A culture of prevention is not built overnight, but it begins with changing attitudes and priorities

Ali Nawaz Rahimoo

The old saying, “Prevention is better than cure,” has never been more relevant for Pakistan. Every year, the country spends enormous resources responding to outbreaks, treating illnesses, and managing health emergencies that could have been prevented through timely interventions, public awareness, and stronger healthcare systems. Yet, prevention often receives far less attention than treatment. As a result, Pakistan repeatedly finds itself reacting to crises rather than preparing for them.

The irrational use of medicines, poor adherence to hygiene and precautionary practices, shortages of essential healthcare supplies, and the absence of effective proactive measures continue to worsen the impact of diseases and epidemics. Time and again, the country responds only after outbreaks have spread widely, exposing weaknesses in preparedness and public health awareness.

However, disease prevention is not only about controlling dengue, chikungunya, or COVID-19. It must become the foundation of Pakistan’s healthcare approach. Infectious diseases, vaccine-preventable illnesses, waterborne infections, and even non-communicable diseases can be significantly reduced through preventive measures.

Pakistan remains among the countries with the highest burden of tuberculosis (TB) in the world. According to the World Health Organization (WHO), the country reports more than 600,000 new TB cases every year. TB is both preventable and curable, yet delayed diagnosis, poor treatment adherence, overcrowded living conditions, malnutrition, and stigma continue to fuel its transmission. The emergence of drug-resistant TB, largely due to incomplete or irrational use of anti-TB medicines, has created another major challenge. Early diagnosis, completion of prescribed treatment, adequate nutrition, and public education can prevent thousands of avoidable deaths.

Similarly, HIV/AIDS continues to emerge as a growing public health concern. Pakistan has witnessed a steady increase in HIV infections during recent years, with more than 300,000 people estimated to be living with HIV. Unfortunately, many remain unaware of their infection status due to limited testing and social stigma. Prevention through awareness campaigns, safe blood transfusion practices, screening of blood products, the use of sterile syringes, and harm-reduction programs for people who inject drugs is essential. Communities must also address the stigma surrounding HIV so that people seek testing and treatment without fear or discrimination.

Vaccination remains one of the most successful and cost-effective preventive interventions in human history. Yet, Pakistan continues to face outbreaks of measles due to gaps in immunization coverage. Hundreds of children fall ill every year from diseases that vaccines can prevent. Likewise, Pakistan remains one of the few countries where poliovirus transmission has not been completely interrupted. Continued support for routine immunization services, community engagement, and trust-building efforts is critical to protecting future generations from vaccine-preventable diseases.

Waterborne diseases also impose a heavy burden on the healthcare system. Typhoid fever, hepatitis A, hepatitis E, cholera, and acute diarrheal diseases continue to affect vulnerable populations, particularly in communities lacking access to clean drinking water and adequate sanitation. Unsafe food handling practices, open defecation, poor waste disposal, and contaminated water sources contribute significantly to disease transmission. Investments in safe drinking water, improved sanitation infrastructure, hand washing facilities, and public education can dramatically reduce these illnesses.

Mosquito-borne diseases have become increasingly common due to changing environmental conditions, rapid urbanization, and inadequate vector control measures. Dengue outbreaks occur almost every year, while chikungunya has emerged as an additional threat. Government authorities often intensify mosquito control campaigns only after outbreaks become widespread. However, prevention requires year-round efforts. Regular insecticidal spraying, elimination of stagnant water, proper waste management, improved drainage systems, and community participation are essential to reducing mosquito breeding sites.

The role of individuals cannot be overlooked. Many people neglect preventive measures such as maintaining cleanliness, using mosquito repellents, covering water storage containers, washing hands regularly, and seeking medical advice promptly. At the same time, self-medication has become increasingly common. Medicines are often used based on recommendations from friends, relatives, or social media rather than qualified healthcare professionals. Such irrational practices can lead to treatment failure, adverse drug reactions, antimicrobial resistance, and increased healthcare costs.

Antimicrobial resistance has emerged as one of the greatest threats to global health. The unnecessary use of antibiotics for viral infections, incomplete treatment courses, and over-the-counter access to prescription medicines have accelerated the development of resistant microorganisms. If immediate action is not taken, common infections may become difficult or impossible to treat in the future. Rational use of medicines, stronger regulatory oversight, and public education are crucial to preserving the effectiveness of life-saving drugs.

Prevention is equally important for non-communicable diseases. Diabetes, hypertension, cardiovascular diseases, chronic respiratory illnesses, and certain cancers are increasing rapidly in Pakistan. These conditions place a significant financial burden on families and the healthcare system. Yet, many cases can be prevented through healthier lifestyles. Balanced diets, regular physical activity, tobacco cessation, reduced salt and sugar intake, stress management, routine screening, and periodic health check-ups can prevent complications and improve quality of life.

The government has a fundamental responsibility to create an environment that supports disease prevention. Strong disease surveillance systems, uninterrupted supplies of essential medicines and vaccines, well-equipped laboratories, trained healthcare workers, and accessible primary healthcare services must become national priorities. Health education campaigns should be conducted throughout the year rather than only during emergencies. Schools should incorporate health awareness into their curricula, while community leaders and the media should actively promote preventive behaviors.

Citizens also have a responsibility to protect themselves and their communities. Personal hygiene, environmental cleanliness, responsible medicine use, timely vaccination, and respect for public health guidelines should become routine practices. Communities must recognize that prevention is not solely the government’s responsibility; it requires collective action and sustained commitment from every individual.

