While national and international sources are trying to help people affected from floods to at least get basic food and shelter, what the future holds is still very alarming as many districts are still submerged in flood water. The stagnant water has become a hub for several diseases such as malaria, dengue, gastroenteritis, eczema and several other skin diseases.

Moreover, where the magnitude of the loss from the floods is huge, the relief efforts don’t quite match the enormity of the crisis at hand.

According to Aga Khan University Hospital (AKUH) Research Department Pediatrics and Child Health Manager Dr Fayaz Umrani, who has been working in Mithi for the last 15 years, nearly 80 per cent of the patients who come to the relief health camps for treatment are women and among them, 20 per cent are pregnant. Every four out of the sixth patient is also malaria positive. Moreover, among in these areas where rain water is stagnant and hygiene is a challenge, diseases seem to be spreading at an alarming rate. Eye, skin and wound infections seem to also be spreading rapidly.

Kiran* is among such people who is currently living with her parents in a makeshift shelter. The shelter is a chicken farm where people from eight to 10 tribes are living together including men, women and children.

When she arrived at the medical health camp in Mithi, she had a wound on her hand which was bleeding and was most probably already infected at the time that the doctors treated it. However, that wasn’t her main source of concern at the time of her visit. The doctors noticed her clothes were soaked in blood and upon asking, she told them that she was menstruating. In the make shift camp, where everyone has lost all their belongings, it is difficult for women to maintain hygiene. “My mother has washed a few dupattas for me to use and other women suggested setting up a charpai for the menstruating women in a corner but so far, this is yet another problem we are facing,” she complained saying that every second woman will suffer from infection as they already are living in very difficult and cramped conditions.

The story of every other person coming to field hospitals, mobile hospitals or camps is the same they either get diseases because they can't leave their flooded houses and farms because that is all they have or they travel miles to get some food to feed their children or elderly.

A young woman around 20 years of age reached the medical health camp and insisted the doctors check her first as she was groaning in pain, the doctors inquired what happened and she showed them a deep wound on her hand which was not just infected but was so deep that even her bone was visible. She was treated, her wound was cleaned and the doctors provided her with some medicines. The woman was also pregnant so the doctors educated her on how certain medicines can be dangerous for her and her child too. “When I asked her how she got wounded, she told me that there was four feet water from where they had to walk in order to get the food that was being distributed during relief efforts. She, along with her father, was going to get some food when they hit something sharp underwater,” a doctor serving in a medical camp narrated her story, adding that even for medical help she walked for an hour and she had to do the same back which is why she was adamant to get any injections. “She wanted to learn how can she clean and bandage her wound so she can manage it by herself,” he explained.

To help people with complicated diseases or who are severely infected, medical camp doctors of AKUH have set up a system where they share pictures of the patient's wound or infection on a WhatsApp group which is accessible to AKUH doctors across the country and the specialist can guide the camp doctor accordingly. “Mostly in the last week, we are getting cases of eye infections and it is always good to take an expert opinion as each camp has two doctors, one male and one female, and only two counters,” said Dr Umrani.

Every day the medical health camps receives patients with skin infections that are already quite severe by the time they seek treatment.

Amna’s* one-year-old son was suffering from a severe skin infection that had spread from his skull to neck and ear. Some kind of mosquito had bit him on his head and later several other insects kept biting his wound. To protect him the mosquitoes and to keep the infection from spreading, she put oil on the affected area but that was of little help. The unclean water she used to wash him also increased the severity of the wound. The child was screaming in agony by the time she was able to reach the medical camp for help.

Many children seem to also be suffering from eye infections these relief camps. Most people have to travel for hours in the scorching heat in order to seek medical assistance. Therefore, in many instances, people have put off seeking treatment until they have no other choice. Oftentimes, aggravating their condition further in the process.

While the medical camps and hospitals are equipped for emergency and first aid treatment, for further treatments patients are mostly referred to Hyderabad. The major impact that the floods leave afterwards will be on non-communicable diseases such as mental trauma, hypertension, diabetes, and others. People who have seen their houses washed away in floods and have nothing left neither homes nor farms will also suffer trauma which they will be unable to recover from easily.

Other than diseases, the security of the families is also a big issue where women are worried about their young daughters as they are displaced and have to live in sharing tents. A middle-aged woman with swollen eyes sat in the corner of a make-shift tent. The doctor, mistook this for an eye infection, however he learned that she hadn’t slept in three days as she lost her husband during the floods and she was left to care for their three daughters aged between 11 and 16 years. “How can I sleep in peace when we have to live under the sky all alone? I have to keep an eye on the surroundings so my daughters can sleep, since only I am there to protect them,” she said.

What can be done to prevent diseases?

The magnitude of the disaster is huge and attempting alleviate its impact with limited resources is not only challenging but nearly impossible. Educating people and informing them about the right ways to address health emergencies is also urgently needed.

