PESHAWAR, Pakistan — Shaheed Rehman Afridi lay in a casualty-packed trauma ward, unable to make sense of the blast that punctured his body with tiny metal missiles and killed dozens of his kinsmen as they met for a traditional tribal assembly.
On nearby beds, children with head wounds writhed in pain, inconsolable by frantic parents. Men with torn abdomens and shattered limbs lay in silent semi-consciousness or moaned in wide-eyed agony as relatives called out for one of Lady Reading Hospital's too few doctors. The air reeked of blood, disinfectant and sweat.
The young fanatic who detonated himself on March 2 and inflicted the suffering on innocent civilians once would have found welcome and honor in Pakistan's autonomous tribal belt, along with other Islamic extremists, including Osama bin Laden and his followers, who fled there after the 2001 U.S.-led invasion of Afghanistan.
The tribes no longer are willing hosts to the foreign fighters, local jihadis and criminal warlords who hold sway over parts of the Pashtun tribes' mountain homeland. They've become tired and infuriated by the bloodshed, coercion and suffering that radical Islam has brought to their lives, said tribal elders and local journalists.
"We also want to get rid of terrorism, al Qaida and extremism," said Hamidullah Jan Afridi, a tribal leader from the Khyber Agency region who serves in Pakistan's Senate.
That sentiment was driven home when voters on Feb. 18 replaced Islamists with secular politicians in all eight National Assembly seats from the Federally Administered Tribal Area, the Massachusetts-size region bordering Afghanistan.
But anger against the Islamists hasn't translated into support for the U.S.-backed Pakistani government, even though it's fighting the extremists with troops, rockets and missiles.
"People are angry at both sides," said Afridi, a 31-year-old shopkeeper who had blood oozing through the bandages that wrapped his shrapnel-pocked thighs, as more victims of a suicide bombing arrived from the tribal region town of Darra Adam Khel.
The region is closed to foreign journalists and international aid organizations, and local journalists operate under self-imposed restrictions to protect themselves.
Interviews with tribal leaders, local journalists, human rights activists and a senior official in Peshawar, however, provided a glimpse of the suffering of desperately poor people who're caught in a secret war between a crazy quilt of foreign and local extremist groups and Pakistani forces backed by the United States.
"We are caught in the middle," lamented Abid Khan, 60, as he waited outside an operating room where surgeons were working desperately to save the life of one of his brothers. A second brother was killed by the suicide bomber.
As the war has intensified, life for Khan and other residents has become harder and more dangerous in areas of the tribal belt that are under the sway of militants and criminal warlords who've wrapped themselves in the garb of Islamic purity.
Militants have turned towns and villages into battlegrounds and forced civilians to witness beatings and executions of alleged religious transgressors or purported spies. The residents are compelled to give food and money to militant groups and their family members to fight the government. Failure to comply can result in a relative being kidnapped or worse.
In the latest violence, a suicide bomber detonated an explosives-packed car Thursday in Wana, the headquarters town of the South Waziristan agency, killing five Pakistani soldiers and injuring nine others, the Pakistan military said.
The militants also have assassinated an estimated 160 hereditary tribal chiefs, crippling the system of tribal gatherings, or jirgahs, which for centuries have been the main mechanism through which tribal laws were enforced, traditions maintained and peace accords negotiated.
A journalist from the Mohmand Agency region, who requested anonymity to avoid retaliation, recounted that in October, Islamist guerrillas called some 5,000 villagers to a funeral for four of its fighters and then forced the crowd to watch the beheadings of six people accused of killing the fighters.
Islamic guerrillas have used civilians as shields against army attacks. They're beaten or whipped for failing to comply with the militants' strict interpretations of Islam, such as growing beards to a required length or praying at specific times. Barbershops and kiosks that sell DVDs or CDs have been blown up.
"If you have a wedding ceremony, you have to have a very simple wedding ceremony," said a Mohmand Agency resident who asked not to be identified further. "They kidnap people as well — people who say they don't want the Taliban or the government."
Girls are barred from schools — one female teacher was found beheaded last year — and women are forbidden to leave their homes without a male relative.
