BY ANY MEANS NECESSARY: An elderly family arrive at a hospital in a rickshaw to seek treatment

Hell hath no fury: After the heatwave

There is a thermal emergency in Karachi: more than 1,300 citizens have thus far perished due to the ongoing heatwave
Published July 5, 2015
By any means necessary: An elderly family arrive at a hospital in a rickshaw to seek treatment
By any means necessary: An elderly family arrive at a hospital in a rickshaw to seek treatment

There is a thermal emergency in Karachi: more than 1,300 citizens have thus far perished due to the ongoing heatwave and some are still reeling from its devastating affects. What did we need to do to reduce the death toll and what should be done now?

What went wrong

They were the worst of days; the most claustrophobic of nights... over 1,300 citizens died in a heatwave that hit Karachi in the third week of June. Could the death toll have been lower?

By Faiza Ilyas

Lying semiconscious in a Jinnah Post-graduate Medical Centre (JPMC) ward for the past five days is Ishaq, an old man in his 70s, and one of the six heatstroke patients still lodged in the hospital. Unlike other patients, he has no full time attendant; the one visitor that comes to see him daily can only tend to him for a few hours as he too has to leave at a certain time.

“He is my ustad, he made an electrician out of me. I owe him in these difficult hours as he has no one to look after him,” says Abdul Zaheer, standing by Ishaq’s bedside.

Zaheer found his mentor lying unconscious in his one-room house in Liaquatabad on June 25, a day after the ferocious heatwave that claimed the lives of hundreds of people in Karachi had subsided to an extent. Temperatures in Karachi soared from 40°C to 45°C on June 20, with the heatwave keeping its intensity for another three days.

“There were slight injuries on his head and neck when I found him. I don’t know how long he had been unconscious before I arrived,” he recalls.

Ishaq was rushed to the Abbasi Shaheed Hospital in an ambulance, but as Zaheer narrates, they were told that there was no bed vacant. Then they reported at a private hospital but were refused help again as the health facility lacked the relevant doctors and equipment that were necessary for heatstroke treatment.

Zaheer finally arrived at the JPMC late at night. The entire journey had cost him Rs1,200 by then, which he duly handed over to the ambulance staff.

While doctors are hopeful about Ishaq’s recovery, Mohammad Yusuf, another patient in the same ward, is in critical state. He was treated at a Landhi hospital for four days before being brought to the JPMC. Treatment thus far has cost the family Rs1,300 but with household income already squeezed, there are separate worries about the increased expense on household goods and transport.

“We couldn’t buy the Rs1,000 packaged milk that the doctors had advised for him,” says Nasreen, Yusuf’s daughter-in-law. “My husband is the only breadwinner of the family, we couldn’t afford it.” Milk is no longer required, she adds, because her father-in-law is now being shifted to the intensive care unit.

According to Dr Tufail Abbasi, the doctor on duty in the ward, one of Yusuf’s brain arteries is blocked while he has also developed some kind of blood infection. A heatstroke is a medical emergency, explains the doctor, and can kill or cause damage to the brain and other internal organs. “It results from prolonged exposure to high temperatures, usually in combination with dehydration, which leads to the failure of the body’s temperature control system.”

While Yusuf struggles for life, over 1,300 people have already perished to the heatwave. It is possible that the death toll must be much higher given the strong likelihood that many poor patients must have succumbed to the sunstroke at home and are thus not recorded in hospital statistics.

While hospital staff rushed to tend to the victims inside the ward, there were hundreds more outside awaiting their turn
While hospital staff rushed to tend to the victims inside the ward, there were hundreds more outside awaiting their turn

With the government largely ignorant of the emergency situation, was it possible to reduce the death toll? Doctors point to public awareness as an avenue where the government could have helped towards that end, with some holding the opinion that a timely weather forecast about the impending heatwave would have helped greatly in minimising human loss.

“It could have been served as a public warning. People should have been asked to limit their outdoor activities and keep themselves hydrated. Sadly, the civic administration too couldn’t take swift notice of the emerging situation,” says Dr Saeed Qureshi, currently serving as the medical superintendent of Civil Hospital Karachi (CHK) where about 2,000 heatstroke patients reported in the first three days. It was only after the death toll had approached 1,000 that the Sindh government felt it necessary to issue public service announcements regarding heatstroke prevention.