Pakistan cannot afford to remain trapped in a cycle of reacting to health crises after they escalate. The economic costs of outbreaks, loss of productivity, pressure on healthcare facilities, and human suffering far exceed the investments required for prevention. Every rupee spent on preventive healthcare saves many more that would otherwise be spent on treatment and rehabilitation.

A culture of prevention is not built overnight, but it begins with changing attitudes and priorities. By investing in awareness, sanitation, vaccination, early screening, healthy lifestyles, and rational use of medicines, Pakistan can strengthen its healthcare system and protect its people from avoidable diseases.

The message is simple yet powerful: prevention saves lives. It is less costly, more effective, and more humane than cure. If both the government and citizens fulfil their responsibilities throughout the year, Pakistan can build a healthier, safer, and more resilient future for generations to come.

Read: The Sanitation Crises in Sindh

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Ali Nawaz Rahimoo, based in Umerkot, Sindh is a social development professional. He can be contacted on anrahimoo@gmail.com 

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Aajiz Hussain Siyal

Following the 2022 flood, a substantial population was displaced, losing their livelihoods and seeking refuge in relief camps situated across different cities in Sindh. These camps, established by both NGOs and government entities, aimed to provide shelter. The flood’s impact was particularly harsh on residents in Sindh, with malnourished children suffering the most. Malnutrition, a global issue affecting many countries, also heavily affects Pakistan, where millions, both children and adults, struggle with it. Disturbingly, nearly 10 million Pakistani children suffer from stunting, as reported by UNICEF.

The flood of 2022 exacerbated existing challenges for affected families. Among these, children bore the brunt of malnutrition, especially those living in relief camps due to their families’ dire economic conditions. In addition, the flood’s destruction of economic resources further strained children’s diets, particularly in Sindh. Cattle, a vital source of milk for many children, perished in the flood, aggravating the situation.

One family applied local remedies to a weak baby by birth that included covering the child’s body with cotton except for the nose, and using burning coils to keep the baby warm

Malnourished children, already at risk before the flood, faced heightened vulnerability. They were susceptible to various diseases, impeding both their physical and cognitive development, while also increasing mortality rates. The dire consequences of the flood and subsequent rains worsened the plight of the already malnourished children. Most families residing in relief camps belonged to low-income groups, resulting in inadequate nutrient intake and heightened susceptibility to malnutrition.

Transitioning to camps led to an exacerbation of children’s malnutrition due to reduced nutrition availability. Consequently, various diseases emerged, including diarrhea, vomiting, edema, chest congestion, low cognitive growth, acute bronchitis, malaria, and cough. Tragically, lack of financial means prevented parents from accessing necessary medical care. In rural Sindh, insufficient health facilities further exacerbated this issue, as government hospitals faced shortages of medicine and inadequate treatment capacity.

Read related article: Almost half the population of Sindh suffers from malnutrition

One significant factor that has played a key role in the alarming increase of malnourished populations is the lack of effective family planning. This issue becomes particularly pronounced when young, malnourished mothers continue to give birth year after year without adequate spacing. These mothers, already struggling with their own nutritional deficiencies, find themselves in a challenging predicament, having to bear the physical toll of frequent childbirth. Consequently, the infants born into such circumstances are deprived of the nourishing breast milk that they desperately need for healthy development.

Malnutrition affects individuals of all ages, but it predominantly impacts women and girls due to factors such as food scarcity, insufficient dietary intake, and increased workload with limited access to nourishment, which significantly jeopardizes their health. Most of the women I interviewed during field work in Dadu and Tando Muhammad Khan districts were primarily homemakers, responsible for household chores, child-rearing, and even tending to animals.

Many of these women took on these responsibilities both before and after marriage. Living in a rural setting, they lacked awareness about proper nutrition and had limited access to educational resources. Illiteracy was common among both men and women I encountered during my fieldwork. Moreover, they expressed their ignorance regarding the importance of a balanced diet for their children. They lamented that government and NGO efforts had not reached their village, leaving them uninformed about children’s nutritional needs and dietary choices.

These villagers were unaware of modern nutritional trends, relying solely on traditional knowledge passed down from their elders. Despite their dire circumstances, they voiced frustration with the entrenched feudal system, which often led NGO representatives and government aid workers to bypass them in favor of landlords. As one respondent put it, “We are poor people, so no one reaches out to us.”

The community shared tales of unconventional treatments like “Kumi Te Winhjaranr,” involving bathing a child on a turtle

Furthermore, the burden on these frail mothers is exacerbated as they attempt to nourish multiple children concurrently, often without receiving sufficient nutrition themselves. This vicious cycle perpetuates the problem, with malnourished mothers unable to provide their offspring with the essential sustenance required for proper growth and development. Addressing this issue is not only crucial for the well-being of individual families but also for combating the broader challenge of malnutrition in our society.

The absence of proper medical care led many to rely on cultural and local remedies. Some parents treated their malnourished children through local practices. Examples included the “Sonr” treatment for stomach issues, “Nazar Jo Dhago Patrayo” amulets for protection from the evil eye, and “Bili Te Winhjaranr,” where a cat was placed beneath a cot during a child’s bath. The community shared tales of unconventional treatments, like “Kumi Te Winjharanr,” involving bathing a child on a turtle. One family recounted their child’s weakness at birth, where they employed local remedies, including covering the child’s body with cotton except for the nose, and using burning coils to keep the baby warm. Awareness about malnutrition remains lacking among many who mistake it for a disease. Consequently, there’s a need to educate people about this critical issue.