"They have divided villages and neighborhoods into zones, and people have to support the group in its area financially and with manpower," said a journalist based in the Khyber Agency who request anonymity to avoid retaliation.
Several local journalists and tribal leaders spoke of criminal groups that operate with Islamabad's tacit approval so long as they refrain from criticizing the government and confronting the army, and keep more radical outfits off their turf.
One such group, the Partisans of Islam, is said to be led by a former truck driver named Mangal Bagh, who holds sway around the area of Bara in the Khyber Agency just south of Peshawar.
Residents of Bagh's fiefdom must listen to his daily three-hour FM radio sermons in case a family member is summoned or cited for failing to attend prayers, said several local journalists. Those who fail to report are punished, they said.
Bagh, who's said to command some 3,000 fighters, is accused of kidnapping critics, storming their villages and executing alleged transgressors of his religious edits, the journalists said. Yet the government has taken no action against him.
Just before Pakistan's Feb. 18 parliamentary elections, Bagh summoned the region's National Assembly candidates to address a massive rally that he organized. Fourteen showed up, the journalists said.
Still, the growing disdain of ordinary people for the militant Islamists hasn't translated into support for Pakistani security forces. That's partly due to intimidation and partly because of the abiding respect for fellow Muslims inculcated by tribal traditions.
In addition, the tribes harbor even greater hatred and distrust for President Pervez Musharraf's regime and its chief patron, the United States, than they do for the militants.
"If you have a friend like the United States, then you have no need for an enemy," said Abdul Karim Mehsud, a prominent lawyer who leads an alliance of moderate tribal leaders that was formed last year to promote the rights of the region's inhabitants.
Islamabad for years encouraged the tribes to support Islamic fighters: first, the Afghans, Arabs and Pakistanis who fought the 1979-89 Soviet occupation of Afghanistan, and then the Taliban, the Afghan Pashtun militia that hosted bin Laden.
But after the 9/11 attacks, Musharraf abruptly reversed that policy and began operations to eliminate bin Laden and his followers and block them and Afghan and Pakistani fighters from attacking U.S.-led NATO forces in Afghanistan.
Unknown numbers of civilians have been killed and injured over the past four years in counterinsurgency operations in which the Pakistani army has employed artillery, helicopter gunships and jets against guerrillas hiding in civilian areas.
Missile strikes by U.S. unmanned aerial drones and U.S. artillery fire from the Afghan side of the border aimed at al Qaida and Taliban targets have claimed the lives of women and children, deaths that demand punishment or compensation under the Pashtun tribal code.
The Pakistani security operations, undertaken with U.S. intelligence, funding and training, also have forced tens of thousands of civilians to flee the tribal region for other parts of the country, according to tribal leaders, local journalists and human rights monitors.
Most of the displaced, they said, have moved in with relatives or found accommodations as far away as the southern port city of Karachi, while some linger in poorly run refugee camps in towns in the North West Frontier Province.
"Hundreds and thousands have been uprooted. In retaliation there have been sympathies for the criminals (militants)," said Afridi, the senator. "We are making our own enemies ourselves."
Qayoom Sher Afridi, a minister in the North West Frontier Province government, said that in January "almost everyone" fled his area of North Waziristan from "indiscriminate shelling" by Pakistani troops pursuing Baitullah Mehsud, an extremist leader charged with ordering the Dec. 27 assassination of former Prime Minister Benazir Bhutto.
A Pakistan army spokesman admitted that civilians had been killed and injured, but said he had no figures. "All efforts were made to avoid indiscriminate fire," Maj. Gen. Afthar Abbas said.
The hatred of Musharraf's regime and the United States has helped stock the pool of potential recruits for the militants with jobless, angry young men whose traditions venerate warriors and mandate aiding fellow Muslims. Many are indoctrinated in religious schools patronized by militant groups.
"People are illiterate, unemployed. They can be inspired by the Taliban to join them," said a journalist who's based in the North Waziristan headquarters town of Miran Shah and asked to remain anonymous to avoid retaliation. "Eighty percent of the people do not support the Taliban, but they are scared."