Sharing similar concerns, Dr Zafar Zaidi of the Indus Hospital says mortalities increased significantly in few days because there was no government plan in place to handle the crisis while there was an acute lack of awareness among people about the simple steps required to avoid a heatstroke.

“Generally, people couldn’t pick up the medical signs for this kind of emergency: high-grade fever, acute weakness, shallow breathing, nausea, lack of sweating despite heat, dizziness and disorientation. It exhausted everyone but especially the elderly, many of whom had other illnesses or were fasting,” says Dr Zaidi.

Lack of public awareness is also indicated by the fact that a significant number of cases reported at major public and private sector hospitals in the city constituted patients who were either brought in dead or arrived in a critical state with hardly any chance of survival.

For instance, at the JPMC, which reported the largest heatstroke mortalities in a week (more than 350), at least 80 patients were dead on arrival. Of the total mortalities, over 90 per cent were aged 50 years or more.

“The JPMC always maintains emergency medical supplies of at least 500 patients at all times. The biggest issue we had to face was that we ran short of beds and stretchers with an overwhelming increase in patients,” explains Dr Seemin Jamali, joint executive director and head of the emergency services at the JPMC, adding that the dead included a large number of drug addicts and street beggars.

“I think death was difficult to prevent in many cases involving the old patients who fainted soon after getting dehydrated at home and were either brought dead or unconscious to the hospital,” she says.

The beds problem was addressed with timely support from philanthropists, young volunteers as well as the army. “If their support was not there, there would have been a bigger crisis at the hospital,” says Dr Jamali.

While the pressures on JPMC were indeed very taxing, Dr Qazi Wasiq, representing the Pakistan Medical Association-Karachi, argues that once again the city’s vulnerabilities were exposed by an emergency situation and the city’s health system was proven ill-equipped to deal with it.

“Why did patients prefer to go to the JPMC, even though they had to bear the extra expense of travelling to this hospital? Why can’t we improve our basic health units and other hospitals?” he asks.

Wasiq contends that the government needed to upgrade the emergencies of other towns and districts and establish an efficient disaster management system.

“We need to activate our bodies, like the provincial disaster management department, civil defence and girl guides, to cater to natural and accidental calamities. There should be massive tree plantation campaign in the city and spaces for parks should be restored to improve city’s environmental conditions,” he notes.

The government, meanwhile, became embroiled in a political blame-game and was quick to shift the entire burden of responsibility for the health crisis on Karachi Electric, the private power utility. Strangely, it didn’t point any fingers at the government-run Karachi Water and Sewerage Board over the chronic water shortages that the city has been experiencing for months.

“It’s not fair to blame the power utility for the deaths as we know that Karachi has experienced similar intensity of temperatures in the past. Besides, people living in the interior parts of Sindh and Balochistan brave much harsher weather in summers and that, too, without electricity,” argues Dr Qamar uz Zaman Chaudhry, senior climate change expert currently serving as special adviser for Asia to the secretary general of the World Meteorological Organisation.

“Unlike people in the interior of Sindh, who are used to hot weather conditions and know how to protect themselves from the scorching sun, Karachiites were caught unaware,” says Dr Chaudhry, pointing out that this heatwave was unique since it prevailed for four to five days.

“The impact of the prolonged hot weather was exacerbated by the urban heat island affect (the concrete cover that retains heat),” he says, adding that intense weather conditions are likely to become more frequent in Pakistan. “It is high time for Pakistan to start learning from other countries that are successfully tackling climate change issues.”

Cooling down: A salve of mud and lime

We speak to architect Yasmeen Lari about how the effects of heat can be mitigated by using smart architectural techniques

By Sumaira Jajja

Karachi’s sea breeze from the Arabian Sea, which cooled down the city and gave Karachiites a spring in their steps, is one of the many blessings from nature this city has received. But as the city continues to grow in size, the waterways and streams that cooled down the temperature were obstructed, tree and mangrove plantation chopped in the name of development, and hastily built coop like structures for offices and apartments have blocked the path of the sea breeze and the ventilation it offered.

