International Working Group for Health Systems Strengthening

This flood exposed the weaknesses of past infrastructure, leadership, and governance structures and approaches, as well as of resource planning, allocation, and implementation. It has opened up a window of opportunity for incorporating transparent systems and policy processes for disaster management, and to proactively plan for the climate crisis to ensure that climate action and justice is at the center of health planning for all.

Dr Shazia Sajjad, IWG Blog, 2022.

Pakistan ranks eighth for countries most affected by extreme weather events in the last two decades and is prone to natural hazards such as drought, floods, heat waves, extreme cold, and earthquakes. 

The ongoing torrential monsoon rains have resulted in severe flooding and lay a stark light on the increasingly visible consequences of extreme climate change and its impacts on public health and human wellbeing. The consequences of this flooding have washed away villages, negatively impacted over 2 million houses, and left around 3.4 million children in need of assistance and families at increased risk of waterborne diseases, drowning, and malnutrition. Millions of people lost their homes all over the country, and more than 1,500 people have died as of September 2022. The condition in Pakistan is severe and life-threatening for pregnant women, elderly people with disabilities, and those with chronic conditions, and all signs point to these worsening in the coming days. According to a rough estimate, as of 30 September 2022, around 7.9 million people are reportedly displaced. They lost everything and are looking for a dry piece of land to start with. People who largely belong from Agrarian communities have been most affected and have lost their current cash crops including cotton, chilies, and sugarcane, especially in the Sindh province.

All this begs the question: Why was Pakistan not prepared to face this inevitable and disastrous situation in the midst of a seasonal monsoon?  

Pakistan is a developing country with limited resources to cope with disasters. Floods, droughts, and earthquakes have become inevitable situations in this country. However, for the last six decades, political tugs-of-war have exacerbated the state of health in the country, as a result of which the nation is suffering from a severe lack of, and appropriate allocation of, funds for development, infrastructure,  education, and health services. The ongoing floods, primarily fueled by the climate crises, have been further worsened by the effects of pre-existing political and economic instability in the country. Several white papers remain buried in dust in the huge air-conditioned office desks of political leaders, while the situation gets worse outside. The devastating floods and the unpreparedness to respond to it also points strongly to the corruption, weak governance, gaps in policy and implementation, and misuse of available resources and donors’ money. Illegal logging, increased deforestation, corruption, mismanagement of the country’s water resources, and a lack of necessary infrastructure, among other reasons, within the country have led to the current situation. Beyond Pakistan, it is imperative to acknowledge the excessive production of carbon emissions by high income countries in the global North, that are causing severe climate impacts everywhere, but especially in low-and-middle income countries in the Global South.

Food stocks (for e.g., wheat and rice) in government reservoirs have also been heavily affected due to the floods and improper arrangements and handling of them. This has the potential to cripple the economy and lead to a food crisis in the future. Unemployment itself is a great social evil, which continues to worsen in Pakistan.

In Sindh alone, there have been nearly 2 million school dropouts due to this disaster. Many schools have been announced as shelter homes in areas where school buildings survived the effects of the floods and rains, and families whose homes have been destroyed are finding alternative measures and have started living in these shelter homes. It is important to note that even before the flooding began, almost 22.8 million children between the ages of 5-16 were out of school in the country, and the floods have significantly worsened the state of affairs. Based on the current situation, it will take us a while for the needed rescue relief and rehabilitation, and based on the current performance to response efforts, it seems school-going children may lose one academic year.

Further, the health infrastructure was already insufficient in Sindh province, and now in the middle of these severe floods and internal migration, pre-existing gaps are widened and new challenges are wreaking an already weak health system. As a result of the floods, we have seen a sudden increase in the cases of Malaria, Dengue, skin disorders and gastrointestinal infections in the shelter homes for IDPs, which has emerged as another set of challenging issues for the health system. 

Lastly, livestock and cattle have always played a critical role in agriculture-based societies like in Pakistan, and are considered as assets to utilize in the time of financial needs. Estimates suggest that about 700,000 cattle have been lost to the floods nationwide, and the rest are growing thin as fodder decreases. Loss of such assets would also disturb the equilibrium of social fabric in Pakistan.

Time for Action: Public Policy Implications of the Flood in Pakistan

The current situation in Pakistan has most disproportionately affected those who belong to socially and culturally vulnerable parts of society, including earlier generations of internal immigrants or IDPs. These people have lost their homes, capital, and tangible resources. These IDPs are politically and sentimentally attached to their villages, where they were born and brought up with a strong linkage to the soil.

Floods create short- and long-term crises implications, such as food emergencies, waterborne disease outbreaks, and unemployment on a great scale because agriculture engages 70% of the country’s workforce. The entire country, and specially the Sindh province, is in dire need of aid and assistance to support and bring people’s life back to normal. 

This flood exposed the weaknesses of past infrastructure, leadership, and governance structures and approaches, as well as of resource planning, allocation, and implementation. It has opened up a window of opportunity for incorporating transparent systems and policy processes for disaster management, and to proactively plan for the climate crisis to ensure that climate action and justice is at the center of health planning for all. Yet, some critical question remain ﹣ who will make sure that aid, assistance or rescue response reaches those who really need it, and that aid practices are grounded in justice and health equity? Who will take up the responsibility for the climate crisis? And will we continue to pay the price?