A view from Badin

Over 90,600 flood victims living in 350 relief camps; a third of all patients are suffering from some disease.

Badin exudes abject misery. According to figures recorded on Friday, over 90,600 flood victims are living in 350 relief camps; about a third of all patients are suffering from some kind of a disease and clean drinking water is scant.

Furthermore, district authorities estimated that approximately 80 per cent of Badin’s Kharif crop has been destroyed and about 85 per cent of Badin’s 1.8 million people affected.

Why we didn’t learn from last year

To contend that the authorities should have learned better techniques to prevent floods after last year’s flooding is valid. However, unlike the floods in 2010, this year’s floods in lower Sindh are not related to breaches in canal embankments. Local authorities explain that these floods are related to overflows and breaches in Badin’s Left Bank Outfall Drain (LBOD), one of the largest saline drains in South Asia.

Criticism for Badin’s ill-planned LBOD is hardly recent. The LBOD was designed as part of a World Bank-funded project for reducing water logging and salinity in Sindh. Members of the anti-LBOD Tehreek and engineers at local universities have criticised the program for its flawed design and implementation process. Locals often blame the LBOD for recurrent flooding, damage to wetland fisheries and seawater intrusion. The anti-LBOD campaigners went as far as to ask World Bank and Asian Development Bank to compensate the people affected by the LBOD-related flooding in Badin in 2003 and waive Pakistan’s debts related to the project.

Dr Yousufani, a local pediatrician, claimed that, “floods occur every time it rains a little more than usual. LBOD’s flawed design prevents water from going through the Rann of Kutch to Shakoor Dandh and down to the sea, the way it has for centuries. And it’s hard to issue warnings for these floods. We knew about the rain forecast but we didn’t know that the four days of rain would cause LBOD to overflow and breach, affecting over a million people.”

How things are different this time

This year’s flooding in Sindh is significantly different from the 2010 floods. Flooding is relatively localised, largely focused in a single district, and has affected a little over a million people as opposed to last year’s 7 million. Also, last year, districts like Badin, Tharparkar, Tando Mohammad Khan, Tando Allayar hosted flood victims from nearby districts but did not experience extensive flooding.

More significantly, nascent effects of experiential learning were visible in the field on Saturday. Last year, resource duplication and concentration, vertical efforts, ad hoc aid delivery, cost inefficiency and nutritional concerns about delivering cooked food to people in camps caused much chaos in parts of upper Sindh.

Learning from last year’s experience, the government decided to implement a relatively strict distribution policy (that the Pakistan Navy and Punjab Chief Minister Shahbaz Sharif did not show respect for). All relief trucks must be handed over to local authorities. After a computerised itinerary of all items is made, and receipts prepared, the district administration arranges to deliver goods to an area with pre-identified needs. Private donors may accompany the district officials for distribution, but political style handouts are avoided to prevent stampedes, fights and snatching.

Also, as of Saturday, the government, a few public private organisations, and some local NGOs and philanthropists were the main forces running relief camps. This time, however, the National Disaster Management Authority and Provincial Disaster Management Authority have not appealed to international aid organisations. It is unclear why this is the case.

At any rate, we must bear in mind that delay with international aid is inevitable, as confirmed by a senior WFP official speaking at a talk about Pakistan’s 2010 floods at Georgetown University. During the 2010 floods, for instance, UN food aid did not reach Khairpur Mirs, a district where I was volunteering till  August 17, 2010 – a good two weeks after the floods.

How the disaster has affected public health and education

Badin’s EDO Health Dr Sattar Channa claimed that there were outbreaks of eye diseases, skin diseases and diarrhea in most flood relief camps. And pregnant and lactating women were in dire need of good quality prenatal and postnatal care.

Responding to these concerns, I volunteered with a medical team funded by Society of Obstetricians and Gynecologists (SOGP) and supported by Pakistan Medical Association (PMA). We delivered trucks of medicines and food aid, conducted a need assessment survey, set up medical camps, and treated about 300 pregnant patients at six relief camps in Badin and one in Golarchi.

At the sixth relief camp, President of the Pakistan Medical Association- Sindh Dr Samrina Hashmi summed women’s health concerns succinctly by quipping, “Almost every woman in these camps is pregnant.”

Every woman we met had Jaam (too many to count) children or wanted to have Jaam children. “Adi, panj bar zaya thee wayaa, tray bar zinda ahein, ayen hik paeth mein ahey (Adi, five children dead, three alive, and one on his way)” seemed like the most commonly reported condition.

Curiously enough, women in camps didn’t want to report pregnancies unless specifically screened. There was a significant discrepancy between the numbers we treated and the numbers reported at the camp.

Cultural problems also featured in women’s responses. In my previous write-up about the floods in 2010, I noted the way inter-clan or caste issues combined with social problems to create potentially near war-like situations in the Mumtaz College relief camp of Khairpur Mirs. Although I didn’t notice potentially conflict prone conditions, it was evident that people of different castes and clans were not content with living in close proximity to each other.

In the relief camp at Iqra School, for instance, a group of Syed women confined themselves to a single classroom. Their high-class status prevented them from condescending to come and see doctors at our medical camp. Their family elders only allowed Dr Nighat Shah to examine them in their classroom after her uncorrupted Syed lineage was traced and corroborated. My token Syed presence in room was also welcome. The non-Syed midwife was allowed in grudgingly.

Dr Shah, the General Secretary of SOGP and a Lecturer at Aga Khan University, has spent almost 10 years holding medical camps, and benefits from extensive experience from flood relief medical camps last year. She commended Lady Health Workers (LHWs) and Public Private Health Initiative (PPHI) units for their active service at all camps our team visited. The LHWs helped her transfer three patients in labor to a public hospital, and received instructions for taking severely anemic patients needing blood transfusions and other procedures to hospital on the next business day. Dr Shah also alerted the district and provincial authorities about the critical cases we encountered and underscored the need to screen and maintain records of all pregnant patients.

To help patients maintain records, our team tried making antenatal pregnancy cards for most patients we treated. And such record cards are highly recommended to avoid unaided deliveries, increased morbidity or possible maternal deaths at camps.

Other medical teams from Karachi will follow in the days to come.

Concerns about the state of public education also surface. Most relief camps were set up in schools and colleges. Unless Badin’s authorities follow the example set by northern Sindh’s authorities last year and shift people into tent cities within the next week or so, Badin’s school children will miss more than a month of tuition, every school’s conversion into an unsanitary pigsty will be complete, and serious disease outbreaks among people living in cramped conditions will be imminent.

How you can help

Although the government, public-private organisations like Public-Private Health Initiative (PPHI) and National Commission for Human Development (NCHD), and local NGOs like Edhi Foundation, Aga Khan Foundation and others are helping, other NGOs, philanthropists’ and volunteers are needed to deal with the crisis.

Donating dry food supplies, tents, clean drinking water or water treatment tablets, medicines, powdered milk, shoes, clothes and other miscellaneous items of daily need would be useful.

Those interested in volunteering to help pack or distribute supplies, keep records, or monitor delivery, should contact local authorities or NGOs.

Deserting people affected by the floods in their hour of dire need should not be on the cards.