KARACHI, PAKISTAN —
Dr. Raza was waiting for his next patient when two young men walked into the consultation room, took pistols from a bag and shot him six times. Left for dead, the Pakistani physician was badly wounded but somehow survived.
Raza, who gave only one name to protect his identity, is one of dozens of doctors to be targeted by Islamist militants and criminals in recent years, spreading dread among senior medics and putting pressure on Pakistan's overburdened health system.
"I tried to duck by covering my face, and I took the brunt of the bullets on my arms and fingers," Raza said of the attack a few months ago in the southern port city of Karachi.
"One bullet got deflected by a stone-studded ring on my finger," he told Reuters. He said the round may otherwise have hit his head.
Raza was initially treated at a Karachi hospital before he and his family went into hiding. Realizing he needed specialist treatment to restore full function to his hands, he traveled to Australia for more surgery.
When he called friends to tell them he and his family had arrived safely, they told him another colleague had been killed.
A record 26 doctors were killed in Pakistan last year, according to police, three times the number in 2010. Most were in Karachi, Pakistan's teeming commercial hub of 20 million people, where militant violence and crime are common.
Of those attacked, a disproportionate number, including Raza himself, have been from Pakistan's minority Shi'ite sect, target of frequent sectarian violence in the Sunni-majority country.
"Lashkar-e-Jhangvi activists revealed in interrogations they target Shi'ite doctors," said Khurram Waris, an officer of Karachi's Counter Terrorism Department, referring to a Sunni militant group that targets Pakistan's Shi'ite Muslims.
Senior physicians are relatively wealthy, making them vulnerable to ransom kidnappings, while security officials say militants also prize doctors as targets because they are well-respected members of society and easy to hit.
The two are often linked, since militants finance their operations through extortion, according to police officials.
Medical groups say that unless the government can stop the killings, the trickle of doctors fleeing the country may become a flood, undermining efforts to ensure Pakistan's population of around 190 million has access to basic services.
More than 9,000 out of nearly 200,000 doctors registered with the Pakistan Medical and Dental Council, a regulatory body, have left Pakistan in the past three years.
The Pakistan Medical Association (PMA) does not track why doctors leave but says fear of attack is a major factor. Some doctors who stay in Pakistan have fortified their offices.
Others, including Raza, have shut up shop entirely. He is considering seeking asylum overseas.
Saira Afzal Tarar, minister of state for national health services, said that in addition to Karachi doctors emigrating, some in Quetta, another city prone to sectarian violence, are deciding to work in safer areas of the country.
"As law and order is improving [in Karachi], we hope that things will get better," she told Reuters. "We are trying everything in our power to improve the situation."
The PMA did not have statistics on how many clinics had shut because of fear of violence or actual attacks.
Mirza Ali Azhar, general secretary of the PMA, said the situation could become acute within 10 years.
"Pakistan may have to import doctors," he said.
In one recent case Azhar recounted, a doctor was working in an operating theater when he received a call telling him he would be killed as he left the hospital.
The doctor fled to the airport in an ambulance and met his family there, and they left the country on the first available flight.
Patients of doctors who are killed or forced to flee can go elsewhere, but finding the right care in Pakistan is not easy. The health system relies heavily on private clinics and hospitals, which many cannot afford, and on charitable services. State spending on the sector is low.
"I found out Raza had been shot when I read it in the newspaper," said one of the doctor's regular patients, who declined to be named for security reasons. "I went to several doctors over the last five months, but didn't find anyone I was happy with. Now I am visiting a doctor at a consulting clinic at a big hospital."
Idrees Adhi, president of the PMA, is among those who have been threatened. His family wants him to leave Pakistan.
"After years of struggle, I am being forced to leave this country," the ophthalmologist told Reuters. "It will be a very painful decision, but I am seriously considering it."