“The materials used in urban areas, concrete and steel, do not have much insulation. That means that the buildings get very hot, the structures absorb heat, and buildings become like ovens unless insulated in some way,” explains architect Yasmin Lari.

“I have often suggested buildings where you may put a frame of concrete and steel, but perhaps the walls could be made out of mud bricks. Also using lots of lime and mud plaster will provide insulation for the building,” she says.

Unlike other parts of the country, where red bricks are used for construction, Karachi relies heavily on concrete, with no insulation used between bricks (since adding insulation would increase costs). Given that a large number of victims came from small homes with no proper ventilation and even tin sheet roofs, it is important that insulation is highlighted and take into account.

Lari says the first and foremost thing to do is plaster the exterior and roof with mud and lime. “A thick layer will act as a barrier. Another thing to do is to whitewash the roof (this reflects sunlight). Planting vines and trees also helps a great deal.”

For immediate relief, she says ice blocks can be placed in the room and turning on the fan will get the room to cool down a bit. At present, she says, all structures can be insulated but it will prove to be an expensive process. “Focus should be on sustainability,” she stresses.

Responding to a question on the need for green spaces, Lari said, “Any kind of vegetation is good. We should be growing vines outside homes. The problem however is the water situation in Karachi, so we need to look into plants that do not require much water but which will provide coverage to the ground. Ground coverage by foliage is very important otherwise the heat will be absorbed and transmitted to the buildings around them,” she adds.

“The more concrete and steel and industrialised materials are used, the more pollution — there is a lot more carbon emission in their production,” she says, arguing that the carbon footprint in the city needs to be reduced.

“If you look at old pre-partition buildings, they were built according to the climate of the city. The higher ceilings allowed the rooms to be cooler and helped in cross-ventilation.”

Lari says the city and most of its structures are not prepared for any disaster, be it an earthquake or a massive storm and this heatwave is clear proof of that.

“This is Karachi’s first experience with the heatwave in the present times and it has been so devastating. However, the factor of climate change cannot be overlooked. There is a dire need to focus on minimising green house gases. Global warming has changed climate patterns, the heat now is far more aggressive than before, the rains and floods more intense, the winds much stronger,” she says.

“We need to sit down and decide how to make sustainable buildings that will help us deal with climate change and avoid tragedies that happened in this heat wave.”

Surviving the heat: secrets from Sindh’s villages

Despite soaring temperatures, there aren’t many heatwave-related casualties in rural Sindh. How do villagers manage to survive?

By Amar Guriro

Keeping hydrated: On their way home from school, Thari boys gather to quench their thirst from a bucket of water, Photo by Daniel Bachhuber
Keeping hydrated: On their way home from school, Thari boys gather to quench their thirst from a bucket of water, Photo by Daniel Bachhuber

When it comes to beating the heat, rural communities in Sindh know their onions. Literally.

The prevailing wisdom in villages across Sindh is to eat raw onions as salad with lunch, as they believe onions have anti-heat characteristics and eating raw onions will save them from sunstrokes. Since famers are most vulnerable to the summer heat as they spend most of their working day in the field, their diet is usually composed of onions with raw mango for lunch.

Then there are juicy fruits and special summer drinks to protect them from dehydration. Watermelons are a common fruit of choice, while lassi and thadal are the drinks of choice for rural communities in the summers. In some northern districts, adding bhang to thadal is fairly common — those who consume this mix say that it keeps their internal body temperatures very cool. In lower Sindh, gur ka sharbat is another remedy used to ward off dehydration.

Apart from the lack of urban sprawl and its heat-intensifying effects, it is such practices that allow rural communities to brave the extremities of temperature and survive the heat. While mercury levels soared in Karachi over the past fortnight, claiming the lives of over 1,000 citizens, other districts in Sindh — Sukkur, Larkana, Shirkarpur, Khairpur, Jacobabad and Ghotki, for example — routinely witness severe heat waves without facing the same death toll.