Also read: Pakistan still an ‘ongoing nightmare’ for millions of children, following major flooding

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Aajiz Hussain Siyal is a Medical Anthropologist. He did his BS Anthropology in December-2022 from University of Sindh. He is a field-based researcher and is currently working in the field of medical anthropology with a focus on public health and child health issues in particular. He has also worked with UNO and multiple voluntary teams during COVID-19. His areas of interest are, Anthropology, Folk Medicine, Healthcare, Culture and Social Change. He can be accessed at email: aajiz.anthro@gmail.com

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Geneva

Every day, some 1.6 million people worldwide fall ill from eating contaminated food, which kills 420,000 people each year, two UN agencies said.

The World Health Organization (WHO) and the Food and Agriculture Organization (FAO) highlighted the issue on World Food Safety Day, observed annually on 7 June.

This year, focus is on the role of established food safety practices and standards which ensure that what we eat, is safe to consume.

Ending ‘preventable deaths’

Food safety has a direct impact on our health, said Dr. Maria Neira, WHO Assistant Director-General.

Over 200 diseases, from diarrhea to cancers, are caused by eating food contaminated with bacteria, viruses, parasites or chemicals.

“We tend to think about food safety only when we get sick, and we should think (about it) more often because foodborne diseases are entirely preventable,” she said in a video message.

“Safe food allows the uptake of nutrients and promotes human development. Nobody should die from eating food. These are preventable deaths.”

Call to action

WHO has called for action from various sectors, including policy makers, who are urged to establish robust national food safety systems that comply with established standards.

Food businesses are encouraged to work with their employees, suppliers and other stakeholders to develop “a food safety culture”, while educational institutions and workplaces should promote safe food handling.

Consumers are also asked to do their part, for example, by practicing safe food handling at home and following WHO recommendations, which include washing hands before preparing meals and using separate equipment and utensils, such as knives and cutting boards, when handling raw foods.

Food sector ‘toolbox’ 

Meanwhile, FAO will launch a website to help the food sector adhere to international food hygiene standards.

Described as a “toolbox”, the site aims to both protect consumer health and promote fair practices in the food trade.

Special focus has been given to small businesses and farmers in developing countries, as the website can be accessed on handheld mobile devices, which are far more widespread in these nations than laptops or other computers.

The website includes guides to personal hygiene, such as how to educate visitors entering a food production site, the correct procedure and frequency for hand washing, and suggestions for appropriate clothing.

The technical content was developed and reviewed jointly by FAO Food Safety Officers and a team from the Department of Food Science at the University of Guelph in Canada.

“Going forward, the plan is to collect feedback and possibly expand the toolbox to provide more in-depth guidance for other sectors of the agrifood system, such as fisheries,” the UN agency said.

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Courtesy: UN News (Posted on June 6, 2023)

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Prof. Dr. Abdullah G Arijo

Results of hierarchical analyses indicate that high coal production levels are associated with worse adjusted health status and higher rates of cardiopulmonary (Heart and Lungs) disease, chronic obstructive pulmonary disease, hypertension, and lung and kidney disease.

Tharparkar coal mines on the one hand are big blessings whereas, on the other hand, there are ample issues associated with this precious asset.

There are significant environmental impacts associated with coal mining and its use. It could require the removal of massive amounts of topsoil, leading to erosion, loss of habitat and pollution. Coal mining causes acid mine drainage, which causes heavy metals to dissolve and seep into ground and surface water.

Besides, Coalmining harms land, surface water, groundwater and even air, impacts on the land from mining cause drastic changes in the local area, damage to plants, animals and humans occurs from the destruction and removal of habitat and environmental contamination.

With an Estimated Cost (US $ 995.4 million) this setup has been able to create 2500 jobs, with a local share of 1800 against the installed Capacity (660MW). The Thar coal project could help the government save up to $6 billion as the expenditure on the import of energy, including petrol and liquid petroleum, which had touched $24bn. This project has given huge benefits when it comes to the power production sector, however, there are health and environmental issues that have not been addressed.

Upon burning, coal produces several gaseous by-products, including carbon dioxide, nitrogen oxide, sulphur dioxide and methane gas, all of which contribute to global climate change

Coal and fuel oil combustion emit fly ash particles into the atmosphere, which contribute to air pollution problems. Upon burning, coal produces several gaseous by-products, including carbon dioxide, nitrogen oxide, sulphur dioxide and methane gas, all of which contribute to global climate change.

Studies reveal that the emissions from the massive clusters of coal mines and power plants in Thar will cause alarming levels of toxic depositions in the region and expose the local population to serious health risks, according to a Centre for Research on Energy and Clean Air (CREA) study.

If not properly taken into consideration, according to one study, the Thar emissions would constitute one of the largest hotspots of mercury and carbon dioxide in South Asia, adding that the increase in mercury concentrations in crops could also be potentially dangerous for the inhabitants of the area.

Reports reveal, serious health problems faced by the locals. It is, therefore, necessary that the concerned company must take the matter aimed at helping the sufferings of the local folks.

Print and electronic media in Pakistan have long been portraying the problem with a particular focus on the emissions from the coal mines and power plants would be responsible for 29000 air pollution-related deaths, 40000 asthma confirm cases, 19906 new cases of asthma in children, 32000 pre-term births, as well as disability related to pulmonary disease. Therefore, we must act quickly and smartly, or in days to come the concentration of the issues may increase and reach the point of no return.

