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Worst floods in living memory leave Pakistan in paralysis

2010; Elsevier BV; Volume: 376; Issue: 9746 Linguagem: Inglês

10.1016/s0140-6736(10)61469-9

1474-547X

Kristin Elisabeth Solberg,

Health and Conflict Studies

In the first of two stories on the floods in Pakistan, Kristin Solberg reports from south Punjab on a crisis that continues to unfold on an unprecedented scale, even as the floodwaters dissipate.Every day since the floodwater destroyed his home and drove him and his family to a nearby hill, Safdar Bhatti had helplessly watched his children getting sicker. The family had nothing but a make-shift tent to protect them against the heavy monsoon rains or, when the rain paused, Pakistan's merciless August sun. The lack of food, clean drinking water, and adequate shelter was taking a heavy toll on their health.“The government should provide shelter and health facilities”, Bhatti said, while looking over at his damaged house, which was still partially covered with water. He held in his arms his youngest child, a 10-month-old boy suffering from fever and acute diarrhoea, a potentially deadly disease. By his feet stood an elder child, 3-year-old Dilshad, whose face was covered with rashes—a result of the contaminated water he had been drinking. “We don't have clean water to wash him”, the father of four said.The family had received no medical help—or any other help for that matter—after the floods hit their village nearly 2 weeks ago, Bhatti said. Aid never seemed to arrive, and, in its absence, he feared his children's health would continue to deteriorate at an alarming pace. 8 weeks after the largest natural disaster in Pakistan's history started, the death toll, which stood at 1752 at the time of writing, could still increase, humanitarian organisations warn.The floodwater has now receded in many parts of the country, but millions of people are still waiting for life-saving aid. According to some estimates, 8 million people are still without access to clean drinking water. 10 million people are left without any form of shelter, and the risk of a mass outbreak of water-borne diseases remains alarmingly high.“If we want the death toll to remain low and not increase into the tens of thousands due to diseases and hunger, we need to reach all the flood victims quickly”, said Maurizio Giuliano, spokesperson for the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) in Pakistan, warning of a “second wave of death”.The floods, which began at the end of July in the northern parts of the country and spread south along the Indus River, continue to paralyse Pakistan. The scale of the disaster is enormous. During a visit to the disaster zone, UN Secretary General Ban Ki-moon said it was larger than the 2004 Asian tsunami, the 2005 Kashmir earthquake, the 2008 Cyclone Nargis, and the 2010 Haiti earthquake combined.An estimated 20 million people—more than one in ten Pakistanis—have been affected by the floods, after the heaviest monsoon rains in generations swelled the rivers and covered about a quarter of the country—an area the size of England—in water.The floodwater reached Safdar Bhatti's village in the Muzaffargarh district in south Punjab on a quiet August morning. It raged through the village and destroyed everything on its way. Bhatti and his neighbours escaped with their lives, but very little else. “Two of my children have skin infections, but we don't have money to treat them”, said Sughra Bhatti, a mother of eight.One of her children, an 8 month-old girl, had acute watery diarrhoea and cried incessantly. She had received some drugs from a mobile clinic in the area, but her health had not improved, her mother said. WHO and its partners have set up almost 1200 mobile health clinics in the disaster zone. The clinics have provided more than 2 million people with basic emergency health care, vaccinations, maternal and child care, and health education, but many more people still need medical attention.