As new areas of Pakistan are affected daily by floods, the zones that had received the first blows suffer another rise in water levels. The continuous and sometimes heavy rains that have fallen on Khyber Pakhtunkhwa and Baluchistan provinces have significantly impeded humanitarian and medical aid. As Médecins Sans Frontières (MSF) teams on the ground struggle to deal with the consequences of the initial floods, more MSF staff are now assessing the needs in the newly affected provinces of Punjab and Sindh. Heavy rains in the last days disrupted delivery of desperately needed items such as soap, buckets, toothpaste and cooking utensils. In Noshwera, an MSF team had to postpone a distribution of basic relief items to around 4,500 families as the place identified had been flooded.

© Ton Koene. Water distribution in a village near Charsadda, Pakistan.

© Ton Koene
Water distribution in a village near Charsadda, Pakistan.

“The place we had identified to organize this major distribution is under one metre of water,” said Anthony Thouvenin, emergency coordinator for MSF in Nowshera. ”Two days ago it was dry, but the water rose very quickly. Now we’ll have to explain to people that the delivery of much-needed goods will have to be delayed by at least one day. Our team is frustrated, but this is nothing compared with affected people who really need help.” Hangu district, spared until now, was hit by flash floods this weekend, affecting the hospital where MSF has a diarrhea treatment centre and surgical activities. Houses were also destroyed and a displaced people’s camp suffered damage as well. MSF immediately donated materials to support the local health centre, and is still trying to get more information about the aftermath of the flash floods. In Baluchistan, the road between Dera Murad Jamali and Khabula was flooded and prevented an MSF truck from reaching a planned distribution point and the team had to use four-wheel drive vehicles to carry out a distribution of hygiene and relief items kits to 1,000 families. The distribution will continue throughout this week.

© Ton Koene. MSF mobile clinic in Utmanzai, about 45 minutes from Peshawar, Pakistan.

© Ton Koene
MSF mobile clinic in Utmanzai, about 45 minutes from Peshawar, Pakistan.

Despite the challenges, MSF continues to provide drinking water, relief goods and medical care to thousands of people in dire need in Nowshera, Peshawar and Charsadda, and to large groups of people around Manjoshori in Baluchistan.

Medical activities

Medical activities are continuing, with mobile medical teams providing care in places, mainly schools, where displaced people are staying.  New mobile clinics are expected to start today in Baluchistan, Malakand and Swat and Peshawar divisions, focusing on those populations who have no access to health facilities right now. MSF continues to support health structures but the constant changes in the level of water also make families move from one place to the other, making the delivery of aid challenging. The number of consultations at the Pabbi hospital, in Nowshera, for example, changes from 100 to 350 per day depending on new floods alerts.

© Ton Koene. MSF distributing kits containing non-food items – including blankets as well as cooking and hygiene sets – to about 500 families displaced from their homes. They have temporarily settled near the highway between Charsadda and Peshawar and have been given tents by the UN.

© Ton Koene
MSF distributing kits containing non-food items – including blankets as well as cooking and hygiene sets – to about 500 families displaced from their homes. They have temporarily settled near the highway between Charsadda and Peshawar and have been given tents by the UN.

In the Nowshera DHQ Hospital, the installation of generators now allows the emergency room to remain open 24 hours a day. After rehabilitation, the outpatient department is now also functional – though patient numbers decreased during the rainy weekend, more than 320 consultations took place last Friday. Three ambulances have also been provided, ensuring around 10 referrals per day so far. In all health facilities run by MSF, the most common pathologies remain linked to the living conditions. The situation is similar in MSF medical programs that existed before the floods – in Dargai, Malakand and Swat district – where the teams have started new mobile clinics. “One out of three patients that we see here has a skin infection,” said Dr Majid, a Pakistani doctor working in one the mobile clinic north of Charsadda. “The fact that people live very closely together in wet and unhygienic conditions is a major factor. Other diseases like diarrhea are also very common.”

Clean water desperately needed

One way to prevent the spread of disease is to ensure access to clean water. MSF water and sanitation teams are working hard to provide water to communities. In places like Charsadda, Nowshera and Swat, teams are supporting the local authorities to rehabilitate the local water delivery system while trucking water to families who need it. “Our priority is to provide drinking water to as many people as possible,” said Thomas Batarday, who manages the water deliver program in Charsadda. ”We are delivering more than 85,000 litres every day and that’s on top of the 21 water points we set up in the city. We’ll keep that set up until the water delivery system is functioning again.” Water points have also been set up in Lower Dir and in eight localities in Swat, providing access for approximately 100,000 people. In addition, MSF also provides clean water to the district hospital in Lower Dir and is working on restoring drinking water provision in the Nowshera through system rehabilitation and water trucking.

New provinces badly affected

More assessments will take place in most affected areas as it is believed many pockets of people remain isolated and have not received any aid yet. But weather has prevented MSF from carrying assessments by helicopter the last few days. The situation in the provinces of Punjab and Sindh is a major cause of concern. The authorities have been organizing the evacuation of hundreds of thousands people as heavy rains have been pouring over the last few days. An assessment team of five MSF workers, including two doctors, left today for Muzaffargarh district, Punjab province, and another team will be evaluating the needs tomorrow in Kashmor, Sindh province. A first cargo plane carrying 60 tonnes of water and sanitation equipment, drugs and logistical material has arrived in Pakistan and will be followed by 50 additional tonnes of relief supplies in the next few days. More than 100 international staff are currently working alongside 1,200 Pakistani in MSF programs in Pakistan.

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