At least 139 children have died of waterborne disease in January 2016 in Pakistan’s impoverished desert district of Tharparkar, which has been devastated by drought since 2013. The Sindh provincial government’s response to the crisis has been insufficient to prevent widespread hunger and disease.
Four years into the crisis, farmers are still in need of seeds and fertiliser, according to preliminary data in an unpublished report being prepared by the Pakistan Food Security Cluster, which is led by the UN Food and Agricultural Organization and the World Food Program.
New irrigation systems also need to be built and old ones repaired.
People are suffering as harvests fail and livestock die.
Although 96 percent of households surveyed said they had received food assistance during the preceding two years, 90 percent said drought had adversely impacted their food consumption.
It can be safely concluded that food deprivation caused by the drought in the southeast is increasing and worsening malnutrition, especially among children, pregnant and lactating women.
In addition to lack of food, 68 percent of households surveyed in Tharparkar reported that they drew water from potentially unsafe sources, which exposes them to diarrhea that can cause malnutrition and vice-versa. The conditions “can be linked in a vicious cycle amongst children.
According to a 31 January report, at least 139 children died in Tharparkar in January. Alhasan Systems attributed the deaths to a combination of drought-related disease and poor access to healthcare. These are the children who die in hospitals. There could be other deaths occurring in small hamlets and villages which we know nothing about.
The survey carried out by the Food Security Cluster highlighted that access to healthcare is a major problem in the region. The average distance to health facilities in Tharparkar is 17 kilometres. Out of the nine districts surveyed in Sindh: Households in Tharparkar travel the longest distance on average to access healthcare services.
Even if a sick person makes it to a clinic, they may not receive adequate care. There are only 298 doctors in the district, which is home to more than 1.3 million people. while more than 215 village dispensaries that sell medication and sometimes provide minor healthcare are non-functional.
Short term relief efforts can only provide immediate benefits to the people whereas the drought is a regular occurrence in the region and its effects can only be countered through long term initiatives which focus on building and strengthening social institutions, providing alternative livelihoods, and strengthening of health, communication and education infrastructure.
The seasonal migration to the barrage areas during the wheat harvest season has traditionally provided livelihoods to thousands of Tharis during the drought season in the desert. The seasonal migration has stopped being beneficial to the communities from Thar because of increased farm mechanization which has made farming less labor intensive in the barrage areas. Resultantly, a smaller number of Tharis are provided with grazing lands, food and shelter by the landlords in the settled agriculture zone. Similarly, the families who do not migrate to the barrage areas are faced with a drought with insufficient quantities of food to feed their families.
The current crisis in the district is an outcome of poor administration and management by the district government. The health facilities in Tharparkar are under-staffed and do not have adequate supply of medicine and related equipment to deal with malnutrition and famine. In addition, there are severe communication issues between the government and the communities whereby the latter are deprived of access to the relevant authorities, even during emergency situations.
One of the major reasons behind recurrence of newborn deaths in Tharparkar is the failure of dispensaries and basic health units to provide adequate treatment to the ailing mothers and their babies, compelling them to rush to Mithi civil hospital, and thereby stretching its already scarce resources to the limit.
About 70 percent government dispensaries in the desert region are either partly functional or without having an ‘approved schedule of new establishments (SNEs)’.
In bureaucratic jargon, a government establishment or infrastructure without an SNE will have no budget, no staff, no furniture and other facilities necessary for running it, thus seriously crippling its capacity to function.
Such establishments are run often on ad hoc basis by sending there some staff posted somewhere else and arranging material enough to make it run.
In Tharparkar, 26 posts of doctors, 25 of them BS-19, are still lying vacant.
The arid region is again in the eyes of media because of newborns’ death which have risen to 13 to date, according to Tharparkar’s District Health Officer (DHO) Dr Arjun Kumar who attributed the deaths to birth asphyxia, underweight, premature labour, diarrhoea and pneumonia.
Tharparkar health facilities were under dual management of the People’s Primary Healthcare Initiative (PPHI) and the provincial health department.
The PPHI caters to needs of 21 per cent of Thar area through 49 facilities, 31 basic health units (BHUs) and 18 dispensaries, whose budgets are with PPHI, while the health department manages six rural health centres (RHCs), four taluka hospitals and Mithi civil hospital.
Thus, out of total 256 health facilities, 49 are under PPHI and 30 under the health department which makes 79 in all with approved SNEs. But, a staggering 177 facilities or 69 per cent of the total are yet to have SNEs for which health authorities offer various explanations.
Tharparkar has, in all, 207 dispensaries and 30 of them have approved SNEs for medicines, equipment and human resource.
Besides, 31 BHUs and 18 dispensaries are with PPHI with approved SNEs. Of the 177, 85 were established in 2015 whose staff has been appointed but their budget for medicine is yet to be allocated. 92 of the facilities under the health department were being run with medicines received in aid. These facilities are as a result not fully functional.
If the six RHCs, dispensaries and taluka hospitals been working satisfactorily, the entire burden of newborns would not have landed at Mithi civil hospital.
Secretary Health Saeed Ahmed Mangnejo gives a different explanation. He said that furniture of 85 dispensaries had been made available and staff — appointed in 2015 — would draw their first salary now whereas tenders for medicines supply would be floated soon. “It will take some time. I don’t have exact numbers but there are also some dispensaries which health department has opened on experimental basis,” he said.
Except for 85 new ones, he admitted, there could be a large number of such experimental dispensaries in Tharparkar. “The dispensaries and BHUs that the health department has handed over to PPHI are fully functional,” he said.
Most deaths of newborns, as confirmed by authorities right from health secretary to director general of health services and down to the DHO of Tharparkar, are reported at Mithi civil hospital.
In view of these figures, a safe assumption can be made that since dispensaries are not functional, the parents eventually rush to Mithi as a last resort.