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Prof. (R) Dr. Abdullah G. Arijo is Advisor and Visiting Professor Shaheed Benazir Bhutto University of Veterinary and Animal Science, Sakrand, Sindh Pakistan. Formerly, he was Chairman, Department of Parasitology, Sindh Agriculture University Tando Jam. After retirement, he also served there as Advisor Academics & P&D to Vice Chancellor. He can be reached at Email: abdullaharijo.faculty@sbbuvas.edu.pk

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Geneva

Overwhelming flooding has affected at least 27.7 million children across 27 countries worldwide, with the number of children affected by flooding in Chad, Gambia, Pakistan and northeast Bangladesh, being the highest in over 30 years.

The UN Children’s Fund, UNICEF, said in its alert on Tuesday as the COP27 Climate Conference continues, that a large majority of the children affected are among the most vulnerable and that rolling disasters are straining the ability of governments and the international community to respond, given the enormous scale of need.

Deadly floodwater

UNICEF says that this year, floods have contributed to the increased spread of major killers of children, such as malnutrition, malaria, cholera and diarrhea, and that the aftermath of floods is often more deadly for children than the extreme weather events that caused the flooding.

In Pakistan, more than one in nine children under five, who were admitted to health facilities in flood-affected areas of Sindh and Balochistan, were found to be suffering from severe acute malnutrition.

In South Sudan, 95 UNICEF-supported nutrition sites have been affected by floods, hampering the delivery of life-saving and preventative malnutrition services for 92,000 children.

An estimated 840,000 children were displaced by floods in Nigeria in recent months.

Heavy rains and flooding in Yemen triggered floods causing extensive damage to shelters in displacement sites. Up to 73,854 households were affected and 24,000 households have been displaced.

‘Drowning in inaction’

“COP27 provides an opportunity to chart a credible roadmap with clear milestones for finance for climate adaptation and solutions for loss and damage,” said Paloma Escudero, UNICEF’s Director of Global Communications and Advocacy.

She added that youngsters “from the most affected places on Earth are drowning in climate inaction. Enough is enough. Lives are on the line – children need action now.”

Adaption is key

As well as pressing governments and big business to rapidly reduce emissions, UNICEF is urging leaders to take immediate action to safeguard children from climate devastation by adapting the critical social services they rely upon.

Adaptation measures, like creating water, health and education systems that stand up to flooding and drought, will save lives.

Paloma Escudero said that “without urgent action, many more vulnerable children and young people will lose their lives in the days and weeks to come. And without climate action, hundreds of millions more will almost certainly suffer like those in Pakistan.”

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Courtesy: UN News (Published on November 8, 2022)

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Verena Hölzl

DADU, Sindh Pakistan

As world leaders address COP27 in Egypt to try to reinvigorate stalled global climate talks, survivors of Pakistan’s heaviest flooding in living memory are facing a health crisis, with stagnating floodwaters fuelling a rise in malaria, dengue, and diarrhea.

The unprecedented scale of the disaster – $30-40 billion in economic damage, 1,700 killed since mid-June, eight million displaced, and almost half the country’s farmland submerged – turbo-charged pre-summit calls for climate reparations. But there are far more pressing concerns in southern Sindh province, where access to assistance has been curtailed by the vast extent of the flooding, massive damage to health facilities, and a chronic lack of medical personnel.

When The New Humanitarian visited last month, the rains had stopped and some survivors were returning to rebuild their homes. But two months after the peak of the flooding, much of the water still hadn’t receded, with many villages still islands that could only be reached by boat. Because of waterborne diseases, this is more than just a transport problem.

Once she finally made her way through the people crowding the office of the pediatrician at the district hospital in Dadu, Shabana carefully laid her baby girl down on a desk covered with medical reports. It didn’t take the doctor more than a couple of minutes to figure out what baby Lareb was suffering from: yet another case of malaria.

“We got away from the floods, but now we are caught by disease,” the 25-year-old mother told The New Humanitarian. All of Shabana’s six children were sick with fever or diarrhea, and she was also not feeling well.

The water has become an extraordinary breeding ground for mosquitoes spreading dengue and malaria. Families must bathe in the brownish sludge, leading to skin ailments, and often they have no choice but to drink it, causing diarrhea.

“Eighty percent of the people I am seeing are sick,” said Sorath Sindhu, a doctor in Sindh’s second largest city of Hyderabad who spends her one free day a week volunteering in areas affected by the flood. “They either have malaria or a skin disease – or they come with both,” she said.

Health officials fear this secondary crisis might become deadlier than the original disaster. “The risk of a cholera outbreak, malaria, and dengue fever threaten to claim far more lives than the floods,” UN Secretary-General António Guterres warned recently.

At the hospital in Dadu, the pediatrician decided to admit baby Lareb. The risk the disease might attack the child’s brain was too high. Given the high patient load, she was likely to have to share a bed with two other children.

Outside the office, an armed police guard had been posted to ensure that distressed parents didn’t crowd the doctor’s treatment room. The pediatrician said he was dealing with five times as many patients than before the floods.

“This is a bigger disaster for us than COVID was,” said hospital director Abdul Kareem Meerani.

The hospital treated around 100 patients for malaria in September 2021. This year, that monthly figure was 30 times higher: 3,000.

