Correspondence
Tharparkar: a forgotten disaster The sandy dune area of Thar and the marshy lands of Parkar, covering an area of 19 638 km,1 lie to the southeast of Sindh province, Pakistan.2 Thar is one of the most densely populated desert areas in the world. The population of 914 0001 subsists on rain-dependent agriculture and animal husbandry.2 The region faces adverse climatic conditions, with droughts every 4–5 years bringing devastation to socioeconomic conditions.2 Rainfall is irregular, with an annual average of 50–300 mm.2 Between March, 2013, and February, 2014, there was a rainwater shortfall of 30%.3 128 children and 105 adults succumbed to the disaster.4 Pneumonia, acute respiratory infection, and diarrhoea were among the major reported illnesses in children.5 Malnutrition is another serious health burden. 60% of the children admitted at the District Headquarter Hospital are malnourished, 54% moderately and 9% severely.6 The region is also suffering from administrative negligence, extreme poverty, lack of basic health facilities, and weak infrastructure, which have increased its vulnerability to the climatic misery. Travel time to the nearest health facility is 2–4 h,6 at a cost of PKR 1000–4000 (US$10–40) in a region with an average monthly income of PKR 4391 ($44).7 Women’s health is neglected, as it is in many remote villages of Pakistan. The problems are rooted in cultural beliefs and lack of reproductive heath facilities. Only 14% of births are attended by skilled birth attendants,8 and among women who conceived in the past 3 years, fewer than half made one antenatal visit.8 The district ranks last in Sindh province in terms of access to improved drinking water and sanitation.8 Fewer than half of the children are fully immunised and only 60% children younger than 1 year www.thelancet.com/lancetgh Vol 2 September 2014
are immunised against measles.8 The infant mortality rate is 87 per 1000 livebirths and maternal mortality rate 297 per 100 000 livebirths.1 The health sector in the region is facing a dearth of doctors, paramedics, medicines, and equipment. There are 150 doctors, eight lady health visitors, 32 midwives, and almost no paramedics.9 There are only three hospitals and 32 basic health units for a population of almost a million.9 We cannot expect the situation to change overnight. Continuous and collaborative efforts at the regional, national, and international level are required. Endeavours should be preventive and not just curative. Coordinated ministries, and proper documentation of records and of available facilities are immensely important to foresee an eminent crisis and for its timely management. Establishing a resilient infrastructure should be the first priority. Developing a permanent source of water, improving sanitation, and building a road network are among the major requirements. Creating employment opportunities will help to eradicate the endemic poverty. A paucity of veterinary doctors and resources in veterinary units must be taken seriously, along with the blanket vaccination of animals, given the huge impact of livestock on the economy. Because of the harsh living conditions, doctors are not willing to work; incentives should be given to deal with this issue. The availability of female doctors and specialist doctors, particularly paediatricians, gynaecologists, and physicians must be made possible. Programmes of immunisation, antenatal care, and child care should be introduced. Public sector dispensaries and maternity clinics should be set up to provide easier access. Improving health is tied to public awareness; hence the importance of antenatal care and complications associated with untrained deliveries must be explained. Parents must be educated
regarding paediatric nutrition and childcare. The need for reforms is dire. This region may suffer for the next 100 years unless we all join hands with a will to upgrade this misery-struck region. We declare no competing interests. Copyright © Naim et al. Open access article distributed under the terms of CC BY.
*Huda Naim, Roshane Shahid Rana [email protected] Dow University of Health Sciences, Dow Medical College, Saddar, Karachi, Pakistan (HN); and Civil Hospital, Saddar, Karachi, Pakistan (RSR) 1
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Thardeep Rural Development Programe. Tharparker region. http://www.thardeep.org/ thardeep/tharparker.html (accessed April 13, 2014). Sahni P, Ariyabandu MM. Disaster risk reduction in South Asia. Delhi: Prentice-Hall of India, 2003: 260. Pakistan Metrological Department. Meteorological report for Tharparkar. March 7, 2014. http://pdma.gos.pk/advisorydThar2.pdf (accessed April 13, 2014). Provincial Disaster Management Authority. Drought condition status report. April 22, 2014. http://pdma.gos.pk/new/Docs/ Drought/22.04.2014%202200%20hrs%20 Drought%20SitRep..pdf (accessed April 28, 2014). Thardeep Rural Development Programme. Drought-like situation in Tharparkar. http:// thardeep.org/thardeep/ckfinder/uploads/ Situation%20Report%20(18%20April%20 2014).pdf (accessed April 13, 2014). WHO. Pakistan-Tharparkar crisis: overview, responses, damages as of March 13, 2014. http://58.65.177.14/who-pak/Sindh%20Maps/ Tharparkar%20Overview,%20Response,%20 Damages%20as%20of%20March%2013,%20 2014.pdf (accessed April 15, 2014). Thardeep Rural Development Programme. Innocence childhood with miserable atmosphere: a rapid assessment 2007. http:// www.thardeep.org/thardeep/Publication/ PubFiles/tjx8w088wnx6child%20labor%20 rapid%20assesment%20report07.pdf (accessed Aug 7, 2014). Ministry of Planning, Development and Reforms. Pakistan Millennium Developmental Goals report 2013. http://www.pk.undp.org/ content/dam/pakistan/docs/MDGs/ MDG2013Report/UNDP-Report13.pdf (accessed April 3, 2014). Bureau of Statistics. Development statistics of Sindh 2011. http://sindhbos.gov.pk/wpcontent/uploads/2013/12/DevelpmentStatistics-2011-with-Graph.pdf (accessed April 3, 2014).