Tharparkar has been a victim of official neglect for decades. Figures about doctors’ availability indicate that 64 doctors were appointed on contract basis in 2014 for two years in BS-17/18, who included chest specialists, paediatricians, anaesthetists, gynaecologists.
Unfortunately, doctors are unwilling to work in Thar because they cannot earn much from private practice there. That’s why the incompetent Sindh Government appointed 60 Thar-domiciled doctors on contract basis with comparatively lucrative salary package equivalent to their counterparts in BS-18.
He disclosed that the government had ensured that the 60 doctors had Thar address in their identity cards and submitted a bond in this regard as well.
Trend of babies’ deaths
About 350 deaths of newborns because of malnutrition were reported in Mithi hospital in 2015.
Perhaps, the PPHI has not taken the trouble to analyse whether the malnourished newborns were from the areas falling under the BHUs and dispensaries it managed as Mirpurkhas regional director Riaz Rahujo insisted that no death was reported last year or this year at any of PPHI’s facility.
DG of Sindh health services, Dr Hassan Murad Shah, said: “The situation is not that alarming. Sporadic cases of diarrhoea are reported. There is in fact no outbreak of diarrhoea. Infant mortality rate in Thar is lesser than other areas and mostly one day to three day old babies have died”.
He considered trend of early marriages amid lacking birth spacing as main culprit behind newborns’ deaths. “We deal with cases in which an underage woman is at lactating stage while having a two month pregnancy at the same time,” he said.
Potential Long Term Interventions
In order to help the community in Thar, one can undertake community mobilization efforts to develop Village Based Groups and their linkages between communities and government offices through. This will allow representatives from the vulnerable communities to voice their concerns to relevant government authorities.
Life based skill trainings can be provided to the people of area for their sustainable future. Skill development is the path for getting new skills, and has long term impact to transform the lives of marginalized sector of the society.
Child Friendly Centers can be established where the child can be provided education, skill trainings.
Awareness raising campaigns on the importance of breast feeding and provision of high nutrition value food to children can be undertaken. In this context, the awareness campaigns will rely on both indigenous and scientific knowledge to apprise the communities of the benefits of breastfeeding and its role in countering malnutrition among newborn children.
Indigenous social institutions like village level community groups can be established to provide village level leadership which can guide the residents to take proactive measures for food security during droughts. This may involve encouraging crop rotation, protection of grazing lands, and cultivation of indigenous crops for subsistence farming.
Potential Short Term Interventions
Health camps (with adequate medication and qualified practitioners) in the affected areas can be set-up.
Relief operations in the affected areas can be undertaken.
Famine of Facts
by Javed Jabbar
Reports in the media during the past few days about a virtual famine in Tharparkar, about a sharp increase in deaths, especially of children due to malnutrition or negligence, and about desperate outward migration of residents have caused justified widespread concern and prompted governmental, judicial, civil and military responses.
While conditions certainly deserve alleviation, the doom-like scenario misrepresents a substantial part of reality.
First: severe adversity affects parts of the population and the region, not the entire area and all residents. Tharparkar is spread over 22,000 square kilometres with a population of about 1.5 million residing in 2,300 villages and urban settlements. Divided into six talukas — Mithi, Islamkot, Chachro, Dihly, Diplo and Nagarparkar — the area often receives varying levels of rainfall or none at all.
The region derives its names from Thar and Parkar. The name Thar is from Thul, the general term for sand region or sand ridges and Parkar literary means “to cross over”.
The region was earlier known as Thar and Parkar, later it became one word. It was in 1843 when Sir Charles Napier became victor of Sindh and this part was merged into Katchh political agency in Hyderabad collectorate, later on in 1858 the entire area became part of Hyderabad. Subsequently, in 1860 it was renamed as “Eastern Sindh Frontier” with Umerkot as its headquarter, controlled by Political Superintendent. In 1882 it was renamed as district and its administrative head was Deputy Commissioner. Lastly in 1906 Head Quarter of the district was shifted from Umerkot to Mirpurkhas.
Until 1990 the present district of Tharparkar, Umerkot and Mirpurkhas comprised one separate district in 1990 i.e. Mirpurkhas and Thar established the town in Mithi as the new headquarter of Tharparkar district, while Umerkot was bifurcated on April 17, 1993.
There is no stream of fresh water in the region. However, in Nagarparkar there are two perennial springs, namely Anchlesar and Sardhro. as well as temporary streams called Bhatuyani River and Gordhro River which flow during the rainy season. There are some hilly tracks called Parkar.
The granite marble has been found there. “Karoonjhar Mountain” is near to Nagarparkar. There are no lakes, glaciers, plains in the district.
This district is mainly a desert area. The Thar Region forms part of the bigger desert of the same name that sprawl over a vast area of Pakistan and India from Cholistan to Nagarparkar in Pakistan and from south of Haryana down to Rajistan in India.
The area is mostly deserted and consists of barren tract of sand dunes covered with thorny bushes. The ridges are irregular and roughly paralleled that they often closed shattered valleys which they raise to a height to some 46 meters. When there is rain these valleys are moist enough admit cultivation and when not cultivated they yield luxuriant crops of rank grass. But the extra ordinary salinity of the subsoil land consequent shortage of portable water renders many tracks quite picturesque salt lakes which rarely a day up. The only hills are in Nagarparkar, on the Northern edge of the Runn of Kutchh belongs to quite a different geological series. It consist granite rocks, probably an outlying mass of the crystalline rocks of the Arravelli range. The arravelli series belongs to Archean system which constitutes the oldest rocks of earth crust. This is a small area quite different from the desert.
The tack is flat a level expect close to Nagarparkar itself. The principle range Karoonjhar is 19 km in length and attains a height of 305 m smaller hills rise in the east, which is covered with sars jungle and pasturage and gives rise to two springs named Anchlesar and Sardhro as well as temporary streams called Bhatyani and Gordhro after the rain.
