Pakistan grapples with rising tide of extremist violence

Worshippers react nervously when they hear raised voices outside the mosque

The faithful line up to pray in a small Shia mosque hidden away down the dusty side-streets of Peshawar.

But the central arch where the imam stands in front of his congregation is covered in blast marks and dark smears.

The ornate blue tiles have been smashed.

This is where a militant blew himself up just two weeks before.

"When I came inside, I saw severed legs, human organs and heads… all over the mosque," says Syed Hussain Hussaini, whose nephew was among the 21 people killed.

On the ceiling, walls and even on a building opposite, are pockmarks from hundreds of ball-bearings which had been packed inside the young man's suicide belt.

Although today the congregation seems determined to set fear aside, tensions rise rapidly when a man with a pistol inside his clothing is stopped at the gate.

A heated argument breaks out as the security guards try to remove the gun.

But the man is not - as had been feared - another militant from the majority Sunni Muslim community trying to carry out a second sectarian attack.

He is a Shia who had lost his father and uncle in the bombing and was carrying a weapon in case of another attack.

He has past form: he shot dead a suicide bomber with the pistol a few years ago.

For Syed Hussain Hussaini, the attack on the mosque and a series of other killings since Nawaz Sharif became prime minister last month, prove once again that whatever government takes office, Pakistan's Shia minority, like the rest of the population, will not be protected.

Lady Reading Hospital is expanding to cope with a rising number of casualties

The Jihadist militants are getting stronger, he says: "You have seen all over Pakistan, in Karachi, Quetta, and Peshawar, there are bomb blasts, targeted killings and suicide attacks. Governments have always failed right from the first day until today. People are on their own."

Figures provided by the Edhi emergency services organisation show that between April and the end of June, 247 people were killed in bombings in Khyber Pakhtunkhwa province and the tribal areas along the border with Afghanistan.

And these figures do not include Waziristan, a militant hotspot.

In response to the increasing flow of casualties from the violence, the main regional hospital has just built a new accident and emergency department with six operating theatres.

It is expected to open later this year.

"It's a huge complex, a hospital by itself," says Professor Arshad Javaid, the chief executive of the Lady Reading Hospital in Peshawar.

Bomb blast survivor Mohammed Shaheen believes the militants are beyond government control

"I think if I called it the world's largest casualty (department), I would not be exaggerating."

Inside the hospital, beneath a sign saying "bomb blast patient", Mohammed Shaheen lies recovering from serious injuries caused by a suicide attack in Mardan almost a month ago.

He was attending a funeral and standing close to a local politician who was killed, along with 27 other people.

Mr Shaheen believes the violence of the militant groups is now beyond the control of the government.

"They wanted to contain it and were taking measures, but they could not succeed. Now only God can do something," he says.

So now Nawaz Sharif is under intense pressure to spell out how he plans to bring the situation back under control.

State 'unprepared'

Many observers believe he came into office without any kind of coherent security strategy and is still in the process of trying to develop one.

Mr Sharif has been adamant the economy is his first priority.

"I am very disappointed," says retired general Talat Masood, a security and defence analyst.

"I think the most important responsibility of the government is protecting people.

"I hope they will get over their state - I won't say of slumber - but their state of unpreparedness."

A leaked document obtained by the BBC Urdu Service says the spate of attacks carried out by jihadist groups in recent years "appears to be the most serious crisis faced by the country since independence".

The document - described as a draft national counter-terrorism and extremism policy - warns that the jihadists want to take Pakistan back "to the stone age", that they have links with al-Qaeda and want the population to "rise up against their un-Islamic leaders".

The biggest of the Sunni militant groups is the Pakistani Taliban which has bases in most of the major cities and seems capable of carrying out attacks at will

There are signs that other extremist groups such as Lashkar-e-Jhangvi - responsible for many of the attacks on the Shia community - are collaborating with the Taliban.

The authors of the document are highly critical of the country's political leaders, accusing them of failing to take the lead in tackling extremism, and call for a much more co-ordinated counter-terrorism policy.

It is not clear whether this refers to the current or previous governments.

So far Mr Sharif's response has been to hold meetings with military and intelligence agencies and call for all major political parties to reach a consensus on the best way forward.

While there is agreement that getting the security agencies on side is essential, some observers describe the prime minister's call for an all-party conference as "passing the buck".

But senior officials of the governing party such as Iqbal Zafar Jhagra, deny there is a policy vacuum at the moment. "We have been working on this for quite some time," he says.

"You have to look at the root causes (of extremist violence) and the best course is dialogue (with the militants).

"It is the only way to arrive at a solution. If you are in a hurry and take hasty decisions, you will never get a durable solution and a durable peace."

But that could take years and it is not clear what the government will do if the Taliban reject talks or if negotiations break down.

Members of the business community in Peshawar, who have been badly hit by the lack of security over the past decade, remain gloomy.

"My business has declined 70%," says Mazhar Ul Haq, a leading carpet dealer.

And he is doubtful much will change in the near future under the new government.

"The militants have spread a lot and I don't know how they (the authorities) can handle it."