“The main diseases we are worried about are acute watery diarrhoea, malaria and acute respiratory chest infections”, said Irshad Shaiqh, regional emergency advisor for WHO's Regional Office for the Eastern Mediterranean. “This is definitely a very serious situation and the magnitude and scale of this crisis is unprecedented. No humanitarian organisation or government agency has the resources to meet the need of 18 million people in one go”, he said.As in any humanitarian disaster, children are particularly vulnerable. The UN has warned that up to 3·5 million children are at risk of being infected with potentially fatal water-borne diseases. “The main health risks at present are principally children under 5, but not exclusively. The floods have led to a wide-scale public health problem and population displacement, which comes on top of weak health infrastructure and seasonal outbreaks”, said Elizabeth Berryman, emergency response coordinator with Merlin Pakistan.Flood victims scramble for food rations dropped from a Pakistan Army helicopterView Large Image Copyright © 2010 Getty ImagesMerlin was among the first non-governmental organisations (NGOs) to respond with mobile clinics in some of Pakistan's most remote areas, including the conflict-ridden and severely flood-affected Swat Valley in Khyber Pakhtunkhwa province (formerly North-West Frontier Province). Reaching some of the most isolated places, Merlin's medical teams sometimes walk for 6 hours, carrying up to 20 kg of supplies on their back. Alarmingly, Merlin reports a 14% diarrhoea morbidity rate, a steep increase from the 5% baseline. Moreover, the NGO projects an estimated 2 million malaria cases within 4 months, compared with between 1·3 and 1·5 cases in all of Pakistan in the whole of 2009.“The flood-affected areas are either under water now, facing the public health effects of receding flood waters, or in the mountains cut off by damaged bridges without access to basic services and facing a cold winter”, said Berryman. To make matters worse, aid has been slow to reach the millions in need. This is partly due to the sheer scale of the crisis, partly because funding has been slow to trickle in, and partly because the disaster struck in some areas where the terrain is difficult, infrastructure is ruined, and the Taliban insurgency is continuing.Logistics is another challenge. “We need more helicopters in order to reach the whole area. Otherwise it will be difficult to help everyone”, said Mohammed Gul Sher, a sergeant in the Pakistan Army, which has played a leading role in the rescue and relief work. From an army air base in the city of Multan in Punjab, Sher had airlifted aid—including food, clean water, and basic drugs—to about 100 families. But with so many millions of people still not reached, it seems like a drop in the ocean.On the ground, the flood victims are becoming ever more desperate. Fights are breaking out when food is distributed. Children start to cry when their parents return empty-handed to their temporary homes—a mat under the open sky, or, for the more fortunate, a tent or an empty school.Into the aid vacuum steps other, more controversial players. Unable to cope with the crisis, the Pakistani authorities are alarmed to find radical Islamic organisations with ties to militant groups handing out aid and providing medical care in the flood-affected areas.Recently, outside a temporary medical clinic in a small town in the Muzaffargarh district, hundreds of patients were impatiently pushing each other out of the way to catch the doctors' attention, while complaining of body aches, rashes, stomach problems, and chest pain. They did not care that the clinic was run by the charity Falah-e-Insaniyat Foundation, the alleged new front organisation of the banned militant group Lashkar-e-Taiba, which is accused of masterminding the Mumbai attacks in November, 2008, which killed about 165 people.“I don't know this organization”, said Shamim Bibi, a 50-year-old widow who had travelled 10 miles from her village to seek treatment for a cough. “But I'm very grateful. They help us when we are dying. They are here to save us.” “The work the government and the NGOs are doing isn't enough. This is a major disaster”, said Nasir Hamdani, a doctor with the charity, denying the claim made by some analysts that the foundation encourages violent jihad while distributing aid.In some parts of the disaster zone, including in Muzaffargarh, one of the hardest hit districts, people are now returning to their homes and trying to rebuild their lives. They face an uncertain future. Some have suffered financial losses that could take decades, perhaps generations, to regain.Worryingly, agriculture, which is the backbone of Pakistan's economy, has also taken a large hit. Crops worth an estimated $US1 billion have been destroyed and millions of livestock and poultry have died. This, humanitarian organisations fear, could lead to food shortages, price rises and increased malnutrition in the months to come.Moreover, about 500 health facilities have been destroyed by the floodwater, according to WHO. “We need to look at how we can restore health systems. If health facilities are destroyed, how can we provide health care at people's door-steps?” said Irshad Shaiqh.Meanwhile, the UN continues to worry about the lack of funding. “If