The Thari people (over 1.5 million) depend mainly on rain-fed agriculture, which is often affected by drought, and on livestock rearing for their livelihood.
Mithi is Headquarter of Tharparkar district that exists in the north-east. Tharparkar district was part and portion of the old Tharparkar district, comprising of Mirpukhas and Sanghar Districts.
Before partition Mithi was sub division of old Tharparkar District with its’ headquarter at Mithi.
In 1992 it was separated as District Thar and then Tharparkar. The population of Tharparkar District according to 1998 census was 955,812, it is now administratively divided into 44 Union Councils and 5 Talukas namely Chachro, Diplo, Islamkot, Mithi and Nangarparkar.
Last year, Nagarparkar taluka received plentiful rain. Crops have been cultivated in over 336,000 acres and are adequate to sustain an average tehsil population of about 212,000.
Agricultural productivity in places like Kasbo can be so high that, currently, after meeting local needs, onions from Tharparkar are being trucked all the way to Gujranwala, Punjab. No case of starvation or even of severe malnutrition has been reported in the whole taluka, and even in some others.
There was scattered, uneven rainfall in the other five talukas. Several tens of thousands are definitely affected by farming water scarcity. But this is a recurrent, periodic feature of life.
People residing in small villages in the rural “baraari” parts cope by seasonal outward migration to the barrage-irrigated parts of Sindh to serve as farm labour.
At this very time, in the normal course, such migration begins: to harvest the imminently ripe wheat crop in the weeks ahead. Thus, ongoing migration is not necessarily linked to suddenly impactful drought.
Second: apart from farming, livestock-related income is a major source of livelihood. Of about six million animals comprising cattle, sheep, camels, goats, about half a million sheep are estimated to be victims of sheep pox or other ailments.
Blanket vaccination of all animals is the best protection against fatal epidemics.
But with only 11 veterinary doctors on duty out of a sanctioned number of only 17 posts and other paucity of resources in the 135 vet units across a large region, comprehensive vaccination was not conducted in 2013, causing loss of some, but not the majority of the livestock population which continues to support the human population.
Third: the livelihoods of a large number of residents come from shop retailing, small- and medium-scale trade, construction, transport, several services, and employment in the government and non-governmental sectors.
Thus, all are not dependent entirely on rain-based crops or livestock-related incomes, though drought does impact in some ways on other spheres.
Fourth: negligence, apathy, corruption, avoidable shortages and poor governance are far bigger ‘killers’ than drought and famine. In cases of a sharp increase in infant and child mortality in the Mithi Civil Hospital, all or some of the above appear to be the main causes. Prompt diagnosis in the recurring morbidity pattern such as of diarrhoea, malnutrition, under-nourishment (as distinct from outright starvation), pneumonia, etc; quick referral to specialists, and sustained treatment with both drug and non-drug therapies could swiftly contain and reduce mortalities.
The inadequacy dimension is typified by the fact that in the Nagarparkar taluka hospital, out of the 32 sanctioned posts for doctors, only four are presently staffed. Non-governmental health centres strive to redress such gross imbalances.
Of the total of 139 governmental health units in Tharparkar, 31 BHUs and 102 dispensaries administered by the stricter-accountability measures of the PPHI intervention will hopefully also correct deficiencies elsewhere, albeit on a limited scale.
Fifth: post-2000, the awkward, inconvenient truth is that, particularly during the regime of retired General Pervez Musharraf and former chief minister Arbab Ghulam Rahim, the physical infrastructure of Tharparkar reached an unprecedented level of progress.
Where, for example, in previous times, only about two kilometres of metalled road was built in a whole year, roads of the same length and more were built every month, and in even less time, for several years.
Grid electricity to main towns, water pipelines to large settlements, preparatory infrastructure for exploitation of coal reserves including work by the post-2008 PPP government, rapid proliferation of telecommunication and mobile phones have vastly enhanced mobility, access and information flow.
This transformative change remains ignored by the media which prefer stereotypical bad news.
Sixth: there is a need for immediate relief for large numbers in some parts. But the priorities should be the efficiency, integrity and quality of relief delivery, rather than quantum alone.
In the list of probable causes for the alarming incidence of baby-deaths, three of the most potent causes arise directly from maternal health. These are: Malnutrition. Too-early marriage e.g. before 18 years of age. Too-frequent pregnancies.
I met Gulaba, seated on the verandah of the infants ward, wife of Dodo Bheel from Goth Chahchaar, near Nafeesnagar, Umerkot. She said she had never been to school and thought she was about 21 years old. She had already given birth to 5 children, 3 of whom had died at, or soon after birth. The fifth child born 5 days ago was suffering convulsions and was in an incubator. As per custom, the baby would be named only after 9 days have passed. Gulaba herself is one of 4 brothers and 4 sisters. Seated nearby on a bench was Sita, wife of Jumman Bheel from Goth Pario near Islamkot. She had studied up to Class V but said she had long forgotten how to write. Her husband dropped out after Class I. Fortunately, after the births of three children, all by caesarian section, with spousal consent she has had tubal ligation to prevent further pregnancies. They were waiting for their most recent born to recover from jaundice.
I also saw, for the first time, a baby with a birth-weight of only 600 gms., whose size would barely fill two palms. Born prematurely to Hussain Nabi’s wife whose profuse bleeding led to premature delivery, this miniature gem of humanity was given zero chance for survival.
One empathizes with the present Government of Sindh as it faces the onslaught of unrelenting, non-contextualized media reportage and Opposition criticism. After all, there are 23 other districts of Sindh, in some of which infant and maternal mortality rates are probably higher than Tharparkar.
For example: general health indicators including the mortality rates for children under five years and for mothers in Kashmore, Kamber Shahdadkot, Shikarpur , Larkana in Upper Sindh are most likely to be higher than in drought-affected Tharparkar.
