Swabi, where Pakistani families have opened their homes to large numbers of displaced people.

American officials and their consultants were barely able to move beyond the highly visible refugee camps set up along the main highway between Islamabad and Peshawar, said Mahboob Mahmood, a Pakistani-American businessman who has visited the area to help find ways to bring additional aid.

“They have been almost completely neutered,” he said.

A version of this article appeared in print on July 2, 2009, on page A1 of the New York edition.