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HEALTH-PAKISTAN: As Floods Recede, Epidemics Wait in the Wings

Zofeen Ebrahim - Asia Water Wire*

KARACHI, Sep 8 2006 (IPS) - Floods and torrential rain have caused public sanitation in this port city to deteriorate to a point where health experts are not sure whether its 12 million inhabitants are going to be hit by malaria first or by gastroenteritis – conditions are rife for both, as well as a host of other pestilences.

Pools of smelly water have stagnated for so long that they have turned a sickly shade of green. And fly-infested mounds of garbage lie around uncollected, emitting a stink so foul that not even the hardiest of scavengers – man, beast or bird – dare venture near.

Mosquitoes swarm over open drains, sewers and manholes that are overflowing with sewage and discarded plastic bags. The mid-August floods, killed more than 80 people.

After touring the city, Moeez Uddin, programme manager for the British charity Muslim Aid said in a statement last week: “The people of Karachi are affected by intermittent rain and the local government infrastructure has collapsed. The water and sanitation situation is dire. It is expected that seasonal and related diseases may cause serious casualties for the poor and low income people due to non-availability of clean drinking water and other necessities.”

It is the perfect setting for a serious outbreak of diseases, agrees Dr Mubina Agboatwala, chairwoman of ‘HOPE’, a non-government organization (NGO) doing research work on public health issues. “Humidity, stagnant water, water supply mixed with sewerage. This provides the ideal setting for mosquitoes and flies and therefore, an epidemic seems imminent,” she adds.

Already, some 30,000 cases of gastroenteritis have been reported in the province of Sindh, of which Karachi is capital, and claimed 14 lives.


An army of the Karachi city government’s sanitation staff, garbed in fluorescent pink, wade daily through knee-deep, murky water trying to clean up the drains and manholes.

Agboatwala said she was not surprised that laboratory tests of water taken from East Karachi showed up high levels of coliform bacteria, clearly indicating that water supplies were contaminated with faecal matter.

Agboatwala, along with her field team, is conducting research to prove that washing hands with soap results in a drastic decrease in diarrhoea cases. But the contaminated water supply means it is of little use. “Despite the use of soap, the contaminated water has resulted in severe gastroenteritis cases. I’d say it has increased four-fold,” she estimates.

”The situation is indeed serious,” says Dr Qaisar Sajjad, secretary general of the Pakistan Medical Association. In the three big government-run hospitals of Karachi, 70 – 80 cases of gastroenteritis, most of them in children, are reported daily. “There have been reports of dengue fever but nothing conclusive can be said,” he told Asia Water Wire.

Sajjad believes that the chances for outbreaks of cholera, Hepatitis A and E, and typhoid are high.

While the United Nations Children’s Fund (UNICEF) is not directly involved in any sanitation in Karachi , Dr Asif Aslam, project officer, says the body is keeping a watchful eye over the situation. “We are in contact with the city government’s executive district officer for health on a daily basis as we fear there will be a gastroenteritis outbreak. Our team is monitoring all major hospitals,” he said.

“There is a pattern to an outbreak. It starts with diarrhoea and other severe forms of gastroenteritis followed by malaria and then typhoid,” explains Agboatwala. “There is a strong chance of a cholera outbreak here”.

Malaria cases, she says, are already on the rise, and the present situation is exacerbating it. “Cerebral malaria has increased and there is cause for worry as it is coming in resistant forms that do not respond to the conventional forms of treatment”.

According to Agboatwala, the government should quickly drain stagnant pools and get rid of garbage lying around. “The sanitary staff must be given anti- malarial vaccines and medication for Hepatitis A and E as they are the most vulnerable to catching the diseases,” she says.

She also recommends the spraying of insecticides to stop breeding of mosquitoes and flies. “The newspapers say that the government has started this, but I have not seen it either near or around my residence or the workplace. Unless all areas are covered, it’s an exercise in futility.”

Dr Abdul Wahid Bhart, a WHO representative, says that while the health situation in Karachi is grim, that in the interior of Sindh province is grimmer still. This, he says, is especially true of districts like Thatta, Badin, Sanghar, Mirpurkhas and Khairpur.

Due to the monsoon rains, displaced residents have had to move to camps set up by district governments in schools, dispensaries and other government buildings. “In Mirpurkhas alone there are 34 camps and in each of these camps there are 10 to 12 families (each family has 10 to12 members),” said Bhart.

According to the health department in Sindh 285 emergency camps have been established in various places in the province. But with the rains continuing, the camps themselves are becoming health hazards.

‘’There is no local arrangement to provide shelter and cures against diseases. The rainy season seems set to continue in the coming weeks. This is why we need to provide shelter and medical treatment to those affected as soon as possible,” The Muslim Aid statement said.

(*The Asia Water Wire is a series of features on water and development in the region, coordinated by IPS Asia-Pacific.)

 
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