Only the most urgent cases can stay for more than one day. “If patients occupy a bed for longer than 24 hours, how can we manage?” Meerani asked.

Poverty and malnutrition

Baby Lareb was one of the lucky ones. Her parents managed to scrape together enough to hire a motorbike to take her to the hospital.

“We could hardly afford to come here,” said Shabana, whose family are day laborers.

They had to pay 200 rupees, less than $1, which represents a significant sum for anyone living from hand to mouth, like most of Pakistan’s flood victims.

In 2018, more than one in five of Pakistan’s 220 million people were already living below the poverty line, according to the Asian Development Bank. More recent official figures aren’t available, but the combined effects of COVID and inflation are likely to have driven that figure higher; and the World Bank has predicted that the flood disaster could push between 6 and 9 million more people into poverty.

In addition to the destruction of much of Pakistan’s farmland in the floods, wheat imports from Ukraine have become more or less impossible since the war. The number of people facing hunger has almost doubled since the floods, according to Save the Children.

Among the biggest health concerns is malnutrition. Even before the floods, more than 40% of Pakistani mothers already suffered from anaemia, and the country has one of the world’s highest maternal mortality rates. At the newborn intensive care unit at Dadu hospital, they have seen a surge in malnourished babies.

When The New Humanitarian visited, little Sorath was only nine days old. Her rib cage, clearly visible through her frail skin, rose and fell inside the transparent walls of an incubator. The smallest diaper available hung loosely from her tiny body. She weighed just 1.5 kilograms.

“We ran out of food,” explained Arbali Laghari, the baby’s grandmother, who was standing watch by her side. “Her mother didn’t get enough to eat.”

Before the flood, they could at least afford potatoes and lentils. Now, those vegetables aren’t reaching the village anymore because of damaged roads. And even if they did, the family of day laborers wouldn’t be able to afford them: They haven’t had any work since the floods.

“Describe this well, so we get help from the government,” Laghari told The New Humanitarian.

Scant support

Last month, as the risks of the secondary health crisis became clearer, the UN raised its ask to $816 million in international aid – more than five times its previous assessment – though it has warned that this figure still falls far short of what will be needed.

Grievances with the government run deep within flood-affected communities. Many survivors told The New Humanitarian they hadn’t seen enough assistance being provided, but they also spoke of seeing little-to-no support from aid organizations.

While Pakistan’s government had been restrictive towards foreign organizations since the 2011 killing of Osama bin Laden (after a fake vaccination drive), they have offered international NGOs blanket access to flood-affected areas without cumbersome applications, although groups weren’t sure how long this would last.

The NGOs, meanwhile, are struggling to cover the vast area. The New Humanitarian visited nine different villages and towns in three different districts over the course of five days and only encountered aid workers in one place: a displacement camp outside Dadu.

For people like Arfa Landhar – who fled her home in Qumicharo after it was washed away by floodwaters in early September – the lack of aid has proven deadly.

Shortly after arriving at a displacement camp, Landhar gave birth. Her son was “light as a piece of cotton”, she said. After six days, when the hospital had sent them away without providing treatment, the newborn stopped breathing.

“I feel so much pain that I couldn’t save my child,” she said.

Landhar blames the death of her son on the rains and the flooding. “I had to run around too much. I needed to protect my home,” she said, rocking her one-year-old, who was sick with a cold.

She is now living in one of the hundreds of stuffy dark tents on a dusty plot of land on the outskirts of Dadu. All there is inside is a bed frame made of wood and rope. She couldn’t bring more than a bundle of clothes for her family.

Coughing and sneezing was already common in the camps by late October. Temperatures in the rural south drop significantly during winter months. Aid groups have now started distributing blankets as the cold season sets in.

Aside from physical health problems, there are emotional burdens too. Landhar’s neighbor almost drowned in the strong current when trying to get a boat to save his family from the floodwaters. His wife weeps every time she recalls the episode.

Many affected by the floods remain worried that the water might come back and hunt them down again, while others don’t feel safe inside their houses any more, having seen them crumble under the intensity of the monsoon downpours.

While Egypt’s resort town of Sharm el-Sheikh is a world away from flood survivors in rural Sindh, what’s agreed in its COP27 summit rooms has a real impact for the future of communities like this, where climate-linked disasters are increasingly commonplace.

But most here feared the recovery from this disaster wouldn’t even be accomplished by the time the next flooding hits. “We should all hold hands and address the issue of climate change,” Azra Fazal Pechuho, Sindh’s health minister, told The New Humanitarian. “This calamity can haunt us every year now.”

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Verena Hölzl is a Journalist formerly based in Yangon covering conflict, displacement, and politics.

Courtesy: The New Humanitarian (Published on November 8, 2022)

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Geneva

Although flood waters have continued to recede in many flood-affected areas across Pakistan in recent weeks, around eight million people need essential health assistance, the World Health Organization (WHO) said.

Public health risks are increasing, driven by damaged infrastructure, stagnant water and inadequate sanitation facilities, the UN health agency said.

Dr. Richard Brennan, WHO Regional Emergency Director, said that the catastrophe has pushed the country to the brink and that diseases are rampant.

He added that a food crisis is looming, the economy is deteriorating, and winter is fast approaching. The eight million flood-affected people who need health assistance require essential medical supplies and access to essential healthcare.

Multiple disease threats

Dr. Brennan said that humanitarian agencies face an uphill battle. “Enormous volumes of persistent flood waters, in particular, have provided breeding sites for mosquitos, resulting in an ongoing malaria outbreak in 32 districts.