not enough funding comes in, more people will die”, Giuliano of UNOCHA said. “The floodwater is finally reaching the Arabian Sea, but the most difficult or dangerous phase may yet come.” In the first of two stories on the floods in Pakistan, Kristin Solberg reports from south Punjab on a crisis that continues to unfold on an unprecedented scale, even as the floodwaters dissipate. Every day since the floodwater destroyed his home and drove him and his family to a nearby hill, Safdar Bhatti had helplessly watched his children getting sicker. The family had nothing but a make-shift tent to protect them against the heavy monsoon rains or, when the rain paused, Pakistan's merciless August sun. The lack of food, clean drinking water, and adequate shelter was taking a heavy toll on their health. “The government should provide shelter and health facilities”, Bhatti said, while looking over at his damaged house, which was still partially covered with water. He held in his arms his youngest child, a 10-month-old boy suffering from fever and acute diarrhoea, a potentially deadly disease. By his feet stood an elder child, 3-year-old Dilshad, whose face was covered with rashes—a result of the contaminated water he had been drinking. “We don't have clean water to wash him”, the father of four said. The family had received no medical help—or any other help for that matter—after the floods hit their village nearly 2 weeks ago, Bhatti said. Aid never seemed to arrive, and, in its absence, he feared his children's health would continue to deteriorate at an alarming pace. 8 weeks after the largest natural disaster in Pakistan's history started, the death toll, which stood at 1752 at the time of writing, could still increase, humanitarian organisations warn. The floodwater has now receded in many parts of the country, but millions of people are still waiting for life-saving aid. According to some estimates, 8 million people are still without access to clean drinking water. 10 million people are left without any form of shelter, and the risk of a mass outbreak of water-borne diseases remains alarmingly high. “If we want the death toll to remain low and not increase into the tens of thousands due to diseases and hunger, we need to reach all the flood victims quickly”, said Maurizio Giuliano, spokesperson for the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) in Pakistan, warning of a “second wave of death”. The floods, which began at the end of July in the northern parts of the country and spread south along the Indus River, continue to paralyse Pakistan. The scale of the disaster is enormous. During a visit to the disaster zone, UN Secretary General Ban Ki-moon said it was larger than the 2004 Asian tsunami, the 2005 Kashmir earthquake, the 2008 Cyclone Nargis, and the 2010 Haiti earthquake combined. An estimated 20 million people—more than one in ten Pakistanis—have been affected by the floods, after the heaviest monsoon rains in generations swelled the rivers and covered about a quarter of the country—an area the size of England—in water. The floodwater reached Safdar Bhatti's village in the Muzaffargarh district in south Punjab on a quiet August morning. It raged through the village and destroyed everything on its way. Bhatti and his neighbours escaped with their lives, but very little else. “Two of my children have skin infections, but we don't have money to treat them”, said Sughra Bhatti, a mother of eight. One of her children, an 8 month-old girl, had acute watery diarrhoea and cried incessantly. She had received some drugs from a mobile clinic in the area, but her health had not improved, her mother said. WHO and its partners have set up almost 1200 mobile health clinics in the disaster zone. The clinics have provided more than 2 million people with basic emergency health care, vaccinations, maternal and child care, and health education, but many more people still need medical attention. “The main diseases we are worried about are acute watery diarrhoea, malaria and acute respiratory chest infections”, said Irshad Shaiqh, regional emergency advisor for WHO's Regional Office for the Eastern Mediterranean. “This is definitely a very serious situation and the magnitude and scale of this crisis is unprecedented. No humanitarian organisation or government agency has the resources to meet the need of 18 million people in one go”, he said. As in any humanitarian disaster, children are particularly vulnerable. The UN has warned that up to 3·5 million children are at risk of being infected with potentially fatal water-borne diseases. “The main health risks at present are principally children under 5, but not exclusively. The