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Tharparkar: a forgotten disaster The sandy dune area of Thar and the marshy lands of Parkar, covering an area of 19 638 km,1 lie to the southeast of Sindh province, Pakistan.2 Thar is one of the most densely populated desert areas in the world. The population of 914 0001 subsists on rain-dependent agriculture and animal husbandry.2 The region faces adverse climatic conditions, with droughts every 4–5 years bringing devastation to socioeconomic conditions.2 Rainfall is irregular, with an annual average of 50–300 mm.2 Between March, 2013, and February, 2014, there was a rainwater shortfall of 30%.3 128 children and 105 adults succumbed to the disaster.4 Pneumonia, acute respiratory infection, and diarrhoea were among the major reported illnesses in children.5 Malnutrition is another serious health burden. 60% of the children admitted at the District Headquarter Hospital are malnourished, 54% moderately and 9% severely.6 The region is also suffering from administrative negligence, extreme poverty, lack of basic health facilities, and weak infrastructure, which have increased its vulnerability to the climatic misery. Travel time to the nearest health facility is 2–4 h,6 at a cost of PKR 1000–4000 (US$10–40) in a region with an average monthly income of PKR 4391 ($44).7 Women’s health is neglected, as it is in many remote villages of Pakistan. The problems are rooted in cultural beliefs and lack of reproductive heath facilities. Only 14% of births are attended by skilled birth attendants,8 and among women who conceived in the past 3 years, fewer than half made one antenatal visit.8 The district ranks last in Sindh province in terms of access to improved drinking water and sanitation.8 Fewer than half of the children are fully immunised and only 60% children younger than 1 year www.thelancet.com/lancetgh Vol 2 September 2014
are immunised against measles.8 The infant mortality rate is 87 per 1000 livebirths and maternal mortality rate 297 per 100 000 livebirths.1 The health sector in the region is facing a dearth of doctors, paramedics, medicines, and equipment. There are 150 doctors, eight lady health visitors, 32 midwives, and almost no paramedics.9 There are only three hospitals and 32 basic health units for a population of almost a million.9 We cannot expect the situation to change overnight. Continuous and collaborative efforts at the regional, national, and international level are required. Endeavours should be preventive and not just curative. Coordinated ministries, and proper documentation of records and of available facilities are immensely important to foresee an eminent crisis and for its timely management. Establishing a resilient infrastructure should be the first priority. Developing a permanent source of water, improving sanitation, and building a road network are among the major requirements. Creating employment opportunities will help to eradicate the endemic poverty. A paucity of veterinary doctors and resources in veterinary units must be taken seriously, along with the blanket vaccination of animals, given the huge impact of livestock on the economy. Because of the harsh living conditions, doctors are not willing to work; incentives should be given to deal with this issue. The availability of female doctors and specialist doctors, particularly paediatricians, gynaecologists, and physicians must be made possible. Programmes of immunisation, antenatal care, and child care should be introduced. Public sector dispensaries and maternity clinics should be set up to provide easier access. Improving health is tied to public awareness; hence the importance of antenatal care and complications associated with untrained deliveries must be explained. Parents must be educated
regarding paediatric nutrition and childcare. The need for reforms is dire. This region may suffer for the next 100 years unless we all join hands with a will to upgrade this misery-struck region. We declare no competing interests. Copyright © Naim et al. Open access article distributed under the terms of CC BY.
*Huda Naim, Roshane Shahid Rana [email protected] Dow University of Health Sciences, Dow Medical College, Saddar, Karachi, Pakistan (HN); and Civil Hospital, Saddar, Karachi, Pakistan (RSR) 1
2
3
4
5
6
7
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Thardeep Rural Development Programe. Tharparker region. http://www.thardeep.org/ thardeep/tharparker.html (accessed April 13, 2014). Sahni P, Ariyabandu MM. Disaster risk reduction in South Asia. Delhi: Prentice-Hall of India, 2003: 260. Pakistan Metrological Department. Meteorological report for Tharparkar. March 7, 2014. http://pdma.gos.pk/advisorydThar2.pdf (accessed April 13, 2014). Provincial Disaster Management Authority. Drought condition status report. April 22, 2014. http://pdma.gos.pk/new/Docs/ Drought/22.04.2014%202200%20hrs%20 Drought%20SitRep..pdf (accessed April 28, 2014). Thardeep Rural Development Programme. Drought-like situation in Tharparkar. http:// thardeep.org/thardeep/ckfinder/uploads/ Situation%20Report%20(18%20April%20 2014).pdf (accessed April 13, 2014). WHO. Pakistan-Tharparkar crisis: overview, responses, damages as of March 13, 2014. http://58.65.177.14/who-pak/Sindh%20Maps/ Tharparkar%20Overview,%20Response,%20 Damages%20as%20of%20March%2013,%20 2014.pdf (accessed April 15, 2014). Thardeep Rural Development Programme. Innocence childhood with miserable atmosphere: a rapid assessment 2007. http:// www.thardeep.org/thardeep/Publication/ PubFiles/tjx8w088wnx6child%20labor%20 rapid%20assesment%20report07.pdf (accessed Aug 7, 2014). Ministry of Planning, Development and Reforms. Pakistan Millennium Developmental Goals report 2013. http://www.pk.undp.org/ content/dam/pakistan/docs/MDGs/ MDG2013Report/UNDP-Report13.pdf (accessed April 3, 2014). Bureau of Statistics. Development statistics of Sindh 2011. http://sindhbos.gov.pk/wpcontent/uploads/2013/12/DevelpmentStatistics-2011-with-Graph.pdf (accessed April 3, 2014).
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