While the Provincial Government is making efforts to improve health facilities in Tharparkar, little independent recognition is being afforded to such actions by media and other sectors. Unfortunately, in overall terms the infant mortality rate in Sindh for 2014 was probably about 80 to 82 per 1000 live births (whereas it had gone down about five years ago to 74) to bring Sindh back to the same level where it was about 25 years ago in 1991.
Punjab is reported to have improved from 88 per 1000 live births to 76 in 2014. Khyber Pukhtoonkhwa is said to have the lowest at 58 while Balochistan is the worst at 97 per 1000 live births.
Even though there are more incubators (13) at Mithi Civil Hospital than there reportedly are at the Liaquat Medical University Hospital in Jamshoro (only 5) there are 6 functional ambulances and three 100 kw generators to provide mobility and power round-the-clock at Mithi. Despite the availability of four paediatricians and three gynaecologists, several posts remain unfilled e.g. ENT specialist, Radiologist, Orthopaedic Surgeon, Urologist, Pathologist, Physician, Medico Legal Officer, Casualty Medical Officer etc. apart from lack of enough qualified female nurses.
One major reason for the shortage of specialized health-care personnel may be the anomaly that the special hardship allowance for a doctor posted to Mithi or elsewhere in Tharparkar is only Rs 200 per month. Whereas there should be at least one, if not two more zeroes in that figure! Most doctors have families with children studying in schools in other cities in Sindh who cannot be transferred to schools in Mithi and have their studies disrupted. Most such doctors have to maintain two households, one in Tharparkar and one in the other part of Sindh, thus justifying the need for a far larger hardship allowance.
While hospital “care and cure” quality, water scarcity, impurity, infection, and physical infrastructure aspects such as distances, cost of road transport etc. are relevant to assess the current situation, the irreducible core factor is the status of the average poor village woman of Tharparkar. “Poor” is as operative as “woman”. One neither saw nor heard of any woman from a middle-income or upper-income family – and there are several thousand such families in the region – suffer the loss of an infant in the on-going phase.
Despite decades of effort and investment, meagre or substantial, sporadic or sustained, by Government or by NGOs working on a smaller scale, despite some notable gains in girls’ education and some other indicators, the harsh reality is that today in 2016 there remain several thousands of poor village women steeped in pervasive poverty.
And more than economic poverty alone. The poverty of illiteracy, poverty of social justice, poverty of non-enforcement of legal rights, poverty of oppressive customs and practices which continue in the name of tradition, honour and faith. If we collectively want to save babies from their premature return to Heaven , we have to first rescue poverty-stricken mothers from their living Hell on earth .
Corrupt practices in relief delivery often provide more benefits to the few rather than succour for the many. Several non-governmental organisations, with their limited resources, contribute to the relief work.
Without reducing the urgency of alleviating current suffering, the far more vital subjects requiring purposeful action by legislators, public office-holders and officials is non-partisan accountability and improved governance.
The media too need to curtail their sensationalist, under-researched outpourings while remaining vigilant. The candid self-criticism of Sindh’s chief minister is a helpful step forward.
by Nida Paras
So this is now the latest challenge for the impoverished Pakistanis: famine; like the conditions faced in the desert area of Tharparker, in Sindh province. After killing the live stock, birds and animals (peacocks, cows, sheep, parrots, deer, camels and goats) of these people this ghost has turned its evil eye towards Thari people and has claimed the lives of 40 children within two months.
Drought in the desert remote areas of Pakistan is natural but the death of people is not. It is due to lack of facilities and irresponsibility of people who are appointed to selected posts that have engulfed the lives of 121 innocent people within the few months. The number can be even more than this as these people are trying to hide the actual figures as the irresponsibility of the elected leaders has made the situation worst in Thar. They are now giving lame excuses and statements in order to escape responsibility from their criminal acts. According to a report to the media by the chief minister who is a feudal lord of Sindh Province the ratio of higher deaths is common and it is due to disease, it is not only because of drought or malnutrition.
However, it we examine the situation many questions will arise, if the deaths are not because of malnutrition then what to the weak bodies of children reflect? If, indeed, the deaths are due to disease then why there were not enough facilities available for the victims to save their lives. On the other side the Commissioner of Mirpurkhas Sindh reported that they had not distributed 60,000 bags of wheat among the Thari people who are living in remote areas because of lack of money for transport.
What a shameful statement to make! In a country where millions of rupees are spent on mega festivals arranged by the ruling party and the leaders go on official tours to other countries they openly admit that they have no money to transport vitally needed food rations.
When the elections were approaching these leaders visited the poor people, begged for the votes and made promises for their welfare but when they are elected they have nothing to do with the people, their problems or their welfare.
Thar is famous because of its beauty in the rainy season and reserves of coal. However, the people living off the lack basic life facilities. They have broken roads, few reserves of clean water, shortage of food, schools and the hospitals in poor conditions, lacking in doctors, staff, nurses, medicines, beds, and machinery and so on.
Around 175,000 families have migrated from the remote areas of Thar to other areas of Sindh for their survival. But according to our leaders that migration to other areas of Sindh is also common. If, indeed, everything is ‘common’ for our leaders then why are they needed at their jobs?
The drought did not just happen suddenly. These people have been facing such difficulties for months. According to the Thari people they are migrating from their parental homes to barrages in order to save the lives of their poor families. They mostly depend on the live stock which is already too weak and unable to move with them to other places and cover the distance. The weak bodies of their wives are unable to feed their children because of which their children are dying due to different diseases.
Since independence these people have been living in difficulty. Regardless of the climate changes the government has not taken enough measures to save their lives. It is only now when the situation has become so severe that the government announced aid for them.
It is our humble request to our political leaders to please create a solid strategy to save the lives of these poor people. Attention must be paid to saving their livelihoods on which their lives depend. These policies should be on a long term basis, not for temporary relief. Instead of spending huge budgets on cultural events and unnecessary official tours invest money on the basic needs of these people in order to save their lives and solve their problems. If proper steps are not taken then the time is not far off when other feudal lords or leaders will celebrate their festivals on the ruins of thar and too late they will remember the rich culture of Thari people.