The basic and few initial things that can be done is providing mosquito nets to prevent malaria and dengue which seems to be spreading like wildfire. “We are educating people to try and boil water with what little resources they have to avoid water-related diseases such diarrhea and dysentery diarrhea (also known as blood diarrhea),” said Dr Umrani. The relief camp doctors are also distributing chlorine tablets to people who do not have access to boiled water so they can at least clean the water they have reserved.

Educating people to drink boiled water is easy but understanding the condition they are in and how will they manage it is difficult so doctors and NGOs are trying to come up with solutions to help people to lessen the damage. “The safest option to avoid any water-borne diseases is to consume bottled water but everyone does not have access to it so the second option is to boil water and drink it but again boiling and storing is also not possible for many who are displaced from their villages. So the best possible solution is to disinfect water by using sunlight, the process is called solar disinfection (SODIS) where you put water in a container for around six hours in direct sunlight and that kills the bacteria in the water and the water can afterwards be stored and used for drinking purposes,” shared AKUH Head of Infectious Diseases Dr Faisal Mahmood. He also pointed out that most of the skin diseases are spreading because of the living setups and unhygienic conditions.

All other aspects and diseases will come under control in some time but we are on the edge of big issues as the pregnant women who themselves are malnourished and do not have clean water to drink and eat food will be giving birth to children. “We are providing them with a sachet to have once a day for two months which is a dietary supplement filled with nutrients,” said Dr Umrani, who is taking records of each patient to keep a check and balance and have been running relief operations in 39 districts across Pakistan.

Other than just educating the people, teams are on the ground are pinpointing locations to the government where they need to provide extra help so that more and more people can be helped. The main need is to have a real-time mechanism that can help people such as spraying anti mosquitoes sprays, providing mosquito repellants, and making sure people get nets to cover their sleeping places and all this is only possible with coordination among Government, DHOs, NGO’s and private institutions.

Who is most affected?

Flood affectees themselves are already in mental and physical trauma and upon that they have also been in a state where they have to take care of their health issues as the water is still there, one third of the country was underwater when floods hit and the situation has not much changed since then. Most people who are reaching the medical health camps are internally displaced people who have migrated from their villages and left their houses because everything was under water. They have migrated towards river banks, roadsides, and safe areas where either water flows away or was on the height of the villages.

Even among them, women are most affected as they feel it a taboo to come to doctors and tell that they are suffering and in this whole process, their infection spreads as they are living eight to 10 families together in tents or makeshift places with skin diseases mostly spread easily.

The current state of affairs

The water conditions, especially due to the relief operations, have become better that wat they were a few weeks ago. Right now, many districts still have standing water and which is costing millions in farming. From the affected areas, Qamber Shahdad Kot, Dadu, Khairpur, Naushero Feroze, Sanghar, Thatta, Mirpurkhas, Jamshoro, a few areas of Badin, and two tehsils of Umerkot are still underwater, varying from four to 10 feet of water.

“Such water conditions are alarming and it is causing diseases because of unhygienic conditions. We are trying to educate people as much as we can to drink clean water and make it easy for themselves,” said Parliamentary Health Secretary and Provincial Minister of Sindh Qasim Soomro. He also said that practically speaking boiling water isn’t possible for everyone, as they are living in such conditions but educating them, is helping. He also feared that malnourishment in the coming days can be an epidemic in Sindh as according to some statistics there are around 40,000 women who are pregnant in the flood-affected areas of Sindh and such mothers who are not getting enough to eat will be in danger in next two months. “People have migrated and need everything from house to food, from clothes to basic necessities,” he added.

Many organisations have been working tirelessly day and night but the target is to register all such women so that they can be tracked down and helped when needed. “We have many international and national partners such as Red Crescent, WHO, UNICEF, AKUH, Indus, Al Khidmat, and many others who are on the ground and trying to move these women to safer places where they can be given proper treatment,” Soomro shared.

Sharing the details of the mobile camps, the parliamentarian health secretary said that, there are 500 mobile camps in the districts that are underwater among which 400 are of Health Department Sindh, while the other 100 are of different partners. “All camps are 24/7 and are well-equipped to provide first aid and medicines to the patients while there are 12 field hospitals also operating to provide treatments to patients with severe issues which include high fever from malaria or dengue,” he said, adding that the hospitals are between five to 10 bed facility.

To ensure food supply, many partners are on board and are making sure that places can be identified and pinpointed where help is needed, other than that irrigation department has also been instructed to start the restoration of fresh water through canals so that farmers can start their livelihood back. “Restoration of fresh water cannot only help in getting back to life but also help in drinking fresh water which can prevent gastroenteritis,” Soomro shared, he also told that water has been residing and fresh water can flow into the right bank canal, some part of it is still underwater, the area of the right bank which is still underwater is 150km X 40kms that makes an estimate of 6,000 sq km, which goes from Baluchistan to Manchar while the left bank is almost similar land which goes from Khairpur to Badin. “It is the jurisdiction of the irrigation department to recede flood water and provide fresh water in the canals earlier this week they started using canals,” he said, adding that they are identifying the places which are clear to provide water and where they should work to withdraw the water