10,000 Villages: Pakistan Floods & Water-borne Disease Spread

As hundreds of thousands continue to be driven from their homes and livelihoods by floods in cities, towns and villages of Pakistan, further heavy rainfall and flooding is predicted for the coming weeks. 160,000 square kilometres of land, or one fifth of the country, is under water. An area larger than twice the size of Ireland has been ravaged by the floods, millions have been left without shelter, food and medical assistance. According to the Pakistani government, an estimated 17 million people have been affected, and the risk of acquiring disease for those displaced is at elevated levels. As of August 23^rd, Pakistani government estimates indicated that 1,542 deaths and 2,327 injuries had occurred as a result of the floods. Life-threatening disease outbreaks now face survivors already weakened by displacement and lack of food, in what UN secretary general, Ban Ki-Moon, referred to as “a disaster of unimaginable proportions.”

The end of July marked the beginning of the Pakistan floods and in the aftermath of the deluge, flood-water has carried diarrhoeal, respiratory and skin diseases. Transmission of water borne diseases is enabled by a lack of clean drinking water and by poor sanitation and hygiene. Water borne diseases have been confirmed to be on the rise. As of August 18^th, there had been an estimated 204,040 cases of acute diarrhoeal disease, 204,647 acute respiratory disease cases and 263,356 cases of acute skin diseases. Annually, water-borne diarrhoeal diseases still cause premature deaths globally for an estimated 2.2 million people, mostly children; organisms responsible for these diseases vary from bacterial to protozoal to viral.

Cholera, with its rapid disease onset and 5% fatality rates, is one of the most feared water borne diseases in situations of natural disaster. The disease is caused by infection with the Vibrio cholera bacterium, after consuming contaminated water or food; person to person transmission is unlikely to occur. After infection, disease symptoms can be mild or even non-existent, but in severe cases the characteristic watery diarrhoea and dehydration can lead to death within hours. In industrialised countries, cholera is no longer an endemic disease, but the bacteria are endemic in many developing countries, including Pakistan. Cholera cases were documented recently in Zimbabwe in 2009; here the cause was not natural disaster, but man made, resulting in nearly 4,500 deaths. While outbreaks of this deadly wasting water-borne disease have been rumoured, they have not been confirmed in the wake of the Pakistan floods. Cases of acute watery diarrhoea are being treated with cholera treatment protocols, including intravenous fluids and oral re-hydration salts, for individuals suffering severe diarrhoeal diseases.

This disaster situation is complicated not only by the uncharacteristically heavy seasonal monsoon rains, the vast area in need of aid and the lack of the immediate, sufficient international aid, but also by fears of political insurgency. Fears that aid supplies could be hijacked by extremist elements have been expressed. While the tardy international response has also roused fears that this international aid vacuum could be exploited by the same extremist elements. Concerns remain that a poor international response to this natural disaster may mean that the Pakistan floods also wash away progress made in the Afghan war. This natural disaster has become as politicised as any could, highlighting the critical connections that exist between international aid and international security. The poorest survivors remain caught in the middle of this debate, and aid remains essential.

Ban Ki-Moon described that “almost 20 million people need shelter, food and emergency care. That is more than the entire population hit by the Indian Ocean tsunami, the Kashmir earthquake, Cyclone Nargis and the earthquake in Haiti – combined.” The scale of this natural disaster is vast in land mass and numbers affected by loss of homes, land and livelihood, but these factors did not immediately demand the necessary urgent response from the international community. It is clear that the Pakistan death toll does not compare to the natural disasters which have ravaged countries of late. Around 230,000 deaths occurred as a result of the 2004 Indian Ocean tsunami, there were over 73,000 deaths after the 2005 Kashmir earthquake in Pakistan, Cyclone Nargis in 2008 is thought to have caused 140,000 deaths and over 210,000 deaths occurred after the 2010 earthquake in Haiti. Death tolls as a direct result of the relentless Pakistan floods do seem remarkably low in comparison. However, while the mortality rates are much lower than recent natural disasters, it is crucial to appreciate that vast regions and vast numbers of people have been devastated by these floods in what Ban Ki-Moon referred to as Pakistan’s “slow motion Tsunami.”

In other parts of the world, dramatic seasonal weather is also causing devastation. China is suffering from floods and mudslides, which have displaced tens of thousands and killed more than 1,500 people, while bringing devastation to homes and livelihoods. After un-seasonally heavy rains destroyed crops, livestock and livelihoods in West Africa last year, they re-visited countries of the eastern Sahel region this year. Niger was hardest hit; causing more than 1,000 deaths and making 100,000 people homeless. In the aftermath of these disasters, as in Pakistan, water-borne diseases carry risks of further mortality after the immediate ravages of the storms have faded.

“These unprecedented floods require unprecedented assistance” urged the UN Secretary-General, the following his visit to flood-affected zones in Pakistan. According to the UN, 8 million people are in need of life saving humanitarian assistance, and 4.6 million are homeless. With the unremitting floods and particularly in the absence of sufficient aid, the immediate future predicts further misery, especially for the poorest of survivors. Pledges are still being calculated for the $460 million requested in international assistance by the UN, but are thought to beyond the halfway mark according to UN spokesperson Farhan Haq. This cash is not yet delivered, and in order to meet the multitude of varied challenges of disaster, Pakistan still needs sustained “waves of global support.”

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