“From July to early October 2022, over 540,000 malaria cases have been reported. Other health threats include increasing cases of diarrheal diseases, an ongoing dengue fever outbreak, measles and diphtheria.

He said that among the biggest concerns were high rates of severe acute malnutrition.

“Access to safe water and sanitation remains limited, with people using contaminated water for household consumption. Pregnant women need access to clean and safe delivery services.”

WHO expressed concern that, in the context of multiple other competing demands, the international response has not risen to the urgent needs of flood-affected communities.

More than $81.5 million is needed to respond to the health crisis in flood-affected areas of Pakistan to ensure coordinated delivery of essential healthcare services, efficient management of severe acute malnutrition, and stronger outbreak detection, and control.

Emergency supplies provided

With the funds available, WHO explained that it is acting quickly to protect health and to deliver essential services, especially for those displaced by the floods, through static and mobile health camps.

To date, medicines and emergency supplies worth $1.5 million have been distributed while over $6 million worth of supplies are in the pipeline.

Efforts have been scaled up to prevent and control disease outbreaks, including strengthening surveillance, undertaking vaccination campaigns against measles and cholera, ensuring early diagnosis and treatment or malaria, and providing access to clean water.

In addition, 10 Emergency Operations Centers (EOCs) and three operational hubs have been established in Sukkur, Hyderabad and Naseerabad districts.

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Courtesy: UN News (Posted on Nov.1, 2022)

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By Zofeen Ebrahim

ISLAMABAD

Amid unprecedented floods which have affected 33 million people and damaged nearly 900 health facilities, Pakistan faces the risk of widespread outbreaks of diseases, including diarrhea, dengue, malaria, polio and COVID-19.

The floods have killed more than 1,300 people since 14 June and injured over 12,000, according to the country’s National Disaster Management Authority. The provinces of Sindh and Balochistan are the worst affected with floodwaters engulfing entire villages and wiping out standing crops.

Mirza Nasir-ud-Din Mashhood Ahmad, special secretary at the Ministry of National Health Services, told SciDev.Net that with most health facilities damaged in the worst-affected districts, outbreaks of vector-borne diseases such as malaria and dengue are “imminent in the next few weeks”.

“Relief and rehabilitation in displacement settlements will remain a challenge; already disease outbreaks are being reported from most affected areas”

Arif Jabbar Khan, WaterAid Pakistan

Ahmad said Sindh is the worst affected as the waters here “will not dry for another three to four months”, hampering rehabilitation work and the restoration of health facilities. The province faces a “health emergency”, with the floods limiting access to a vulnerable population and worsening an already ailing health system, he added.

National rainfall was 243 per cent above average in August, according to the Pakistan Meteorological Department which is forecasting more rains in the month ahead.

Indrika Ratwatte, director for Asia and the Pacific at the UN Refugee Agency (UNHCR), says this will likely worsen conditions for nearly half a million displaced people and force more to abandon their homes.

“People are facing many challenges in the informal settlements, camped along roadsides to escape surrounding flood waters, setting up shelters with whatever resources they have,” said Ratwatte, urging the international community to step up its support.

The World Health Organization warned that ongoing disease outbreaks in Pakistan including diarrhea, dengue fever, malaria, polio and COVID-19 are being exacerbated, particularly in the camps and places where water and sanitation facilities have been damaged.

Public health in Pakistan was already considered compromised before the flood. About 38 per cent of children under five are stunted and the country has the world’s second-highest global burden of hepatitis C.

With 116 of Pakistan’s 154 districts impacted by the floods and a third of the country submerged, many immunization programs have been disrupted.

“Our vaccinators are working diligently to ensure that routine immunization continues in the flood-affected districts where health facilities have been damaged,” said Muhammad Ahmed Kazi, director general of the Federal Directorate of Immunization. “Immunization is a priority and we must reach children in affected districts with vaccines, especially for diseases like rotavirus, typhoid and measles,” he told SciDev.Net.

“Relief and rehabilitation in displacement settlements will remain a challenge; already disease outbreaks are being reported from most affected areas,” said Arif Jabbar Khan, country director of WaterAid Pakistan, adding that the risk of disease outbreaks will continue as long as people remain displaced. An estimated 500,000 people are currently sheltered in camps.

Women and babies at risk

Khan said when people return to their homes they are likely to encounter deteriorated conditions, including contaminated water sources. “It is important that the water sources at the household and institutional levels are restored and decontaminated on an urgent basis,” he said.

The camps set up to provide emergency shelter also face huge challenges. Maria Mushtaq who cooks and serves meals for internally displaced people in the Khairpur district of Sindh, said: “Even in the better organized camps functioning out of school buildings, the washrooms and latrines are not enough to cater to the huge numbers. Despite being cleaned every day, these camps are swarming with mosquitoes and flies.”

Of the 6.4 million people in need of humanitarian assistance in Sindh, more than 1.6 million are women of childbearing age, said Sindh Health Minister, Azra Pechuho. He told journalists that there were at least 47,000 displaced, pregnant women at different camps around the province.

The UN Population Fund has estimated that there are 650,000 pregnant women in the flood-affected areas of Pakistan, in need of skilled birth attendants, newborn care and support. Of these, about 73,000 are due to deliver this month. With almost one million houses damaged, the UN agency warns that women and girls are at increased risk of gender-based violence.