floods have led to a wide-scale public health problem and population displacement, which comes on top of weak health infrastructure and seasonal outbreaks”, said Elizabeth Berryman, emergency response coordinator with Merlin Pakistan. Merlin was among the first non-governmental organisations (NGOs) to respond with mobile clinics in some of Pakistan's most remote areas, including the conflict-ridden and severely flood-affected Swat Valley in Khyber Pakhtunkhwa province (formerly North-West Frontier Province). Reaching some of the most isolated places, Merlin's medical teams sometimes walk for 6 hours, carrying up to 20 kg of supplies on their back. Alarmingly, Merlin reports a 14% diarrhoea morbidity rate, a steep increase from the 5% baseline. Moreover, the NGO projects an estimated 2 million malaria cases within 4 months, compared with between 1·3 and 1·5 cases in all of Pakistan in the whole of 2009. “The flood-affected areas are either under water now, facing the public health effects of receding flood waters, or in the mountains cut off by damaged bridges without access to basic services and facing a cold winter”, said Berryman. To make matters worse, aid has been slow to reach the millions in need. This is partly due to the sheer scale of the crisis, partly because funding has been slow to trickle in, and partly because the disaster struck in some areas where the terrain is difficult, infrastructure is ruined, and the Taliban insurgency is continuing. Logistics is another challenge. “We need more helicopters in order to reach the whole area. Otherwise it will be difficult to help everyone”, said Mohammed Gul Sher, a sergeant in the Pakistan Army, which has played a leading role in the rescue and relief work. From an army air base in the city of Multan in Punjab, Sher had airlifted aid—including food, clean water, and basic drugs—to about 100 families. But with so many millions of people still not reached, it seems like a drop in the ocean. On the ground, the flood victims are becoming ever more desperate. Fights are breaking out when food is distributed. Children start to cry when their parents return empty-handed to their temporary homes—a mat under the open sky, or, for the more fortunate, a tent or an empty school. Into the aid vacuum steps other, more controversial players. Unable to cope with the crisis, the Pakistani authorities are alarmed to find radical Islamic organisations with ties to militant groups handing out aid and providing medical care in the flood-affected areas. Recently, outside a temporary medical clinic in a small town in the Muzaffargarh district, hundreds of patients were impatiently pushing each other out of the way to catch the doctors' attention, while complaining of body aches, rashes, stomach problems, and chest pain. They did not care that the clinic was run by the charity Falah-e-Insaniyat Foundation, the alleged new front organisation of the banned militant group Lashkar-e-Taiba, which is accused of masterminding the Mumbai attacks in November, 2008, which killed about 165 people. “I don't know this organization”, said Shamim Bibi, a 50-year-old widow who had travelled 10 miles from her village to seek treatment for a cough. “But I'm very grateful. They help us when we are dying. They are here to save us.” “The work the government and the NGOs are doing isn't enough. This is a major disaster”, said Nasir Hamdani, a doctor with the charity, denying the claim made by some analysts that the foundation encourages violent jihad while distributing aid. In some parts of the disaster zone, including in Muzaffargarh, one of the hardest hit districts, people are now returning to their homes and trying to rebuild their lives. They face an uncertain future. Some have suffered financial losses that could take decades, perhaps generations, to regain. Worryingly, agriculture, which is the backbone of Pakistan's economy, has also taken a large hit. Crops worth an estimated $US1 billion have been destroyed and millions of livestock and poultry have died. This, humanitarian organisations fear, could lead to food shortages, price rises and increased malnutrition in the months to come. Moreover, about 500 health facilities have been destroyed by the floodwater, according to WHO. “We need to look at how we can restore health systems. If health facilities are destroyed, how can we provide health care at people's door-steps?” said Irshad Shaiqh. Meanwhile, the UN continues to worry about the lack of funding. “If not enough funding comes in, more people will die”, Giuliano of UNOCHA said. “The floodwater is finally reaching the Arabian Sea, but the most difficult or dangerous phase may yet come.”