Pakistan: MSF boosts relief work in Sukkur, Sindh province

Displaced by water

The battered sign reads: “Welcome to Sukkur: City of Rivers and Canals”.

More than five weeks have passed since the floods first struck Pakistan, and some of the water has started to recede in provinces like Khyber Pakhtunkhwa; but as it travels south, where fresh floods have hit Sindh recently, it forces hundreds of thousands to leave their homes.

Fleeing Jacobabad, Kashmore, Shikarpur, Shadadkot- more than 500,000 people have arrived to Sukkur- this city of rivers and canals, in the North of Sindh province is now home for those displaced by water. Reportedly, one out of every three people in Sukkur is a newcomer, seeking dry shelter anywhere: empty school buildings, streets, and even old railway lines are full of people who need food, medicine and safe water.

Mohssen ALI, 54, and his family of ten were among the first to settle in a land plot in Sukkur town where Médecins Sans Frontières (MSF) has distributed tents to 150 families. “It took me years to make a house for my family, and now it’s just a pile of mud.” he said. “The water drove us out of Kashmore so quickly; I couldn’t even get my wife her medicine. She has a chronic heart problem and I don’t know how long she will last without her pills. I can’t even buy food for my children. I’m their father, I have to take care of them, but I can’t. What are we going to do?”

Medical care
Improving access to essential healthcare services is one of the priorities of MSF teams working in Sukkur today. “The influx of people has stretched the capacity of the 13 hospitals in this area to the limit. At least half of the people being seen in hospitals now are from the displaced population. I’ve seen 3 or 4 patients on the same bed.” recalled nurse Anja BRAUNE, who is in charge of MSF medical activities in Sukkur.

To reach those who cannot even get to the health centers, MSF teams are now conducting mobile clinics in various locations around the area. Screening for malnutrition is also one of the main components of the mobile clinics. By measuring the middle upper arm circumference (MUAC), health workers are able to identify moderate to severely malnourished children who need extra support, and refer them to the recently opened MSF run Intensive Therapeutic Feeding Center in Railway hospital.  

To prevent dehydration, setting up oral rehydration salt (ORS) points is another one of the essential activities of teams working in the area. Established in camps and schools and staffed by two health workers, these sites provide ready rehydrating solution for anyone who needs it. MSF nurse Petra Frankuizen is in charge of setting up more than 9 ORS points and training the 15 health workers who all come from Sukkur. “The heat is unbearable, and the water is contaminated.  The combination of the two means that a lot of people, especially children are thirsty and dangerously dehydrated” said Petra.

The poor living conditions, including bad hygiene and sanitation are quickly transforming the schools and makeshift camps into sites where waterborne diseases, like acute watery diarrhea, can flourish. Epidemiologist Todd SWARTHOUT has been working to get a better picture of the health needs of the displaced in Sukkur, “one of the main challenges is the size of the area and the overwhelming number of people” he said, “I’ve visited schools where hundreds are using the same toilet. Cramped spaces, with poor sanitation and too many people is simply a breeding ground for disease”.

Low Quantity, Poor Quality Water
In Sukkur, there are three main treatment plants drawing water from the Indus River, which is the main source of water. However, the river has a very high turbidity- a measure of cloudiness- this means that an efficient filtration system is essential for the water to be useable. Although some people can afford to purchase drinking water from private vendors, for the remaining majority the only water that is available is low in quantity and poor in quality.

For this reason, the provision of safe water is another main priority for MSF staff working in Sukkur. Teams have installed two 5000 liters refillable containers in an Internally Displaced People’s camp, as well as put in place a purification system that treats water directly from one of the town’s water plants.

“We are targeting the health structure so that at least sick people are not given the same bad water that made them ill in the first place, ” explained Imran ALI, MSF water-sanitation technician.

By putting in place an Assisted Direct Pressure (ADP) filtration system, up to 80,000 liters of safe water is now being provided daily to health structures around Sukkur, but still more needs to be done.

“The situation is very precarious here, because there is no chlorination happening anywhere.  If there is any contamination that enters the river, it’s going to wind up directly in people’s homes, boreholes and wells, making everybody ill”, he continued.

Nowhere to go
Clearly, the relief efforts of national and international organizations working in Sukkur must scale up and continue in order to match the various needs of the displaced there.  In a few weeks the schools are due to reopen, which means that most of the people huddled in the, for now, empty school buildings will need to find another place to go.  Children like 12 years old Yasmeen HAJ, will bear the consequences of the floods long after the water recedes. “Maybe it is weeks or months from now, but everybody is praying to go home eventually”, she said, “Baba died last year, and we lost our mother in the floods. My brother is only five, so I’m his mother now. We have nowhere to go back to”.

Since 1988, MSF has been providing medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care and natural disasters in KPK, FATA, Balochistan, Sindh, Punjab, and Kashmir.

Since the start of the floods in Pakistan MSF has distributed 24,834 non-food item kits and 6,801 tents; performed 27,151 medical consultations; set up 7 Diarrhoea Treatment Centres; continuously conducts 12 mobile clinics; distributes 718,000 litres of clean, safe water per day; built 258 latrines and installed 11 Oral Rehydration Salt points.

152 international staff are working alongside 1,279 Pakistani staff in MSF’s existing and flood response programs in Pakistan.

MSF does not accept funding from any government for its work in Pakistan and chooses to rely solely on private donations.