The floods were caused by heavy torrential rains since June. The Pakistan Meteorological Department’s monthly summary for August termed it the “wettest August since 1961”.  The monthly summary for July said that average rainfall in Balochistan was 450 per cent above average and 307 per cent above average in Sindh.

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Courtesy: SciDev.Net

The post Flood-hit Pakistan faces spread of infectious diseases first appeared on Sindh Courier.

Dr. O P Kapoor

Sindhis are unusual Indian patients. They have no state of their own. After the partition many of them have spread all over the world and are living as NRIs, e.g. In West Africa (Lagos and Siereleone), Dubai, Hongkong, Singapore, Indonesia, Japan, Phillipines, Taiwan, Spain, Las Palmas, Gibraltar, Bahamas, UK, USA, etc. All over the world they continue to remain religious, God fearing and still speak in their Sindhi language. They are possibly the hardest working people in India, though they also enjoy eating, drinking, music, sex and a very good social life. Many of them have turned to various cults like Radhoswamy, Chinmayanand, Satya Sai Baba of Bangalore, Saibaba of Shirdi, Dada Vaswani of Poona, Aasaram and many more cults. To me it appears that they have no secure feeling. They are taking the help of these cults to maintain their mental health (less commonly Osho, Brahmakumaris and ISKCON). After adopting these cults many of them stop drinking and develop sober habits but continue to eat more.

They are so ambitious that it is worth noting that our Home Minister and one of the other Central Ministers were Sindhis in our Indian Government. It is interesting to note that 2 out of 4 best private hospitals in the city of Bombay are run by Sindhis. Thus the Sindhi man works the whole day and has no time for exercise. This aggressive attitude person disposes them to certain diseases like ischaernic heart disease, hypertension, etc. Most of them will never miss their good lunch and have a hearty dinner and even on the days of fasting which many of them do once a week, the caloric content of the fruits and milk which they consume is very high. Nearly 100% Sindhis offer regular prayers every day. Unfortunately, even the “prasad” which they consume consists of greasy sweet kada (may be followed by a big papad of equally high caloric content). Thus the prasad can amount to as much as a small meal.

The Sindhi women continue to be old traditional ideal wives and mothers and most of the time are home bound, busy cooking and looking after the house. Many of them do not leave their house for days together and continue to eat a good breakfast, lunch and dinner and snacks (specially “tikkis”, fried potatoes and sweets) in between, thus leading to obesity and predisposing them to diabetes and hypertension and osteoporosis (due to sedentary life).

Many genetically transmitted diseases are common in Sindhis. These include ischaernic heart disease, diabetes, hypertension, thalassaemia minor, G6PD deficiency, obesity and possibly gross osteo-arthritis. The following are my other observations:

On general examination most of them are overweight. The commonest musculo-skeletal symptoms of “lingan mey soor” is due to a combination of overweight and lack of exercise. Many of them have got a prominent protuberant abdomen, in males often due to alcohol and excessive calories and in females often due to multiple deliveries. This leads to reduced abdominal tone and appears to me as one of the factors of chronic constipation (pet saaf kona acheyto). Most of the Sindhi women complain of swelling and oedema of the feet and slight pitting. On majority of the occasions it is due to salt retention following marked obesity and deep venous insufficiency. Many of these women have very fat thighs, buttocks and calves hidden in their very roomy dresses. Many of them mistake fat on the legs as oedema.

The gross osteo-arthritis of the knees and hip joints is possibly familial and some of the most advanced cases of such osteo-arthritis in our countries are seen in Sindhi communities.

Most of the Sindhi women do not take any hormone pills after menopause which often occurs around 45 to 48. Thus after 10-15 years, around the age of 60 to 65 they start getting repeated fractures with minimal trauma and most of the doctors do not make the diagnosis of osteoporosis which is rampant in elderly Sindhi housewives.

Many Sindhi women appear anaemic on general examination. Most of them will say that they have gone to a number of Doctors in their life time but their anaernia does not respond to treatment. This is because they have thalassaemia minor which they should be told to learn to live with and for which there is no permanent cure.

The incidence of G6PD deficiency is very high in Sindhis. Off and on I see rich Sindhi males coming with severe anaemia from Far East after having an attack of malaria for which they are given anti-malarial drugs. This is because of deficiency of G6PD which was missed by clinicians in those countries.

Premature greying of hair in both sexes is universal in this community and they keep on using hair dyes for years.

Most of the Sindhi patients especially women complain of symptoms of “monjh” which is equivalent to ghabrahat (chest apprehension) in other Indian patients. Many of these patients have absolutely no heart disease and have nothing else but panic disorder. The incidence of this symptoms is so high in Sindhi females that every alternate patient complains of the same not responding to any treatment! However, ischaernic heart disease in Sindhis specially those living abroad is extremely common (like the Asians in UK) and should be excluded before diagnosing functional complaints. Many of the females will complain of symptoms due to so-called “low blood pressure”. Most of these symptoms are due to anxiety and tension and not due to low blood pressure. The symptoms of “Saheko” which really means dyspnoea is often present along with “monjh” without any organic disease.

Diabetes and hypertension are extremely common in this population. Often they neglect the treatment of these diseases and develop ischaernic heart disease (both sexes). Fortunately, because they can “afford”, many undergo angioplasty and coronary bypass heart surgery and then agree to take drugs life time. Even the incidence of 11 strokes” due to abnormal brain circulation is more common in Sindhi population (mainly due to negligence and not taking treatment of “detected” or 11 undetected” hypertension). For the same reason kidney failure (CRF) is more common in Sindhi population.