A total of 193 deaths of children have been reported from the Thar district over the last three months. Though the governmental authorities are trying to attribute these deaths to different ailments, there is strong evidence that hunger, chronic shortage of water, extreme poverty and lack of health facilities are the real reason behind them. The situation is so grim that the Chief Minister of Sindh had to concede that 60 children have in fact died in the area during past two months but blamed the deaths on cold and mother-child health conditions. He also ordered the release of 60,000 bags of wheat (each of 100 kilo grams) from the official store for immediate distribution but asserted that the children did not perish to the famine conditions prevailing in the area. He has also declared a 200,000 Pakistani rupees (USD 1960) compensation for the bereaved families. It must be noted that until now only 2,000 bags of wheat have been distributed as against those totally released.
Even if one takes that claim on face value, the government cannot absolve itself of its criminal dereliction of duty as it has not invested in building health facilities in the area. The situation of health services is so dismal that there is just one specialty 74 bed hospital catering to a population of more than 1.5 million. The famine and consequent hunger have definitely caused serious health issues in children like iron deficiency and other serious deficiencies related with malnutrition. The lack of medical facilities coupled with drought conditions going on for years in the area has resulted in ill health of mothers, thereby making them vulnerable to bear under nourished children. The lack of serious action by the government over the issue can be understood from the fact that half of the posts of doctors are lying vacant for years and barring the hospital in Mithi no hospital has a lady doctor. Most of the victims belong to the Dalit community of minority Hindu religion and it is believed that governmental apathy and inaction emanates from the institutionalized persecution of religious minorities in Pakistan.
It is not that the government was not aware of the grim situation as it has been building up for years of drought with 2013 itself receiving less than 100 millimetre of rainfall as against a minimum of 300 to avert drought conditions. Further, the authorities have violated the clear policy of declaring an emergency if the rainfall is acutely short of expected by August end but such declaration was never made this season.
Local and national media have also been raising the issue relentlessly as the area does not has any irrigation system and is completely dependent upon rain water for everything from drinking water to irrigation. Still the government had failed to recognise the severity of the issue and put preventive measures in place taking advantage of the bumper wheat production last year in the rest of Pakistan. The authorities woke up only after foreign media started raising the issue of rising death toll and started taking cosmetic measures like punishing the superintendent of Mithi hospital instead of addressing the real issues causing the crisis.
The inefficient handling of the situation has led to the Army being pressed into service but this is a measure too little and too late. Worse even, most of the relief work is centered around Mithi, district headquarters, while there is no decline in the number of deaths in the countryside. There are no significant attempts of making the relief material reach those in distress in far flung areas of this huge district. Forget relief, no statistical data is being collected by the authorities thus denying those affected from any claim on the relief.
The Sindh government woke up after a media outburst when people started going down like ninepins and more than 150 children succumbed to inexorable morbidity. Although mainstream media emphatically used terms like drought, famine and disaster interchangeably without any recourse to lexicology of technical definitions; it was certainly an appalling human catastrophe. Irrespective of its definition, the intensity is undeniably horrific.
Sprawled over 22,000 sq. kms, Thar desert is a mosaic of miseries. With merely one-tenth under canal command, the landscape is dominated by perennially thirsty sand dunes. Tharparkar is a district in Thar desert with a total area of 10,638 square kilometer. The area is characterised by arid climate, sparse vegetation and recalcitrant poverty. Rainfall is scant, water table is too deep to pull buckets through human effort and require camels to haul water. Rain-fed agriculture is the major source of livelihood.
A population of over 1.3 million possesses five million cattle heads, to sustain their dietary needs and a frugal household economy. In other words, below-normal rainfall can spark an imminent drought, which can culminate into a nutritional hemorrhage potentially leading to a cataclysm if not confronted at early stage.
Drought is a pernicious disaster. However, even a cursory observation of rainfall pattern can help determine the ominous situation brewing up ahead. The current situation in Thar could easily have been forecasted and forestalled with little diligence.
According to Pakistan Metrological Department, monsoon rainfall between the months of June and September is the main source of water for Tharparkar region in which 87 per cent of annual rainfall is observed. During monsoon 2013, Tharparkar region received 30 per cent less than normal rainfall. Local variations ranged from only 6 per cent deficit in Chhor to 54 per cent less in Mitthi. From March 2013 to February 2014, a significant 31 per cent less rainfall was recorded in Mithi, which received 189 mm of rainfall against normal of 277.2 mm. Alarmingly, no significant rainfall has been recorded in Tharparkar district since November 2013.
This deficit of rainfall caused depletion of water table and localised loss of crops and fodder. It gripped a large part of Thar in drought and resulted in proliferation of morbidity and mortality among livestock, which in turn deprived women and children of their only source of nutrition i.e. dairy products.
It is outrageous that the wheat dispatched by the provincial government in September last year remained dumped in warehouses to stale and could not be distributed. The government’s blithe excuse of unavailability of transport budget is a hilarious explanation. It indicates the magnitude of an unfathomable apathy and an unpardonable negligence on part of indolent government functionaries.
Relatively harsh winter aggravated the situation particularly for malnourished lactating mothers and infants. Their immunity plummeted due to lack of nutrition and disabled them to sustain hunger and cold wave. When scores of children started pouring into the hospital of Mithi, it lacked adequate staff, medicine, beds and other facilities to withstand this deluge of patients. Most of the deaths reported from Mithi are caused by lack of proper medical facilities.
Tharparkar is a badly neglected district. According to an official document Development Statistics of Sindh 2010, the district has only three civil/taluka hospitals with 124 beds and 32 Basic Health Units with only 68 beds. The district has only 139 doctors (i.e. one doctor approx per 10,000 people) and 8 LHVs/Technicians. Local communities claim that many of these doctors do not attend their duties. Due to abject poverty and long distances, clutches of death often reach before a health facility.
