‘What can we do?’: Waterborne diseases continue plaguing Pakistan 2 years after devastating floods

SUJAWAL, Pakistan: Two of Fatima Bibi’s children have died of mosquito-borne disease malaria, and she fears her three-year-old will be next.
Her toddler Fizza has contracted the life-threatening disease for the second time in a month. The local hospital sent her home with some medicine, but her mother fears that it is too little, too late.
Fatima lives with her five children in a small mud house in Pakistan’s Sujawal district, with no toilet or running water. For them to get clean drinking water, the nearest source is a 30-minute walk away.
“In our village, there’s a lot of dirt and litter is everywhere. There are also many mosquitoes,” Fatima told CNA.
“What can we do? We’re poor and have to live here – where would we go? We don’t have the resources to settle in the city or take care of the kids there.”
Every family in the village, located in the nation’s southern Sindh province, has at least one child suffering from skin disease, diarrhoea, cholera, dysentery or malaria.
Much of this is a consequence of the devastating floods in 2022 that left a third of the country under water and impacted 33 million people. Many are still struggling to piece their lives back together two years on.
One of their biggest challenges is the continued and persistent spread of waterborne diseases, especially among children.
Cholera and dysentery are spread through contaminated water and food, while malaria is spread by infected mosquitoes which breed in stagnant water.
People have been demanding urgent action to combat the crisis, while health officials warn of a looming public health emergency in the months ahead if the situation does not improve.
The region where Fatima lives, along with areas in neighbouring Balochistan province, are among the hardest hit in Pakistan.
Both provinces reported the biggest rise in malaria cases after the floods. Such cases across the country surged from 400,000 in 2021 to more than 1.6 million in 2022, according to the World Health Organization.
In many parts of Sindh province, flood waters have not receded, and water supply and drainage systems have gone unrepaired. Severe monsoon rains in August this year once again flooded ponds, wells, rivers and bunds.
The community is now forced to use stagnant and contaminated water for cooking, bathing and drinking, leaving them at increased risk of suffering from recurring health problems.
Sujawal District health officer Muhammad Hanif Memon said that by improving hygiene conditions, diseases can be reduced by 15 per cent.
“If individuals and the government collaborate on this effort, even better results can be achieved,” he added.
“The water consumed by the prime minister, president, and chief minister, as well as by other stakeholders, should also be accessible as clean drinking water for the average citizen.”
A lack of toilets and basic sanitation has also worsened the problem, forcing villagers to defecate in the open.
According to UNICEF, 53,000 Pakistani children die annually from diarrhoea due to poor water supply and sanitation.
Sindh’s provincial government is trying to address the problem by working with local NGOs and UNICEF to install hand pumps and toilets. But it said more needs to be done, and has accused the international community of ignoring Pakistan’s plight.
“The international world should … help countries like Pakistan. We are a third-world country. We have to admit we don’t have that capacity,” said Sadia Javed, a member of the Sindh Provincial Assembly.
Nevertheless, observers said the Pakistani government’s approach to climate mitigation means the most vulnerable citizens often get overlooked.
“I think political will (and) priorities are not that high. From the climate change perspective, most of the people who have been suffering are poor,” said environmentalist Ejaz Ahmad from the Institute of Urbanism in Islamabad.
“They don’t have that kind of political strength, which can reach to that level where people get resources from the government.”
At the Institute of Maternal and Child Health in southern Sindh, only the most severe cases are admitted due to an overwhelming number of patients.
The hospital is currently treating about 300 to 400 patients, including 150 to 200 cases of malaria.
Dr Arshad Ali, who is on the frontlines of this battle, said a shortage of malaria medicine is impacting urgent care.
The assistant professor of paediatric medicine pointed out that primaquine – which is used to prevent and treat malaria – can sometimes run out as the government provides the medication, which means people cannot buy it from private pharmacies.
He also expressed worries that the hospital’s inability to treat every case is endangering the future of an entire generation.
“When hygiene and sanitation conditions are poor, especially after floods, the situation has become even more challenging,” he added.
“The situation was bad even before the floods, and we also have a population living in poverty.”