Pakistan: Working for the best, preparing for the worst

In the aftermath of any disaster suddenly hitting a population, the immediate impact in terms of deaths and injuries is often followed by other health risks that can be linked to difficult living conditions, lack of hygiene and restricted access to clean water and basic health care services. The recent Pakistan floods are no exception; presently, Médecins Sans Frontières and others are working hard to avoid outbreaks of disease and to provide essential health care to a population in need.

From the outset of the current crisis, Médecins Sans Frontières continued to provide health care in existing programmes in Khyber Pakhtunkhwa and Baluchistan, in addition to expanding its scope of activities to new health structures and setting up mobile clinics in other affected provinces of Pakistan like Sindh and Punjab.

Currently, the most common diseases seen in our clinics are linked to the difficult living conditions and lack of access to water.

“Out of more than 10,000 consultations in the last two weeks, the most common diseases we are treating are skin infections, respiratory diseases and acute diarrhoea” said Dr. Ahmad Mukhtar, medical coordinator for Médecins Sans Frontières in Pakistan.  “Among those patients, there are some suspected cholera cases, and while we wait for official confirmation, we continue to provide them with the necessary treatment”.

In the eight mobile clinics that Médecins Sans Frontières is running in different areas of Pakistan, approximately 10% of the 10,000 patients seen so far have been treated for Acute Watery Diarrhoea. In Swat alone, the medical teams have carried out a total of 321 consultations out of which, 24 people were admitted to the Médecins Sans Frontières Diarrhoea Treatment Centre in Mingora hospital.

Cholera is endemic in some parts of Pakistan, including the flood affected areas of Khyber Pakhtunkhwa, so the few possible cases would not be very surprising. In Lower Dir district of this very same province, Médecins Sans Frontières treated 2500 patients when cholera broke out in August 2009.

Cholera is a disease that you can contract by ingesting infected water or food, and it can spread very easily in unhygienic conditions.  Once contracted, cholera prevents one’s body to hold on to water, and this leads to rapid dehydration. By providing oral rehydration salts, or through intravenous drips for more severe cases, the disease can be overcome fairly easily. 

“Cholera is one of the severe forms of acute diarrhoea. However, a few suspected cases do not mean that we’re on the verge of an outbreak” added Dr. Ahmad Mukhtar. “We need to remain very vigilant and make sure that we keep identifying and treating people with acute diarrhoea as soon as possible. We treat people with acute diarrhoea exactly as if they had cholera. Our staff in mobile clinics and in hospitals play a vital role in identifying and following up possible cases in the community”.

The floods, and ongoing rain, obviously make the situation more challenging as people have limited access to clean water and hygienic living conditions continue to worsen. For this reason, Médecins Sans Frontières teams are also working hard to improve people’s living conditions and access to water.

Every day, Médecins Sans Frontières provides more than 300,000 litres of clean water per day to affected communities in different parts of the country. In places like Nowshera or Charsadda, water tanks are placed in different neighbourhoods and refilled regularly. In other places like Swat Médecins Sans Frontières works with the community to make sure water is provided and shared at different places where people gather like mosques and schools.

Throughout Pakistan, Médecins Sans Frontières has distributed different kits to more than 50,239 people so far. In Fadfedar canal in the province of Baluchistan, distributions of hygiene kits and cooking sets have also included chlorine tablets (to clean water) and mosquito nets to prevent malaria infection.  Health promotion activities are carried out in conjunction with these distributions in order to guide people on how to best purify water with the available resources.

If an outbreak – a steep increase in the number of cases – were to occur, Médecins Sans Frontières is ready to respond by expanding its intervention in terms of treatment of acute diarrhoea.  Emergency kits are already prepositioned in the majority of health facilities where Médecins Sans Frontières is working. However, the teams are hopeful that the delivery of water and large-scale distributions of hygiene kits and cooking sets (covering more than 7,000 families to date for Médecins Sans Frontières alone) will provide the necessary conditions to avoid the spread of any disease like cholera, but also scabies, dysentery, typhoid and malaria.

Without a doubt, much more still needs to be done to provide even basic relief to people in the flood affected areas of Pakistan; more than two weeks after the onset of the floods, too many people have still received too little.

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