Impoverished local communities in a cash-strapped local economy lose all their means and resort to migrate to barrage areas called “Sindh” in parlance of arid zones of the province. Apart from food scarcity, skyrocketing prices of commodities break their backbones.
According to a study “Food Price Crisis in District Tharparkar” conducted a few years ago by Thardeep, a local non-governmental organisation, prices soar beyond the reach of poor communities. The study reveals that prices of wheat, rice, pulses and vegetables respectively increased by 90 per cent 160 per cent, 90 per cent, and 80 per cent in just one year. In such a situation, only a proper intervention by the government can fetch some succor to emaciated communities.
Because of a variety of deprivations, Tharparkar lags behind in key indicators of human development. A recently released official document “Millennium Development Goals Report-2013” provides district-level ranking on various human development indicators. According to the report, Tharparkar was ranked as second last in fully immunised children among 23 districts of the province where only 45.9 per cent children were immunised. Similarly, the district was on 20th number out of 23 districts on immunisation of children against Measles, which shows only 61.7 per cent coverage.
The district had 6th highest number of under five-year children who suffered from diarrhea. Only 13.6 per cent births are attended by skilled birth-attendants placing the district in bottom within the province. The gap can be compared with 87.8 in Karachi ranked at the top. Concomitant to that just 44.6 per cent pregnant women received antenatal care consultation ranking it as 5th lowest in Sindh.
Another report Multiple Indicator Cluster Survey 2003-04 also revealed that only 31 per cent deliveries are managed through institutions in Tharparkar compared to 73 per cent in Karachi. Similarly, infant mortality rate in the district was 87 out of 1000 live births, higher than the national average of 74.
According to the MGD-2013 report, the district was the last on access to improved sources of dirking water and sanitation with only 17.2 and 7 per cent coverage. Regrettably, government officials and ministers inaptly scrambled to justify infant mortality by comparing it with previous years’ mortality toll. The figures of the yester years were equally abominable and should have been a source of consternation rather than a justification.
A mission of UN agencies recently released a report, which provides useful insight to understand the reasons behind this tragic situation. The report mentions that more than 64 per cent deaths occurred in the neonatal phase and 60 per cent of the children admitted at District Head Quarter hospital were malnourished (54 per cent moderate & 9 per cent severe malnutrition). According to the report, there are inadequate mother and child health services due to non-availability of female health staff. Whereas insufficient human resource and limited budget for medicines makes it difficult for the existing system to work and deliver efficiently. The report also highlighted that difficult terrain and poor infrastructure makes it difficult for the people to access health facilities.
All these factors snowball into a crisis that takes its toll with all cruelty at its disposal. Poverty, lack of infrastructure, dearth of social services and administrative inefficiency collude to unleash havoc for Tharris.
An accumulated development deficit and administrative negligence have brought torment for local people and ignominy for the government. A tad of political commitment and administrative efficiency could have averted the catastrophe at early stage.
Pulsating with frequenting VIPs, Tharparkar is in limelight these days but not for a reason to celebrate. An exasperating callousness was demonstrated by serving sumptuous buffet for the Sindh chief minister and his coterie. This is a glaring example of poor governance in Sindh, where ubiquitous cronyism has nurtured a meritless administrative web. A listless and lethargic bureaucracy rules the province, which is coddled by ruling elite. An unholy alliance of rapacious politicians and a wicked bureaucracy is ruining Sindh. A land bestowed with plethora of natural resources and a glorious history has been turned into a hell for its residents. While the chief minister of Sindh has sheepishly admitted the remiss on part of his government, discourse should veer towards sustainable solution. Flurry of accusations and condemnations fully justified though, will not serve the purpose alone.
The recent experience had highlighted some urgent actions. Some of these needs include effective mechanism to monitor rainfall pattern and concomitant relief supplies of staple and fodder, a functioning network of health services, potable water supply schemes for communities, extending road network to enable communities to reach emergency facilities in shortest possible time and special nutritional supplies for pregnant women, lactating mothers and infants. Thar needs a long term sustainable solution and not just a momentary relief operation.
Thar Disaster: A Goldmine for NGOs
Tharparkar, with a population of just 1.5 million people, has been hit hard by droughts every two or three years. Since 1967, there have been 14 droughts in the Thar area. The first one was in 1968, then in 1978, 1985, 1986, 1987, 1995, 1996, 1999, 2001, 2004, 2005, 2007 and as recently as 2014.
This year around, most of the deaths were reported from Diplo, Mithi, Nagarparkar and Chahro tehsils of Tharparkar district. Thar has been hit by a rainfall deficit of roughly 30 percent between March 2013 and February 2014, according to government data. The worst-hit towns of Diplo, Chachro and Islamkot were barely touched by a drop of water for months.
According to the Pakistan National Nutrition Survey, the food insecurity and prevalence of malnutrition in Sindh was higher compared to that in the other provinces. The survey estimated stunting prevalence in children under the age of five in Sindh at 49.8 percent, anemia levels at 72.5 percent, while 40.5 percent children were underweight; anemia in pregnant and lactating women was estimated at 60.7 percent.
Tragedies in Thar – like the one unfolding in the Sindh desert area just now – have gone on to uncover the real face of NGOs.
These NGOs, instead of acting as saviors of deprived people truly act as Draculas, sucking the blood of these poor people. These NGOs actually profit from the human disasters, hoarding food items, medicines and other relief goods.
The NGOs ask people in major cities for donating cash, food items and medical supplies, but it is surprising how little of all this material reaches the people for whom they collected it.
The NGOs are not working for development but printing and telecasting advertisements highlighting their business and political interests.
Influential leaders of these organizations term themselves “development workers”. How one can be a “development worker” without allowing the local people to participate and how can one even know or define their problems without being on the ground where the tragedy is happening?