Official records of the Pakistan Meteorological Department’s (PMD) Sindh chapter show that Larkana recorded 51°C on June 08, 2014 and that on May 26, 2010, the historical city of Mohenjo Daro witnessed 53.3°C — the highest-ever recorded temperature in the country’s history. But even then, the list of casualties is never as high as that seen in Karachi last week.

Anthropologists and environmentalists say that adaptation to the extreme weather conditions by these rural communities, their weather-friendly diets, culture, architecture, forest cover in rural areas, availability of abundant water sources, and their indigenous knowledge about the surrounding environment helps them protect themselves from extreme weather.

“In rural areas, people are well aware about the weather conditions and in summer, when they feel there is a very hot day ahead, they will wake up early and try to finish their work before noon,” says social activist Paryal Mari from Shikarpur district. He believes that rural communities are mostly consuming freshly picked vegetables as well as lots of dairy products to protect themselves from the summer heat.

In the Thar Desert, for example, a special drink is made by mixing goat milk with cold water. “Thari people have their own instinct and they can ‘smell’ the severity of extreme summers many months before. They tend to start preparing for the sizzling days ahead as early as when winter ends,” says Bharumal Amrani, anthropologist and social activist. He explains that in March, before the summer has set in, the neem tree gets new flowers. People pick those flowers and grind them like thadal to make a drink.

Some rural communities also consume the seed of the paneer plant (biological name: Withania Coagulans); some seeds are added in two glasses of water and kept overnight in an earthen pot. In the morning, the mix is sieved with thin cloth and the water is then consumed.

Beside dietary considerations, Sindhi culture also lends itself to braving the weather. Anthropologists believe that the Sindhi topi (cap) and turban became part of Sindhi culture because of extreme heat across Sindh. By covering their heads with a cap or turban, people protect their heads from the direct impact of the scorching sun.

Then there is the culture of having lots of trees to help protect against blistering temperatures. There is either one huge tree in every village or in the courtyard of every home, the colonnade of which is much cooler than the air outside.

“Just imagine: it is extremely hot outside, but you have just spent two hours swimming in the canal and then you drink two glasses of lassi ... most people do that, and then take refuge under the cool colonnade of the tree, sometimes catch some sleep, and stay there till evening,” says Mari.

Traditional charpoys are usually used in most rural communities to sleep on — they are woven in such a way that air passes through their wooden frame, thus keeping whoever is resting on them cool and (relatively) fresh. Rural people also use another technique, in which they keep wet towels on their head when they go out for some work under the scorching sun.

Environmentalists believe that rural communities have great adaptation skills, and they acclimatise to the changing weather accordingly.

“Rural communities have changed themselves according to changing weather patterns: they change their diets, their working hours and even their everyday routines. This helps them to protect themselves from extreme weather events such as a heat wave,” says Nadeem Mirbahar, Ecosystem Management expert at International Union for Nature Conservation (IUCN).

Mirbahar argues that rural communities are more educated in environmental knowledge as compared to those living in mega cities such as Karachi. Talking about the deadly Karachi heat wave, he says that in the city, due to lot of vehicles, industries and urban architecture, there is the formation of what are known as “heat islands.”

“We need more indigenous trees with big canopies to weaken the impact of these heat islands. But in rural areas, there are still so many trees with big canopy spreads — these trees protect rural populations from the formation of heat islands,” says Mirbahar. “In future, we will face more extreme heat wave events. We need to start massive plantation drives of indigenous trees which provide great canopy spreads.”

Amar Guriro is Karachi based environmental journalist. He tweets @AmarGuriro

Looking back to look forward

From meticulous planning in the colonial era to haphazard, undesired developments in recent times, today’s Karachi is simply not geared towards handling climatic emergencies

By Ahmed Yusuf

Dr Noman Ahmed is the chairman of the Department of Architecture and Planning at the NED University of Engineering and Technology, Karachi. Considered among the foremost voices on Karachi’s cultural geographies and cityscapes, Dr Ahmed has been involved in academia, journalism, public policy and matters of metropolitan planning since the past 26 years. We speak to him about how the city’s built environment dovetails with environmental considerations

The British planned Karachi on a grid, harnessing the sea breeze of the city in their architectural designs. Have we bulldozed those design traditions?

