Flash floods destroyed 70 per cent of the region’s standing summer crop. The stagnant flood water has derailed the planting of the next crop. For a population already tethering on the brink, this spells doom. I’m petrified of the famine looming on the horizon – something my friends at the #FixSindhDrainage Twitter Space have been communicating for the past three months.
The heat from the sun penetrates my scalp as I visually scan the makeshift medical camp our volunteers have set up in Keti Bandar, district Thatta, in Sindh province of Pakistan. It takes time for my body to adjust to the heat. I did this so many times after the 2010 floods that it still feels like second nature.
Observations from the three years I spent here race through my head, though now it’s been ten years since I was last in Sindh. But today, on day four of our two-week flood relief mission, it feels like I never left. I’m going over items in my mental checklist: Chair. Table. Medicines. Waiting area. Shade from the sun. Stethoscope. Check.
While visiting Pakistan from New Jersey in 2010, I got sucked into volunteer medical work by my friend, social worker Sabyn Zaidi. We later launched the nonprofit Life Bridge. The catastrophic floods that hit Pakistan in the summer of 2022 propelled us out of our comfort zones and back into the field, even if for a few weeks.
In August 2022, Sabyn, who moved to the US a few years ago, started sounding the alarm as she watched the upstream water levels rise in Pakistan. As a former UN staff member she receives emergency alerts about disasters around the world. By September our small team – Sabyn, our friend Dr Amna Buttar, and I – decided to go to Pakistan and provide emergency relief in whatever way we could.
Sabyn started conducting assessments in the areas she identified as most vulnerable. As before, we targeted villages that had received no aid. This means those with limited access, damaged roads, and standing water above three feet.
It takes us six hours to reach Keti Bander, normally a 3–4 hour drive from Karachi.
Despair in their eyes
The bright colours of the sheets serving as tents seem to mock the despair apparent in the villagers' eyes. Volunteers scramble to place chairs and desks in a way that will keep the crowds in check and allow room for patients to be seen. They look apologetic for making me wait. I sit down and start taking out my stethoscope and other medical instruments to place on the table.
Women have already lined up, cradling children in their laps. All ten chairs in front of me are full. More women stand behind them. Many have started telling me their ailments already, speaking over each other. I ask them to speak one at a time. They take a moment and one of them starts.
My peripheral vision registers an elderly woman sitting down on a chair on the left that’s meant to be a blockade. She ignores volunteers beckoning her to leave. I continue examining patients to my right, slightly turning away from her, hoping she’ll come around to the other side. She doesn’t.
I’m aware that the situation can turn ugly if those in line get angry. People can even get physical and volunteers can get caught in the middle. Mostly, the queue-jumpers are just trying to get ahead – but sometimes, there’s an emergency.
Every few minutes the woman taps me on my shoulder, touches my arm, or tries some other benign way to get my attention. Ahead of me about six mothers sit with their children in line, another 50 standing behind them. There’s some whispering. Everyone is in bad shape. Each person feels they have an emergency.
The woman’s persistence worries me, and I finally turn to face her. “Chha khapay amma?” (What do you want, mother?).
“Mukhay thokhay pehenjo putt dikharno aa” (I want to show you my child.)
I can sense the irritation of the woman who’s next in line.
“Kithay aa taajo putt? Sab jiya line may waitha ahin tha bhi acho na hin pasay?” (Where is your child? See how everyone is waiting in line, why don’t you join them on this side?)
As I start to turn away, she removes her dupatta from her lap and shows the baby. “He’s not well. He’s only a year old. Look!”
A child starving to death
The infant she held up looked about six months old and was crying nonstop. The look on the child’s face broke my heart. My brain stopped functioning. I couldn’t think. After a few seconds, I had to look away, tears welling up in my eyes. I was paralyzed by what I saw.
The baby wore a loose-fitting shirt and pants that started to slip off as his grandmother lifted him up. The tiny, frail skeletal body was that of an infant too small in size and weight for his age, struggling to stay alive.
“He won’t stop crying. I don’t know what to do. I know he’s not well but what do I do?”
She said his 13-year-old brother had died in the hospital just a few hours ago. “Please look at this one.”
“Amma, what are you feeding him?”
“I don’t have anything. I have nothing. And now, I don’t even have a house. Everything was destroyed.” She gestured behind her. “This is the boy’s father. I am his grandmother. These are his brothers. We’re all living under the open sky.”
I tried to wrap my head around the loss and helplessness of these people. What do you say to a woman who has just lost a grandchild, and is in danger of losing another? What words are there to explain that the child is crying because he’s starving to death? Literally.
I haven’t found the right set of words yet. Even after spending three years doing medical relief. Not every child I saw in the medical camps was starving to death. Sindh hasn’t reached that point yet. But almost every child is suffering from some form of deficiency ranging from malnourishment to severe acute malnutrition. Either they’re living on poor limited diets like bread and red chili or are getting nothing to eat.
I turned to the father to get a history. The two boys standing with him look about eight and ten years old.
“How many children do you have?” I ask the father, Sulaiman Shah.
