GHALANAI, Pakistan -- The United States plans to pour $750 million of aid into Pakistan's tribal areas over the next five years as part of a "hearts and minds" campaign to win over the lawless region from al-Qaida and Taliban militants.
But even before the plan has been fully carried out, documents and officials involved in the planning are warning of the dangers of distributing so much money in an area so hostile that oversight is impossible, even by Pakistan's own government, which faces rising threats from Islamic militants.
The question of who will be given the aid has quickly become one of the most contentious ones between local officials and U.S. planners concerned that millions might fall into the wrong hands. The local political agents and tribal chiefs in this hinterland on the Afghan border have for years accommodated the very groups the U.S. and Pakistani governments seek to drive out.
A closely scripted visit to the hospital here, which is being used for a pilot project by the U.S. Agency for International Development, showed the challenges on full display. The one-story hospital was virtually empty on a recent day.
Local people had no way to get there. Only three of the 110 beds were occupied. Two operating tables had not been used in months. Many doctors had left because the pay was too meager and security too precarious, said Dr. Yusuf Shah, the chief surgeon.
Sher Alam Mahsud, the local political boss who escorted a journalist on a rare visit, said he wanted all the U.S. aid money "delivered to us." But the precarious security does not allow U.S. officials to assess the aid priorities firsthand or to provide oversight for the first installment of $150 million that has been allocated by the Bush administration.
"Delivering $150 million in aid to the tribal areas could very quickly make a few people rich and do almost nothing to provide opportunity and justice to the region," said Craig Cohen, the author of a recent study of U.S.-Pakistan relations at the Center for Strategic and International Studies in Washington.
Yet it is here in Pakistan's Federally Administered Tribal Areas, or FATA, as the region is formally called, that Washington is intent on using the development aid as a counterinsurgency tool, according to a draft of the Agency for International Development plan given to The New York Times by an official who worked on it.
The draft warns that the "severe governance deficiencies" in the tribal areas will make it virtually impossible for the aid to be sustainable or to overcome the "area's chronic underdevelopment and consequent volatility."
The ambitious plan was publicly highlighted during a visit to Pakistan in June by Richard A. Boucher, the assistant secretary of state for South and Central Asian affairs, as a measure of Washington's support for Pakistan's president, Gen. Pervez Musharraf.
"The objective driving this decision is the hope that by bringing the FATA into the mainstream and assuring that basic human services and infrastructure are on par with the rest of Pakistan, the people of FATA would be less likely to welcome the presence of al-Qaida and Taliban," the draft states. The projects include health and education services, water and sanitation facilities, and agricultural development, it says, making it clear that these are a means to a broader end. "The main goal of the United States government in relation to the FATA is counterterrorism," it says.
One way to improve the chances of the U.S. aid's efficacy would be greater emphasis on political reform in the tribal areas, according to the draft. The Pakistani government has created a panel to study reform of the political structure in the areas, the draft noted, and "USAID should explore opportunities for contributing its substantial experience in local government capacity building to any reform efforts the government of Pakistan decide to undertake."
Even if the tribal areas were not under the sway of the Taliban, which they increasingly are, the development challenge here would be steep enough, the document and interviews make clear.
The area, home to 3.2 million people, remains a desolate landscape where women are strictly veiled. Female literacy - at 3 percent - is among the lowest in the world. Schools are often used to run businesses. There is no banking system. Smuggling of opium and other contraband is routine.
The hostility to almost anything that smacks of foreign influence is such that the modest development agency program, which is being administered by the charity Save the Children at the hospital here, was being delivered anonymously, undercutting any public relations benefit for the United States.
"We can't do branding," said Fayyaz Ali Khan, the program manager for Save the Children in an interview in the city of Peshawar, a Pakistani provincial capital outside the tribal areas. "Usually we say the aid comes from the American people, but here we can't."
Suspicions about modern medicine are rife. A Pakistani doctor was blown up in his car in June after trying to counter the anti-vaccine propaganda of an imam in Bajaur, one of the tribal agencies, Pakistani officials said.
The Pakistani government has virtually no writ here. After years of fighting to assert its authority, at the cost of about 600 soldiers, it negotiated a series of peace accords with tribal authorities that have all but confined Pakistani Army troops to their barracks.
Tribal elders, local imams and political agents - a kind of governor whose title goes back to the British colonial days - are the on-the-ground arbiters of all decisions in many districts. The political agents are widely considered corrupt and arbitrary.
A senior U.S. official in Islamabad, Pakistan's capital, who would not speak for attribution, defended the plan's goals as necessary and achievable. The official said that "Pakistani firms, consulting organizations and nongovernmental organizations" would be the main deliverers of the assistance.
The official said, referring to the international aid agency, that these would in turn be "managed under USAID direct contracts and grants to American and international organizations."
Cohen, of the Center for Strategic and International Studies, was skeptical. Almost every potential recipient of the money was suspect in the eyes of the people it was supposed to help, he said. "The notion that there's going to be $150 million a year to Pakistani nongovernmental organizations who are going to be out in the open seems naive to me," he said.
"The insecurity of the area will require a heavy reliance on local partners," such as Pakistani nongovernmental organizations, to administer projects, he added. "But the nongovernmental organizations don't trust the military, the military doesn't trust the tribal chiefs, and the tribal chiefs won't trust us unless they're getting a cut of the money."