The decline has started in the past 15-18 years, when open public spaces, parks and playgrounds and any kind of amenities were very brazenly violated. They were grabbed, there was unplanned densification, and there was the construction of undesirable residential units. This all happened in shoddy ways, but it meant that the city’s overall design pattern became very haphazard. As a consequence, low-income groups in particular were deprived of access to their spaces of relief.

Dr Noman Ahmed
Dr Noman Ahmed

Real estate values also shot up. Before, when we needed more housing, we’d expand the city. Kutchi abadis brokers would expand along their colonies. Because there was a functioning system of public transport, connectivity between various parts of the city was intact and people were not unduly hassled if they lived away from the city centre.

This is not the case anymore. In peri-urban areas, even in Surjani Town or other areas that are apparently planned, those living there are bearing many hardships. Two years ago, Arif Hasan Saheb and I conducted a research titled Karachi Rising on the reasons for densification. Many complained to us that the two to two-and-a-half hours that they spend in travelling in extremely shoddy, totally inhuman transport to reach their place of work was not worthwhile in any way.

It is an expensive way of travelling; a common labourer with typically spend Rs100-Rs120 on travelling expenses daily but earn about Rs400. This stratum will tell you that it is very difficult to make ends meet with such costs. This drag on their income, added with discomforts of various kinds, prompted them to make a move towards the city centre.

Thus began the densification of existing kutch abadis, albeit in very dangerous forms. All of this was being carried out in the informal sector, and so, there weren’t any rules or standards, there were no design systems or support, no technical advice. Even the kutchi abadis surrounding major posh neighbourhoods such as DHA grew very fast and densified in hotchpotch ways — Shah Rasool Colony, Punjab Colony, Neelum Colony, upper and lower Gizri.

But these kutchi abadis that we spoke of are exactly like pigeon holes — they don’t have any system of ventilation. The most dangerous thing is that a lot of buildings were constructed without any solid foundations. There are ground-plus-six buildings that have been built this way. If an earthquake were to hit Karachi, one can’t even begin to imagine the catastrophic damage that will be caused.

If we connect our discussion of the built environment with respect to the climate, then we’ll be hard pressed to find a location that presents liveable quarters.

They say about rivers that humans should not interfere with their natural course. Does the same hold true for wind? What happens to natural wind channels because of these unplanned developments?

Thankfully, there haven’t been many major changes to Karachi’s layout till now. But it is starting to change.

Because of the most-recent laws that have been introduced, and because of the developments that are being carried out as a result of the new legislation, the wind pattern of the city is being drastically affected. Some time ago, the Sindh Assembly had passed the Sindh High-Density Act — the law created a body to be headed by the chief minister. This body could declare any area high-density and allow high-density construction there.

Through this law, they first targeted Clifton and I I Chundrigar Road, which are both already very dense. And from there, it is spreading elsewhere. The NGO Shehri has documented this process extensively, and explained that the number of ground-plus-18 to ground-plus-22 constructions in high-density areas is growing at a rapid pace. When we look at it from the lens of wind, in many areas, this density is disproportionately high.

There can be absolutely no logic for creating such high density in an already congested cluster. The problem that will eventually arise — because its commercial as well as residential land — is that the quality of life, quality of built environment, and even chances of survival will be severely impacted.

There has been much work in the world of Karachi academia on population densities but perhaps not as much on heat densities ... is there a reason for that?

I agree with you, there hasn’t been much work carried out on the climatic attributes of the city, perhaps because the accepted wisdom was that Karachi’s sea breeze was a natural saviour. I think this heatwave has negated that — the low pressure that had built up over Karachi completely cut off the breeze.

From the Met Department statements and feedback, we understand that in terms of the day-time climate, the factor of the breeze (which acted as the city’s lifeline) was not only negated, but the consequent impact of the breeze was also denied. Usually, low pressure means that rainfall is just around the corner; but in Karachi, our dry spell seems to have stretched forever because there is so much atmospheric pollution in the city. As a result, we are deprived of any rain.