“Seven.” Six, since a 13-year-old son died just hours ago.
This baby, he said, has been weak since birth. “Since our home was destroyed he’s got worse.”
“What are you feeding him?”
“Is the mother breastfeeding him?”
“She stopped making milk.”
“He needs a milk supplement. He can’t survive without eating.”
“I can’t work right now. I don’t have money. I don’t have anything.”
“What are you feeding your other children?”
Another blank look.
“Why do you keep having children if you can’t afford to feed them?”
“It’s God’s will.”
“Is it also God’s will to starve your children?”
He smiles and looks away, ashamed.
I tell him I will treat the baby only if he agrees to stop producing children. He promises and begs me to save his son, Azeem.
No nutritional supplements
Infants suffer the most as they depend almost entirely on breast milk. Where does it come from when the mother can’t produce any due to dietary deficiencies? The average family size in Sindh is 6.5 people ranging from infants to the elderly. With so many mouths to feed, the mother is usually the last to eat, often surviving on scraps.
The only treatment available for severe acute malnutrition is ready-to-use therapeutic food, RUTF, usually available at UNICEF’s malnutrition treatment centers. This time, Sabyn’s contacts at the UN tell us that the Sindh government has all the emergency relief medical supplies and will decide who gets what.
We had tried to obtain RTUF for the Life Bridge medical camps before arriving in Pakistan. Based on past experiences, I knew it would be difficult. I didn’t know we would find so many children suffering.
Dr Amna Buttar, a geriatrician from the US who used her vacation time to volunteer with Life Bridge, tried coordinating with the government of Sindh the day before her medical camp in Mirpur Khas. We tried from September to October, using different avenues to prepare for this situation. All our efforts were in vain.
In anticipation of the issues we would be confronted with, we did some groundwork prior to leaving for Pakistan. We heard about the Panadol shortage so Amna got six boxes of paracetamol donated which she carried in her luggage.
Seeing that Amna was unable to obtain medicinal and RTUF support from the health department, Sabyn and I purchased what we could prior to our departure. Supplies included wound care supplies like saline wash, ointments and bandages besides nutritional supplements for children, like Cerelac. In Karachi, we also purchased nutritional supplements like Lactogen, readily available over the counter in Pakistan.
We were able to give Suliman Shah’s family one month’s supply of Lactogen for Azeem. Meanwhile, coordinating with Dr Soomar Khoso, Provincial DEWS Coordinator WHO Sindh, we learned of the malnutrition treatment center at Thatta Civil Hospital. However, that is two hours from where the family lives. Due to social constraints, the mother cannot take him on her own. If the father, a daily wage earner, spends the day in the hospital his family does not eat. Life Bridge has been providing the family with nutritional supplements for the last three months. Although the child’s condition is not optimal, he is now stable.
Malnutrition the biggest problem
It is now 2023. You’d think hunger isn’t an issue. Yet, it is.
Malnutrition is the biggest problem facing the affected people whenever floods rip through Sindh. However, it is a chronic issue affecting millions even without the burden of a natural calamity. I worry what the coming months hold for the region, many parts of which are still inundated.
Flash floods destroyed 70 per cent of the region’s standing summer crop. The stagnant flood water has derailed the planting of the next crop. For a population already tethering on the brink, this spells doom. I’m petrified of the famine looming on the horizon – something my friends at the #FixSindhDrainage Twitter Space have been communicating for the past three months. Many of the participants are flood affectees sharing their ground realities.
The human body weakened by malnutrition is more susceptible to disease. Ordinary illnesses become more difficult to treat and heal. Everyone has the right to a balanced diet and basic healthcare – we need this to reach our fullest potential. Healthy persons can focus on saving themselves, their homes and their livelihoods. Unhealthy individuals cannot focus on rebuilding life, returning to work and being productive. Mothers who are ill cannot be good caretakers; sickly children cannot function well in school.
Multiple studies stress the overall effect of nutrition on brain function, and on the generational effects of famine. Apparently, hunger doesn’t just hinder an individual – it has a profound impact on a population’s health for generations.
There are no shortcuts to the phase-by-phase support needed in a disaster situation – in this case, the emergency relief, rehabilitation, recovery and resiliency. When all funding is spent on rehabilitation like rebuilding homes and livelihoods, there are no resources left to help people recover their health.
To rush forward without taking overall health and nutrition into account is an injustice.
We can’t fix the problems of millions. We can’t fix the world. But does it have to be all or nothing? What if we can fix it for one mother, who can then feed her infant, and make more handicrafts because she has the energy? She can contribute more towards the household income and help feed five other mouths. Is it worth it then? How many mothers and children make it worthwhile?
How long do we need to wait? If not now, then when?
(The author is a US-based volunteer physician who spent three years working in various districts of Sindh after the 2010 floods. Life Bridge US (501c3) and Life Bridge Pakistan Trust, which she co-founded with Sabyn Zaidi, has conducted over 30 projects around Sindh, from medical camps and vaccination campaigns, to maternal and child health clinics and COVID response. Views are personal. By special arrangement with Sapan)