Regarding diseases of lungs, COPD is still off and on seen in so-called poor Sindhis (from Ulhasnagar) who continue smoking bidis and cigarettes. The modem Sindhis have more or less given up smoking.

The standard complaints of most of the Sindhis specially women are “ograai” and “pet saaf konaache ‘ vto” which literary means belching and in complete evacuation. The belching is so severe that the patients often present with aerophagy syndrome. Belching is not a disease and is not only a habit (which started in this community in childhood) but is associated with over eating. In my experience Sindhis have the highest incidence of belching and aerophagy in the world. Another common complaint is the “Coated” tongue. They continue using tongue cleaners and always correlate their coated tongue (which is normal) with their abdominal complaints of distension and constipation.

Incomplete evacuation is often due to their sluggish colon and associated poor abdominal tone and flabby abdomen and possibly lack of outdoor exercises. Blood cholesterol and triglycerides are often very high in Sindhi population and are mainly related to intake of alcohol and rich diet.

As compared to many other communities, in Sindhi women the symptom of leucorrhoea is very common. In males the symptoms of sexual weakness are more or less universal often due to excess of alcohol, tension, diabetes, iatrogenic causes and more “expectations”! However, the incidence of urethral syndrome and Dhaat (male leucorrhoea) as seen in many other Indian males is more or less never seen in Sindhi males (although they often over indulge in sex). Interestingly like in Arabs, I find that the incidence of AIDS is much less in Sindhi population.

Regarding the different sub-communities in Sindhis – the picture described by me above is commonly seen in Sindhwarkis. Although, Hyderabadis and Amil Sindhis have also more or less same illnesses, belching, aerophagy and other gastrointestinal symptoms are less common in them. More often Bhaibandh and Shikarpuri Sindhis join cults like Radhoswamy and after taking “Naam” stop non-vegetarian food and often alcohol, though many of them who were smokers continue smoking. Also many of these type of Sindhi like to retire from sex life around the age of 50-55.

Finally, in poor Sindhi population of Ulhasnagar most of the above picture described by me would often be seen.

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The writer was Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai.

Courtesy: BHJ

The post PROFILE OF SINDHI PATIENTS IN MY PRIVATE PRACTICE first appeared on Sindh Courier.

Sindh meets more than eighty percent of country’s chili demand. The chili produced here are very much liked the world over – Dr. Fateh Marri, Vice Chancellor SAU

From Our Correspondent

Tando Jam

Like the production of cotton and other crops, the per acre yield and quality of chili is also on the decline in Sindh mainly owing to climate change, water shortage, hybrid seeds and various diseases, as the provincial agriculture department seems in deep slumber.

This transpired at a national symposium on the diseases that have infected the chili crop in the province. The symposium was held at Sindh Agriculture University (SAU) Tando Jam on Monday.

The agriculture experts said that the chili crop in Sindh is under the attack of 46 different diseases and the quality and quantity of chili produced here is fast declining due to water shortage and diseases.

Chili crop in Badin district is worst affected by the diseases.

It is pertinent to mention that the chili crop is cultivated in different districts of Sindh however Kunri in Umerkot district is the largest chili growing area of Sindh and is said to be the Asia’s largest chili market.

“Sindh meets more than eighty percent of country’s demand of chili while the chili produced here are very much liked the world over,” Dr. Fateh Marri, Vice Chancellor of SAU, who presided over the event, said in his address.

He told that it was Kunri chili market which introduced online trade of chili in the country.

VC said that besides decline in per acre yield, the climate change, drought-like situation and the substandard seeds have also left adverse effects on the quality of chili.

According to him, despite a certain setback, there exists a great potential for the export of chili.

The experts from various organizations presented their papers on climate change effects, water shortage etc. and suggested ways and means to control the diseases that are harming the chili crop.

Mian Muhammad Saleem, a progressive grower, and president of Chili Growers’ Association, revealed that the hybrid seed has devastated the Kunri chili market, once known as Asia’s largest market. “The hybrid seed has also damaged the local variety of chili called ‘longi’.”

Mian Saleem urged the seed producing and pesticide companies to affix a code on their products so that they could be identified with regard to their quality. He also suggested formation of Chili Development Board for resolving the issues.

Dr. Manzoor Ali Abro, Dean, Faculty of Crop Protection, told in his address that currently the chili crop in Sindh was under the attack of 46 different diseases.

Prof. Abdul Mubeen Lodhi apprehended the decline in chili cultivation area, per acre yield and the quality of the produce.

Prof. Tariq Mukhtar of Pir Mahar Ali Shah Arid Agriculture University Rawalpindi, said that since the farmers were not aware of diseases in Chili crop, it was the responsibility of experts to tackle the issue.

The experts and other stakeholders agreed to constitute a forum of national experts and growers to jointly work for conducting research on new varieties of chili and finding ways to protect the crop from diseases.

Dr. Imran, Dr. Saleem Aijaz, Dr. Sabuhi Raza of Karachi University, Dr. Abdullah Ahmed, Dr. Muhammad Imran, Dr. Qamar-u-ddin Chachar, Dr. Aijaz Khoonharo, Dr. Syed Ghayasuddin, Dr. Altaf Siyal, Dr. Abdullah Arijo, Dr. Ismail Kunbhar and others were present.

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The post 46 different diseases devastate Sindh’s Chili crop first appeared on Sindh Courier.