The security and humanitarian situation in Pakistan's Kurram region has deteriorated significantly, local leaders and analysts told RFE/RL's Radio Mashaal.
Kurram Agency, on the Afghan border, is one of Pakistan's seven tribal agencies.
I.A. Rehman, the chairman of Pakistan's Human Rights Commission, says that people in Kurram Agency are facing a humanitarian crisis.
Jawad Hussain, a member of the National Assembly from Kurram, says the region has been cut off from the rest of the country for the last three years. He says various Taliban groups dominate the main route between Thal and Parachinar, which in turn connects Kurram with Pakistan's main urban centers.
"Our people are forced to travel through the hard and mountainous regions of Afghanistan to reach the cities of Peshawar and Islamabad of Pakistan," Hussain says. "It takes 24-27 hours instead of six hours' travel between Thal and Parachinar. The local residents [face] really dismal conditions, but no one pays attention to it."
Last week, unidentified gunmen opened fire on a bus carrying passengers from Parachinar to the provincial capital of Peshawar. The attack, in Afghanistan's Pakthia Province, left 13 people dead and two injured.
Afghan officials have said those killed were Afghan refugees running small businesses in Kurram.
Zulfiqar Ali, a resident of the area who works as a reporter in Peshawar, says the deadly incident makes it even less likely that Kurram residents will travel the alternative Afghan route.
Ali was among a delegation of journalists who visited Kurram on a trip sponsored by Pakistan's military. He says that he witnessed local residents suffering from lack of food and medicine. "People in [the Kurram town of] Sadda looked like they [were] prisoners," Ali says.
The humanitarian group Doctors Without Borders said in a recent report that it has become extremely difficult to provide relief to the sick in Kurram. It noted that medical supplies are becoming increasingly scarce and even hospitals have been attacked.
Pakistan's military sends food and medicines twice a month. However, locals say that is not sufficient for the area's more than half a million inhabitants.
While the situation in Kurram has further deteriorated in recent years, the agency has been riven by militant and religious strife since the "Afghan Jihad" of the 1980s. Kurram lies on the border with Afghanistan and the Taliban bastion of Pakistan's North Waziristan.
In recent years, it has also been the site of clashes between Shi'ite and Sunni sects of Islam. Officials say at least 3,000 people have been killed in such religious violence since 2007.
Recent fighting between Taliban militants and Pakistan security forces in the area has also displaced thousands of Kurram's inhabitants.