Dispatch from Sindh: Children at risk from disease

SUKKUR, SINDH PROVINCE — In the ad-hoc child malnutrition facility at the Railway Hospital in Sukkur, mothers cradle and nurse their toddlers, all emaciated and weakened. A row of beds runs either side of the ward in the brown and gray-painted Raj-era hospital.

Three year-old Zamina was malnourished before the floods hit, but the flight from the family farm in Thulla to this heaving city in northern Sindh worsened the tiny girl’s condition considerably, says Dr Sakina Jafri, pausing to speak as she moved from bed to bed.

“With the threat of disease all around, young children are most prone,” she said. “And when they are so young and are malnourished, it only adds to that level of vulnerability.”

UNICEF Director Anthony Lake says that almost 9 million children are at risk of disease, an alarm call rung out in tandem with World Food Program head Josette Sheeran’s warning of a second wave of disaster looming even as flood waters slowly recede.

Authorities have also struggled to cope with a growing number of cases of severe diarrhea and malaria caused by dirty water that offers a perfect breeding ground for insects and disease. More than 500,000 cases of acute diarrhea and nearly 95,000 cases of suspected malaria have been treated since the floods first hit, the U.N.’s World Health Organization said Tuesday.

The big fear is a cholera outbreak, given that little or no capacity is in place to deal with what could be a devastating epidemic. Cases have been reported in Sindh province in recent days, but the Pakistani government has not yet officially announced anything. Cholera can kill within 48 hours if not treated, and is highly contagious. Once identified it can be treated quickly, usually with basic rehydration treatments.

Over 6 million people have been displaced by the floods, with over 3.5 million of these in Sindh alone. 1.2 million homes have been damaged or destroyed — five times as many as the Haiti earthquake. While some of the homeless are in camps set up by the military and NGOs, the majority are pitching down wherever possible, constructing ad-hoc shelters and often sheltering under beds or blankets in the baking heat.

The Sindh Provincial Disaster Management Authority (PDMA) said that there were almost 900,000 people in camps and spontaneous settlements in the province as of 28 August, figures that may not be inclusive of more recent displacement. In any case, sanitation facilities and clean water are absent from most camps, compounding an already parlous public health environment and laying the ground for the spread of disease. Even as the waters in Punjab and the north of Pakistan, towns and cities in Sindh remain at risk, with evacuation orders issued for 400,000 people in Mehar and surrounding areas.

Hunger is a problem now and emergency rations are needed for adults and children, as well as therapeutic feeding needed for severely affected young children such as Zamina.

It is a problem for the government as well, with implications for the country’s economy. After briefing the country’s cabinet, Prime Minister Yusuf Raza Gilani last week worried aloud about food insecurity due to the damage to agriculture, and follow-on impact on social welfare.

“The floods have inflicted damage to the economy which may, by some estimates, reach $43 billion (£27.9 billion), while affecting 30 percent of all agricultural land,” he said. Agriculture is the mainstay of the economy, with cotton the main cash crop. Textiles, which are cotton-dependent, are the country’s biggest export. The next wheat harvest is at risk after the floods destroyed more than 500,000 tons of seed stocks in Asia’s third-largest wheat producer.

Hunger and malnutrition are major issues now, but food shortages will be a problem in the near future as well. With millions of acres of cultivable land under water, it is uncertain to what extent such terrain can be readied for the next planting season, which should start in October, or if people will be able to return home in time. With so many draught animals drowned in the river, it will be difficult for farmers to prepare the ground, which will be covered in heavy silt.

Zamina’s mother Zeina knows this, her head bowed and her words translated through Dr Sakina. She nurses her youngest, an eight-month old boy, while a nurse feeds Zamina.

Life will be immensely-difficult for her and millions more families in the same position from now on. “I have nine children”, she says. “My husband and the other children are in a camp. What will we do now? We just don’t know,” she laments.

Simon Simon Roughneen is an Irish journalist currently based in southeast Asia; he has previously reported from conflict zones in the Africa, the Middle East, and Europe. His website is www.simonroughneen.com.