Perhaps a focal point of new climate-based research on Karachi could be the types of man-made interventions that can counter these low-pressure spells. These types of low-pressures which cut off the breeze will continue to form, whether its sea-to-land breeze or land-to-sea. Imagine in the winters, if a low pressure cuts off the land-to-sea breeze, then we are talking about a chilling cold wave. This is a terrifying prospect, since survival will be very difficult for the droves of people living in this city.

There is great scope in such research, but it will be important to juxtapose and correlate meteorological data with the built environment. Met indicators tell us part of the reality, but when we dovetail it with the built environment, what kind of outcomes are being generated? I think this research could be the need of the hour.

If we are indeed looking at a future with more low depression spells, should the absence of wind or the absence of the sea breeze be now assumed as a key factor in any development or construction?

In terms of devising a mitigation strategy, yes. Because now you have a precedent that it can happen; before, we weren’t even prepared to consider this possibility. We assumed that with the wind blowing, temperatures would also mellow down. But now, we know wind can be cut off and the damage that entails. We also know that the corresponding variables are mostly intact; they too are all man-made.

Take for example the indiscriminate rise in heat islands. There is an absurd increase in the number of vehicles on the road in Karachi and every car is a heat generator. When stuck in a traffic gridlock, the micro-climate of the immediate surroundings changes very quickly. These multiple heat islands need to be looked at.

The second factor to consider is that the shrinking of our public spaces has meant that there are fewer possibilities for tree plantation — this has to be looked into. Two clusters are very important: Malir River and Lyari River. The banks of both these rivers have drastically shrunk in the past 10-12 years because of developments of various sorts. Both rivers have become conduits of sewage rather than water.

First, you need to stop any kind of development on the river banks. Secondly, you need to start spot interventions of land reclamation.

The rivers lost land because garbage was dumped in them or there was construction; as a result, not only was the natural course of water impeded, but nearby utilisation factors were also compromised. In Lyari, for example, there were lots of trees planted on both sides of the riverbank. But they don’t exist in those numbers anymore.

It is important for Karachi that we take some tough decisions. Bank space on our waterways — particularly the two rivers — needs to be reclaimed and plantations started anew. This is key because plantations along river banks have double value: the first is for rainwater drainage, and second, the quality of environment in its immediate surroundings automatically starts improving.

Another suggestion I want to put forward is to fix local governance. The city is currently operating without any administrative framework, and has been operating this way since the last local government concluded its tenure. There is no governance or management structure. Such a gigantic city cannot be run like this.

We need to revitalise our local government institutions, irrespective of whatever format they adopt. A political debate is always sparked on the topic of local government and how much power they should enjoy, but the point is that whenever a local government comes into power, it’ll settle the issue of administrative responsibility on its own. Local governments have social value, and whenever they acquire power, they’ll be able to deal with all of these problems in a systemic way. Times when Karachi had a local leadership were always better times, irrespective of whichever political domination was in power.

From what was being reported in the press during the current heatwave, there was a sense of helplessness among common people about whom to approach, whom to ask for help from the government. In a local government system, I’d argue that they can still approach their local councillor and demand answers of them. This helplessness wasn’t only witnessed in low-income areas, but also middle-class areas. People were angry about what was happening, and it is important to revisit this factor.

Till such time that this legitimate right of governance is not returned to representatives of the city, I think it’ll be a huge problem to manage a city of Karachi in an emergency like this. This emergency was like boiling a frog — it was gradual. What if the city is hit by an earthquake, where things happen very fast? There will be total mayhem in that scenario.

Does academic research ever reach the corridors of power? If it does, are recommendations implemented or trashed?

Of course they are sent to the government, but nothing happens because there is no structure for incorporating them in policy. The government might appreciate the research conducted but since there is no mechanism for incorporating them on a long-term basis, the effort goes to waste.

The incorporation happens at the level of the city government. When the municipalities existed, in whatever form and whichever party, they were more receptive and more accommodating. Whether it was the MQM or the JI, their responses were better. In fact, a lot of their corrective actions were very useful. It’s a separate matter that their own sustainability was always under question, and so they could not take things forward. I think this heatwave should also become a reason for the revival of local government, as soon as possible.

The writer tweets @ASYusuf

Published in Dawn, Sunday Magazine, July 5th, 2015

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