Atta2The CIA drone campaign in Pakistan has been a triumph with few downsides:

In more than 300 missile attacks there since 2008, dozens of Qaeda and Taliban leaders have been killed, and the pace of the strikes, which officials frequently describe as “surgical” and “contained,” has dropped sharply over the past year.

But viewed from Miram Shah in North Waziristan, the frontier Pakistani town that has become a virtual test laboratory for drone warfare, the campaign has not been the antiseptic salve portrayed in Washington.

In interviews over the past year, residents paint a portrait of extended terror and strain within a tribal society caught between vicious militants and the American drones hunting them.

“The drones are like the angels of death,” said a shopkeeper in Miram Shah. “Only they know when and where they will strike.”

Their claims of distress are now being backed by a new Amnesty International investigation that found, among other points, that at least 19 civilians in the surrounding area of North Waziristan had been killed in just two of the drone attacks since January 2012 — a time when the Obama administration has held that strikes have been increasingly accurate and free of mistakes.

Miran ShahBut nowhere has the issue played out more directly than in Miram Shah. It has become a fearful and paranoid town, dealt at least 13 drone strikes since 2008, with an additional 25 in adjoining districts — more than any other urban settlement in the world.

Even when the missiles do not strike, buzzing drones hover day and night, scanning the alleys and markets with roving high-resolution cameras.

That is because their potential quarry is everywhere in Miram Shah — Islamist fighters with long hair, basketball shoes and AK-47 rifles who roam the streets, fraternize in restaurants and, in some cases, even direct traffic in the central bazaar.

The men come from an array of militant groups that take shelter in Waziristan and nearby, including Al Qaeda and the Afghan and Pakistani Taliban.

The militants’ commanders, however, are more elusive. Some turn up at the town’s phone exchange, to place ransom calls to the families of kidnapping victims who have been snatched from across Pakistan.

Others run Islamic-style courts, filling the place of the virtually invisible government system.

Still others stay completely out of sight, knowing they are being sought by the CIA.

In theory, the Pakistani security forces should be in charge.

A sprawling base, with a long airstrip that is home to a fleet of American-made Cobra helicopter gunships, dominates the northern part of the town.

Military engineers have just completed a new road that leads to the Afghan border, 10 miles to the north.

But apart from sporadic exchanges of fire with the militants, the soldiers are largely confined to their base, leaving residents to fend for themselves.

Unusually for the overall American drone campaign, the strikes in the area mostly occur in densely populated neighborhoods. The drones have hit a bakery, a disused girls’ school and a money changers’ market. One strike occurred in Matches Colony, a neighborhood named after an abandoned match factory that is now frequented by Uzbek militants.

While the strike rate has dropped drastically in recent months, the constant presence of circling drones — and accompanying tension over when, or whom, they will strike — is a crushing psychological burden for many residents.

Sales of sleeping tablets, antidepressants and medicine to treat anxiety have soared, said a pharmacist in the town bazaar. Women were particularly troubled, he said, but men also experienced problems. “We sell them this,” he said, producing a packet of pills that purported to treat erectile dysfunction under the brand name Rocket.

Despite everything, a semblance of normal life continues in Miram Shah. On market day, farmers herding goats and carrying vegetables stream in from the surrounding countryside. The bustling bazaar has clothes and food and gun shops.

Communication, however, is difficult.

The army disabled the cellphone networks, so residents scramble to higher ground to capture stray signals from Afghan networks. And Internet cafes were shut, on orders from the Taliban, after complaints that young men were watching pornography and racy movies.

That ban distressed families that use the Internet to communicate with relatives working in Dubai, and across the Persian Gulf states. Emigrant remittances are a cornerstone of the local economy.

On the edge of town, where buildings melt into low, tree-studded hills, young boys play soccer on the banks of the Tochi River. As in so many other countries, some youngsters wear the jersey of the English soccer club Manchester United.

But the veneer of normality is easily, and frequently, shattered. Every week the streets empty for a day as army supply trucks rumble through. The curfew is strictly enforced: several children and mentally ill residents who have strayed outside have been shot dead.

In the aftermath of drone strikes, things get worse. Many civilians hide at home, fearing masked vigilantes with the Ittehad-e-Mujahedeen Khorasan, a militant enforcement unit that hunts for American spies. The unit casts a wide net, and the suspects it hauls in are usually tortured and summarily executed.

Journalists face particular risks. In February, gunmen killed Malik Mumtaz Khan, the president of the local press club. Some blame Pakistani spies, while others say the Taliban are responsible.

Meanwhile state services have virtually collapsed. At the local hospital, corrupt officials are reselling supplies of medicine and fuel in the town market, doctors said.