These so-called NGO leaders, instead of going to the poor people in the calamity-hit area, prefer to sit luxuriously in air-conditioned offices and roam around in huge cars and SUVs.
Leaders of the NGOs can only think about promoting their own businesses and how to best exploit everyone – people and the government and foreign donors – all in the name of development. Many political leaders visit the Thar area to see NGOs actually working but in reality, they just go there to take some photographs along with the poor people to show their party office-bearers and government functionaries. This encourages for those NGO to work whatever they want and those political leaders can support them.
People in Thar are vulnerable and have no alternative for development but these NGOs should focus on the welfare of the Thari people, instead of just filling their own bellies. It should be remembered that the aims of these NGO call for facilitating rural communities, empowering them to secure their rights, commanding their local resources and engendering capabilities to manage the process of sustainable development. Everyone concerned should keep this objective in mind all the time, instead of focusing on profit-oriented businesses being run by NGOs in Thar.
Thari people linked the crisis to long-term failures to provide a proper healthcare system and infrastructure in the region. They insist that they just need roads, water pipelines and electricity to lead their lives in peace. But the remoteness of this vast area makes it almost impossible to lay pipelines or build roads in this sensitive border area. Other real problems being faced by the people of the area include poverty, shortage of food and basic health units, and above all else, the lack of female doctors. Hence, the worst affected by the recurrent droughts are children and pregnant mothers.
Malnutrition Stalks Pakistan’s Desert Regions
Pastoralists and others in Pakistan’s desert regions of Cholistan in the southern Punjab and Tharparkar in Sindh are facing a grave crisis: Their livestock are dying, their children are malnourished, and when families move to less drought-affected areas they often get a hostile reception.
Aid workers say the drought is widespread, and large-scale help is required. This is the worst drought we have encountered since 1998.
201 deaths were reported in Tharparkar from 1 December 2013 to 28 March 2014 of which 51 were men, 34 women and 116 children. He said rather than starvation, sickness was the main cause of these deaths.
Starvation is not usually a direct cause of death in severe drought situations. But children who are severely malnourished, such as those coming into Tharparkar hospitals, fall sick faster and fail to recover, unlike healthy children.
Drinking contaminated water as supplies ran short also contributed to disease, he said, with water often shared by animals and humans.
The World Food Programme says the drought has added to the malnutrition crisis in Tharparkar District. To help combat it, the organization is increasing its ongoing nutrition support to cover the entire district, in order to cater to the immediate needs of the children and pregnant and lactating women.
The request for support had come from the health and nutrition departments of Sindh. Over 18,000 children with moderate or acute malnutrition and nearly 16,000 malnourished pregnant and lactating women in all union councils of Tharparkar will benefit from the nutrition program.
As a result of the drought in Cholistan, more than 90 percent of the 1,100 ponds and 155 underground storage tanks in the region, spread over 26,300 square kilometres, had gone dry. As a result almost 90 percent of people had left their homes and almost every family had been affected. Cholistan has an estimated population of 190,000.
Government Partly To Blame?
The drought is one of the worst we have faced in a long time – probably since at least 2002. The situation could have been “handled better” by the authorities, but he said the issues were now being managed by the Sindh government with committees set up to oversee relief efforts.
The Supreme Court has accused the Sindh provincial government of failing to truthfully report the facts [ http://www.thenews.com.pk/Todays-News-13-29236-Sindh-govt-report-an-attempt-to-hoodwink-court-SC ] and the chief minister of the province has admitted major administrative flaws, [ http://tribune.com.pk/story/680221/tharparkar-tragedy-negligence-pneumonia-and-malnutrition-main-causes-of-deaths/ ] notably the failure last December to distribute 60,000 bags of wheat flour allocated for the region, which remained in warehouses reportedly because payments were not made to transporters.
The Sindh High Court has also noted that the failure to fill 271 posts for doctors at government hospitals [ http://www.thenews.com.pk/Todays-News-4-239091-281-posts-of-medical-officers-vacant-in ] in Umerkot, one of the towns serving Thar, contributed to inadequate health care for sick people, especially children.
The media is citing 221 deaths since January this year, based on hospital data. But these deaths began in October, and the figure is higher. There had been “no significant change” in the situation since relief efforts began, mainly because the government is distributing wheat flour, but not “food required by infants, pregnant and lactating mothers, such as milk.” The lack of dietary balance meant the malnutrition crisis was continuing.
According to the Sindh Relief Department’s official data, this is the first drought in Thar since 1999 when there was starvation or near-starvation.
Displacement – Without Animals
Livestock is closely related to human life in Thar. Because pregnant and lactating mothers depended essentially for their food needs on milk and milk products obtained from their animals, the death of cattle and sheep contributed to acute malnutrition among them and consequently their young children.
The current crisis in Thar and adjoining desert areas is actually a result of gross mismanagement and criminal negligence on part of administration. The failure to distribute wheat and medicines in time and the lack of medical staff and services resulted in alarmingly high infant mortality.
Government hospitals are now turning away pregnant mothers and newborns, because very young children make up the largest group of the dead, and they do not want this figure to rise. This would happen if newborns died in hospitals and deaths had to be officially recorded.
The current crisis could have been averted by a careful monitoring of rainfall data in 2013 which could have raised alarm of a drought. That it was not, is the real tragedy.
In Cholistan, over 100,000 people living around dried out ponds have moved, mainly to towns and cities, according to Yousuf of the Al Sadiq Desert Welfare Organization. The displaced are vulnerable because of their loss of livelihoods and security.
In Bhawalpur, it just feels so unsafe. We do not know anyone around. People are hostile to us and I cannot find work. All my sheep died so we have nothing to live on.
Nearly 200,000 cattle have died in Cholistan. The figure for Tharparkar is unclear, with 42,000 sheep [ http://www.thardeep.org/thardeep/ckfinder/uploads/Situation%20Report%20(21%20March%202014).pdf ] have died mainly due to disease.
