FIRST, a few snapshots from the road with water dunes on both sides, as far as one can see. These frames are now going to live with me.

A large family of old women, men and children sleeping under a parked truck on the side of a non-functional petrol pump and a young emaciated man sitting as a guard using the truck tyre as back support.

A huge brown-pink-green camel corpse with a long folded neck resting on the side in the water after floating around.

A limp body of an adolescent boy with a naked upper half and blue shalwar being brought to a medical camp followed by a small crowd. The boy was drowning. Not clear if he is still alive.

We don’t have any appreciation of preventive healthcare and our system is entirely curative.

A very old man with a beard sitting in shallow water by the roadside with his face in the middle of his two kneecaps and a big staff, with an old hand emerging out of the water to support himself and his floating dhoti around him. His eyes are fixed in the air on nothing. I don’t understand why he is sitting there. A young naked boy with a protruding tummy standing beside him on a dry patch.

A child sleeping on a solar plate.

A biting soundbite: “photo wala hai ya kuch deney wala hai” (is he just here to take a photo or is he going to dole out something).

Today’s column is made up of excerpts from my notes, on the road to some of the flood-hit areas.

“I am here with a member of a board of trustees of the Islamic Medical Association of North America and his small team from Alight (formerly the American Refugee Committee). It is a short, exploratory visit to see from close the devastation caused by the floods and how the affected people can be supported in their struggle to survive. Healthcare is our special focus.”

“We landed in Sukkur, went straight to some medical camps set up on the side of a narrow road among the tents where the people are living. On one side of the road there is an ocean of water and somewhere in the water these people had their homes.”

“A man tells us that we have travelled inside this water on a boat for three and a half hours to provide relief goods to people still there. Some of them are sick and we are providing them with medicines through mobile teams on boats. Their houses are slightly on elevated land so they are there. This is just besides the Indus.”

“After Sukkur, we keep driving on Shikarpur road, pass Lakhi, pass Shikarpur, pass Lodra, pass Sultankot, pass Humaayoon Shareef, pass Dera Allah Yar and reach Dera Murad Jamali. We stop at some places just to see the devastation caused by the water, hapless people trying to find shade and food, with some of them running besides vehicles asking for something.”

“Each camp here receives around 500 patients but some camps are more busy than others. Two key issues causing people to turn to medical camps are diarrhoea and skin problems.”

“A senior dermatologist from Sukkur, a local medical director of Alkhidmat Foundation is going to these camps and managing 60 others; he saw 1,800 patients himself in one camp the other day and now he himself is down with diarrhoea and a backache. He still invited us to his place and we had the most useful discussion with him about the health challenges, healthcare provision and the inadequacies.”

“We don’t have any appreciation of preventive healthcare and our system is entirely curative. Handwashing, antenatal care, childbirth planning, proper nutrition of pregnant women and young children, safe drinking water — we don’t do anything about prevention. Healthcare means you have to be sick, you have to be seen by a doctor and you should be taking medicines and injections. What we need to do is to expand the concept of healthcare in the minds of the people as not just limited to curative care.”

“We are just seeing the beginning of diseases as a result of the floods. The scale of this calamity is such that it is going to create huge health crises in the country in the coming days and we should brace ourselves for it.”

“A very well-informed and articulate local organiser, a young man, explains to us that with only an interval of few hours, there were nine days of non-stop heavy rain. ‘We haven’t seen anything like this in our entire lives. Our parents and elderly grandparents haven’t seen anything like this in their entire lives. It was silent and constant heavy rain. No thunder, no lightning, nothing, just constant water pouring from the sky. And then after some days, the houses started crumbling one by one, animals start drowning one by one. We didn’t know what to do, where to go’.”

“He continues: ‘local administrations in these areas are in the pockets of local landlords. When government supplies arrive, they are quietly driven to the private stores of these people from where they never come back. The government is nowhere to be seen during these floods. We are hardly receiving anything except from welfare organisations’.”

“He explains to us how lack of planning and bad planning in these areas have obstructed the natural flow of water and how when badly planned built channels overflow they create havoc in these areas. He has an impressive and intricate knowledge of the local geology and topography and speaks with authority on the dynamics of the floods.”

“The people you see on the sides of the roads in the tents and camps are those who didn’t have money even to buy tickets to go to the big cities for safety. Some of them are those who could save their animals and cannot leave them behind. So, they are stuck here. They are the poorest of the poor.”

“We don’t learn from our experiences. Every time we start from scratch as if it is happening for the first time. There is no coordination in response effort.”

“Climate change, yes, but governance failure in Pakistan is at the root of all this.”

The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.

[email protected]

Published in Dawn, September 9th, 2022

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