At the government high school, pupils are paying bribes to cheat in public exams — and threatening teachers with Taliban reprisals if they resist, one teacher said.

The collapse has created business opportunities for Taliban spouses: one commander’s wife is a gynecologist, while an Uzbek woman works as a homeopath, the pharmacist said.

For some residents, the only option is to leave.

Hajji, a 50-year-old businessman, moved his family to Karachi in 2011. His family was scared by militant pamphlets that threatened to execute American spies, he said, and the militants prevented his children from obtaining polio vaccinations.

“They think vaccinators are spies who are looking for militant hide-outs,” he said.

For a number of outraged Pakistani officials, the drone debate has centered on claims of civilian casualties, despite American assurances that they have been few. In defending the drone strikes, which have sharply decreased this year, American officials note that the operations have killed many dangerous militants.

One major militant killed this year was the Pakistani Taliban deputy, Wali ur-Rehman. He was killed at Chashma village, just outside Miram Shah, in May.

Still, in a speech announcing changes to the drone program in May, Mr. Obama admitted that mistakes had been made. Civilian deaths from drone strikes will haunt him, and others in the American chain of command, for “as long as we live,” he said.

He added, “There must be near-certainty that no civilians will be killed or injured.”

But the new Amnesty International report, which examines the 45 known strikes in North Waziristan between January 2012 and August 2013, asserts that in several cases drones killed civilians indiscriminately.

Last October, it says, American missiles killed a 68-year-old woman named Mamana Bibi as she picked vegetables in a field close to her grandchildren. In July 2012, 18 laborers, including a 14-year-old boy, were killed near the Afghan border.

Ms. Bibi’s son, Rafiq ur-Rehman, and two of her injured grandchildren are due to travel to the United States next week to speak about their experiences.

“The killing of Mamana Bibi appears to be a clear case of extrajudicial execution,” said Mustafa Qadri, the report’s author, in an interview. “It is extremely difficult to see how she could have been mistaken for a militant, let alone an imminent threat to the U.S.”


The Deaths of Innocents

One of the arguments for America’s heavy reliance on drone strikes against suspected extremists has been surgical precision. The weapons are so finely calibrated and precisely targeted, officials argue, that only militants are killed, and that collateral damage to innocent civilians is rare. These claims were always hard to accept, especially given the government’s refusal to provide corroborating data. Now two human rights groups, Amnesty International and Human Rights Watch, have marshaled impressive new evidence challenging them.

In separate reports released on October 22, 1013, Amnesty International examined in detail nine suspected drone strikes in Pakistan.

Human Rights Watch looked at six suspected strikes in Yemen. The groups reached a similar conclusion — that dozens of civilians have been killed and that the United States may have violated international law and even committed war crimes.

Mr. Obama took an important step in May 2013 when he announced that he would reduce the number of drone strikes, allow only those that posed no threat or virtually no threat to civilians, and issue guidelines codifying the use of force against terrorists, including a provision that they be shown to pose “a continuing, imminent threat to America.” The new reports provide fresh evidence that Mr. Obama’s promised policy changes are long overdue. They also require better answers from the president than the vague responses the White House has so far delivered.

The Pakistan attacks occurred between May 2012 and July 2013 in the border region of North Waziristan, where extremists have havens and American drone strikes have been the most intensive. Amnesty International’s report, based on Pakistani and other sources, says there have been 374 strikes since 2004, including four incidents it investigated in which more than 30 civilians were killed.

In one case, in October 2012, a 68-year-old grandmother was gathering vegetables in a field, her grandchildren nearby, when she was “blasted into pieces” by a drone strike that appeared aimed directly at her.

Three months earlier, 18 male laborers, including a 14-year-old boy, were killed in a series of drone strikes on the remote village of Zowi Sidgi. The first one struck a tent where the men had gathered for an evening meal; others struck those who came to rescue the injured.

Both President George W. Bush and Mr. Obama have used the attacks on Sept. 11, 2001, and the state of war that has existed since as cause to target terrorist suspects. But under international law, parties to armed conflict must minimize harm to civilians in a war zone and observe rules about what is or isn’t a lawful military target.

Hence Obama’s promised guidelines. But those guidelines have never been made public, so there is no way to judge whether or how well they are being carried out. Similarly, because the government won’t talk about the attacks, there is no way of judging whether the military is honoring Obama’s pledge that “there must be near-certainty that no civilians will be killed or injured” before authorizing a strike.

Drones are important to America’s arsenal, not least because they can reach extremists in lawless areas who otherwise could not be captured and because they avoid putting American troops in harm’s way. But they are also creating enemies for the United States among people in Pakistan and Yemen who say the weapons are killing civilians, as well as militants. That alone argues for greater transparency and accountability from the government.