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Pakistan floods pose serious health challenges

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2141 (Published 02 September 2022) Cite this as: BMJ 2022;378:o2141
  1. Sonia Sarkar
  1. New Delhi, India

With a third of Pakistan inundated by the floods that have affected more than 33 million people, local relief workers and public health experts have said that they are fearing a rise in several waterborne and mosquito-borne diseases and skin infections.12

Public health expert Malik Muhammad Umair, who was part of response teams led by an international non-profit organisation after the 2005 earthquake and floods in 2010, told The BMJ, “With most of the flood affected areas having limited access to safe drinking water, the biggest threat is from waterborne diseases such as diarrhoea, typhoid, and cholera. Also, mosquito breeding that has increased because of stagnant water may also lead to high numbers of malaria and dengue cases, which Pakistan has already been grappling with.”

Of Pakistan’s 154 districts, 116 have been affected by the floods, caused by heavy monsoon rains that started in mid-July.3 Over 1162 people have died so far.4

Amid criticism that the government isn’t doing enough for people affected by the floods,5 on Wednesday 31 August the prime minister, Shehbaz Sharif, announced 10 billion Pakistani rupees (£40m; €46m; $46m) to rehabilitate affected areas.6

Around half of the villages in northwestern Khyber Pakhtunkhwa province are not accessible because most roads and bridges have collapsed. Medical teams have had to swim to reach flood victims, said the freelance photographer and social worker Mohammad Asmar Hussain of the 150 volunteer strong Dera Ismail Khan Flood Relief Force, which has supplied food to more than 30 000 people and makeshift tents to those made homeless, as well as medical care.

Its medical teams have found a rise in scabies and fungal skin infections, Hussain said.

The World Health Organization said that around 890 health facilities had been damaged and that access to “health facilities, healthcare workers, and essential medicines and medical supplies” remained the main healthcare challenges.7

Umair, who recently visited flooded parts of southeastern Sindh province, said that many basic health units and rural health centres there were under water. “Pregnant mothers are facing a major challenge because of the lack of healthcare centres to assist childbirth,” he said.

Nadeem Jan, an expert in health and public policy who led Pakistan’s polio eradication programme in Khyber Pakhtunkhwa, warned that the floods will effect the nutrition of children in the province, where every second child (an estimated 800 000 children under the age of 5 years) is stunted.8

The Pakistani sportswoman Noorena Shams, who distributed sanitary kits to 7525 women in Khyber Pakhtunkhwa using 1.5 million Pakistani rupees that she collected for relief work, said, “The disposal of these sanitary pads, however, is a big problem. We are looking for someone who can supply reusable ones.”

Shams is also working with local relief workers on the ground to provide makeshift toilets only for women.

Jan feared that the “high population displacement” and change of national priorities brought by the floods would pose a formidable challenge to sustain the momentum needed for a successful polio vaccination programme. Pakistan has reported 15 cases of wild poliovirus so far this year.

WHO has diverted mobile medical camps to affected districts, delivered more than 1.7 million water purification tablets, and provided sample collection kits to ensure early detection of infectious diseases.9

The scale of the emergency was “huge,” but the overall response to the floods from UN agencies and international non-profit organisations had been “sluggish” in comparison with the more coordinated efforts after the 2005 earthquake and 2010 floods, said Umair, the founder of the Pakistan Public Health Forum, a virtual network of over 250 public health experts across the country.

Government agencies and the non-profits must coordinate their efforts to provide food and safe clean drinking water and healthcare facilities, he added. “People’s homes, agricultural land, and livestock have been destroyed in the floods. There isn’t any food security either, so they need dry food such as chickpeas, biscuits, powdered milk, and dates, besides portable water purification tablets.”

Pakistan’s planning minister, Ahsan Iqbal, has asked rich nations to help the country pay for the damage—estimated at $10bn—caused by the flood, which the government has called a “climate catastrophe.”1011

This year Pakistan, which is responsible for only 1% of the world’s carbon emissions, has witnessed climate related disasters such as searing heatwaves, droughts, and melting glaciers.12

Rain cycles and weather patterns have changed over the past decade, the Khyber Pakhtunkhwa based climate change activist Ehtisham Hassan said, but he added that local authorities were also partly responsible for disasters induced by climate change. “For example, they dump uranium waste into the river Indus, which flows by Punjab’s Dera Ghazi Khan district, one of the flood affected areas. The government must frame its policies keeping the impact of such irresponsible actions in mind,” Hassan said.

Local communities in Khyber Pakhtunkhwa blamed the government for allowing the construction of hotels on the banks of the river Kunhar in the alpine Kaghan valley and adjacent valleys, affected by the flooding.13

Hassan said that many people made homeless will be displaced for life.

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