KARACHI: Though alarming by all standards, the health crisis in Tharparkar is not unique to the region but prevails in all remote rural parts of the country as well as urban slums, for instance Rehri Goth located close to the Defence Housing Authority, said an expert during a panel discussion held on the Habib University campus on Saturday.

Titled Malnutrition and Health Crisis in Tharparkar, Sindh, the programme highlighted the different dimensions of the health crisis, the many problems communities face and how the area has changed over the years.

“With a stunting ratio of 44 per cent and 58pc households facing food insecurity, Pakistan faces a health emergency. The situation is more serious in Sindh (58pc stunting) and Balochistan, where families facing food insecurity are 72pc and 64pc, respectively,” said chief executive of HANDS-Pakistan Dr Sheikh Tanveer Ahmed while citing the National Nutrition Survey 2011 data.


‘It is a highly vegetative area, wrongly described as a desert’


Statistics showed that the national immunisation coverage was only 33pc with the result that preventable diseases claimed lives of 450,000 children (below five years of age) every year. Forty-four per cent of these deaths occurred in the first month of life indicating that mortalities were strongly linked to mother’s poor health, he added.

The maternal mortality rate of Pakistan is 270 per 100,000 live births and that of Sindh stood at 320 per 100,000 live births.

Sharing data on child mortalities in Thar, he said of the 398 deaths reported between Jan and Dec 2015, 326 were reported at the district headquarters hospital in Mithi alone.

“Few people in Thar have access to the district hospital so one can easily believe that the number of mortalities would be much higher. The number quoted by private sources runs over a thousand,” he said, while pointing it out that many districts of Sindh and Balochistan had only one tertiary care hospital each, often without proper equipment and adequate staff.

In the case of Thar, he said, health challenges multiplied as safe water sources were scarce and a majority of the people lived in abject poverty. The poor were also losing their livestock assets due to a lack of immunisation coverage.

Rejecting some common perceptions, Dr Sonu Khanagarani, who has done extensive work in Tharparkar and now heads the Hisaar Foundation, said the region was a highly vegetative area and was wrongly described as a desert.

“Small rains change its landscape altogether. It’s densely populated, more populated than the 11 districts of Rajasthan. Ninety-five per cent of the people live in the rural areas and the only major town is Mithi. In olden times, the region was used as a hiding place to avoid conflict or was sought for grazing purposes,” he said.

Though rich with mineral resources, Thar didn’t have any groundwater resource and 97pc of its people were dependent on groundwater, more than half of which was unfit for human consumption. Livestock, around seven million in number, was a precious asset of the Tharis.

“Over the last 100 years, the region has seen 70 droughts and a number of famines, one of the most disastrous one documented in 1901 in which one million people died,” said Dr Khanagarani.

According to him, the region that had remained isolated for decades underwent a major change in 2000 when roads and communication networks were established and many civil society organisations stepped in to initiate community-based projects.

“Growing awareness encouraged more and more patients to contact government health facilities. The limited number of public health settings, however, couldn’t cope with this increasing influx of patients,” he said.

Replying to a question, he said migration was a general trend in the country whereas in Thar it was specifically linked to social fears people had due to forced conversion. A lot of madressahs had opened due to a ‘security threat’ that had also created a sense of alienation in the people.

He said that since 1901 there was no casualty in Thar directly due to drought and the people had died due to the impact of drought.

‘Education is the key’

A unique feature of the region, he said, was the peaceful coexistence of people of different faiths who had been living there together in harmony for centuries.

Apart from the region’s physical characteristics, what had prevented its development was lack of government focus on education and till today female literacy rate was not more than six to seven per cent. Thar had its first school in 1906.

“Education is the only choice. Unfortunately, it has been highly politicised,” he said.

Speaking about government efforts to combat the health crisis in Thar, Dr Shireen Mustafa, representing the health department, said conditions had greatly improved at health facilities in the district, including the Mithi hospital, which now had trained staff and well-equipped wards. The government had also introduced a ‘hard area’ allowance to motivate professionals to work in the remote area.

“But there are challenges, too. We need the people in the system to perform and it’s not about incentives all the time. Today, medical schools are largely producing female professionals, many of whom are not willing to work in remote areas,” she said, indicating that health facilities in the rural areas, especially Thar, faced a serious shortage of medical professionals.

Answering a question, she stressed the need to change public mindset and said the people, especially the young, should come out of their comfort zone and fulfil their obligations as citizens.

The programme was moderated by Dr Asif Aslam and Dr Aaron Mulvany.

Published in Dawn, April 10th, 2016