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For Pakistan, the 2011 floods came at a time when the country was already struggling to recover from last year’s floods. This year however, Sindh turned out to be the worst affected province with 22 of its 24 districts flooded. According to a report released by the Provincial Disaster Management Authority (PDMA), 8,920,631 people were affected by the floods in Sindh. Of these, 599,224 are still in relief camps all across the province.
Dr. Shershah Syed from the Pakistan Medical Association feels that the floods have highlighted a broader dilemma. “We are facing a humanitarian crisis – it is shocking to see the degree of malnutrition in the children at relief camps," he says.
Dr. Syed was also involved in coordinating flood relief work last year and thinks that “these people are likely getting better access to healthcare in relief camps than in their own villages.” He further added that this is especially true of Sindh, a predominantly feudal province “where poor debt-ridden farmers toil lands not owned by them.”
Pakistan is included in a list of 20 countries which contain 80 per cent of the world’s undernourished children. Maternal and child under-nutrition is the underlying cause of 3.5 million annual deaths globally. The major causes of mortality in Pakistan in children less than the age of five years are diarrhea, acute respiratory infections and sepsis, with chronic malnutrition, an important but indirect cause of child mortality.
“With rising numbers of children suffering from diarrhea secondary to unsanitary water and hygiene we need to optimise access to clean drinking water and sanitation services,” says Dr. Zulfiqar Bhutta, Chair of the Division of Maternal and Child Health at the Aga Khan University.
Dr. Bhutta, who has done extensive work on how to best combat malnutrition in developing countries, says that rescue efforts in the these areas needs to be more directed to be as nutritionally optimal as possible. “There is little realisation that Sindh has the worst rates of maternal and child undernutrition in the country as exemplified by the nutrition surveys undertaken during the floods last year and confirmed by the recently concluded national nutrition survey. The current floods have just compounded a chronic emergency and underscored the importance of large scale preventive strategies.”
The UN's Food and Agriculture Organisation (FAO) estimates that nearly three quarters of southern Sindh province crops have been damaged, while two thirds of food stocks have also been hit. Given the scale of the disaster, it is still a long way before relief or rehabilitation comes to the worst affected. In the meanwhile, what we see are millions of hungry people waiting for two square meals a day.
Given the present situation, we need to look hard and critically at our national and local priorities. Pakistan is not a poor country, it is a nation with poor allocation of resources and recently we have had more than our fair share of bad luck. With years of meager investment into health and education, two years of flooding has highlighted issues that have been festering for years particularly that of malnutrition. There is no magic bullet to solve the problem of undernutrition nor can we depend upon emergency responses and donor funding to affect change.
Evidence-based interventions can make a difference to short-term outcomes – these interventions include strategies to improve maternal nutrition before and during pregnancy, early and exclusive breastfeeding, and good-quality complementary feeding for infants and young children, with appropriate micronutrient supplementation. In addition to these nutrition interventions, other health promotion strategies include attention to programs to address unsafe water, inadequate sanitation, and poor hygiene.
We also need long-term investments in the role of women as full and equal citizens—through education, economic, social, and political empowerment. To find widespread malnutrition in Pakistan in the midst of plenty is a travesty and points to the huge inequities that exist in Pakistan. Responding to this silent emergency should be a national priority and not a knee jerk response to natural disasters.
The writer is in final year of pediatrics residency at Duke University.