Tune in to any Sindhi TV channel and death toll in Thar with heart-rending footage marks every hourly bulletin.
The piling dead bodies were initially ascribed to a drought and famine that prompted sympathetic responses. The tragedy was considered as an isolated incident of the wrath of the nature, triggered by scant rainfall and an ensuing drought.
Many still consider Thar as a remote inaccessible territory. However, the reality on ground has drastically altered during recent years. The bewitching reservoir of Thar coal has converted Thar into a favorite destination of investors and officials. Metalled roads snake through the parched land, connecting major towns and randomly sprawled hamlets. The social fabric is going through a rapid jolt, leaving the local communities disarrayed.
Awaiting promised prosperity, the people of Thar are witnessing an unprecedented rise of religious outfits, frequent congregations of the faithful, sprawling seminaries and mosques. This social upheaval is eclipsing the once-cherished communal harmony that dominated the social landscape of Thar where faith never became a fault line.
An insidious shift in demography is another perilous phenomenon which is yet to unfold fully. Physical and digital connectivity of the area has extricated it from forlorn isolation, and distance is no more a pardonable excuse to justify unrelenting deaths.
In short, the socio-cultural and economic setting of Thar is going through a phenomenal shift that merits separate comprehensive research. The state and government exist with full tentacles in Thar and it is no more a desolate nature-dependent territory. In this context, the tormenting situation in Thar ought to be understood with a fresh approach.
Bad governance and pervasive administrative lapses multiply the impact of a natural shock not alien to the area otherwise.
Three recent reports unveiled a complex blend of administrative, social and political dimensions of this human tragedy.
On the recommendation of Sindh High Court, the Sindh chief minister constituted a four-member commission to probe the Thar drought issue. Excerpts of a yet-to-be made public report provide an insight to the human-induced disaster.
The commission observed that there was a lack of coordination among the government’s departments for carrying out relief activities during drought. It also found huge coordination lapses among Town Municipal Administrations (TMAs), special initiative department, NGOs and public health departments. It also found that departments like social welfare, agriculture, environment, forest, population welfare, transport and tourism were underperforming.
The commission recommended setting up a provincial monitoring team having the representation of departments including health, food, livestock, irrigation and meteorology to report to the chief minister after every quarter. The drought commission called for preparing a comprehensive nutrition and drought policy and the related sectoral planning for issues ranging from poverty to education. The commission also found that local population had been excluded from reaping the fruits of development schemes, and urged the government to provide employment to the local population while excavating coal reserves.
Identifying an important administrative lapse, the report revealed that 309 posts of specialists, medical officers and others of BPS-17 to BPA-19 were lying vacant. The commission in its report stated that there were 14 ambulances in the entire district, out of which six were being used by the Mithi Civil Hospital. There is shortage of doctors in the hospitals in Thar. The commission also observed that doctors with domiciles of Thar were not willing to serve in the area and recommended the implementation of the Essential Services Act in letter and spirit.
Similar observations were echoed by the Chairman National Commission for Human Rights, Justice (Retd) Ali Nawaz Chohan. Presenting his report on Thar calamity, he lamented that the government of Sindh and its departments of health, education and local administration were responsible for the Thar tragedy.
Recently, appalling details were presented before the National Assembly Standing Committee on Human Rights. Members of the committee were told that 828 children had died in Thar over the past three years. Briefing the members of the committee, Fazila Aliani, a member of the committee from Balochistan, blamed corruption and lack of political will for the mounting deaths of children in Thar. Aliani further shared that the government decided to install 700 plants of reverse osmosis (water purification) but only 432 were installed and a number of them have become out of order.
The Senate’s committee was astounded while hearing from the Sindh government’s representative that the provincial government has spent more than 10 billion rupees during the last three years on public welfare. The situation on ground is different and one can hardly trace a fraction of the spending.
These reports show the political and administrative collapse in Thar that has intensified the impact of a natural calamity. A chronic deficit of human development and administrative neglect by successive governments has culminated in total chaos.
Droughts are not new to Thar. The Sindh Relief Department’s official data reveals that Thar witnessed five severe droughts, eight moderate and 11 mild droughts since 1965. Each time a fleeting response to the situation allowed it to perpetuate since the root causes were never addressed. Every drought was treated as an isolated episode and an integrated long term remedy was never contemplated. Free distribution of wheat was used as a magic wand to end the miseries of Tharis.
Seasonal migration has become an annual feature for the Thari community due to famine. The socio-economic indicators of Thar narrate the accumulated development deficit of the area.
An official document “Millennium Development Goals Report-2013” ranked Tharparkar as the second last in fully immunised children among the 23 districts of the province where 56 percent children did not receive any immunisation doze. Similarly, the district was 20th out of the 23 districts on immunisation of children against measles, which shows only 61.7 per cent coverage. The district had 6th highest number of under five-year children who suffer from diarrhea. Only 13.6 per cent births were attended by skilled birth-attendants placing the district in the bottom within the province. Concomitant to that just 44.6 per cent pregnant women received antenatal care consultation.
The district is the last on access to improved sources of drinking water and sanitation with only 17.2 and 7 per cent coverage.
The government of Sindh has shown little seriousness in addressing the root causes. Laying reverse-osmosis water treatment plants is being obsessively pursued. The idea was not bad had it been done with proper homework and due diligence. Plagued with customary malpractices, the project is set to become another scam marked with embezzlements and nepotism.
Thar does not need ephemeral charitable solutions it needs a well-meditated multi-sectoral long term strategy. One such promising project is extending Raini canal to Thar. The canal with the design discharge of 10,000 cusecs is currently under construction. The project has a design provision of an off-taking Thar canal with a capacity of 5000 cusecs.
The Sindh government has been spending billions of rupees on the lining of selected reaches of canals for inexplicable reasons. This amount can be diverted for betterment of millions of hapless communities of Thar. An immediate construction of Thar Canal can bring dramatic changes in the lives of Tharis.