September Issue 2010

The trail of destruction across KP is hard to believe. In part because in some places it sneaks up on you. One village on the banks of the Kabul River in Akora Khattak doesn’t even look devastated at first glance. The roads have turned into muddy fields, but on either side of the steep slope leading to mohalla Malla there are no water-logged streets and the buildings are still standing — but in reality, some are and others aren’t. A short walk around the village reveals the unmistakable signs of the floods. Whole buildings have been reduced to piles of rubble. The devastation seemed selective, though. While one house has fallen, the one next to it stands. While the boundary wall of another building has collapsed, the walls of one across the lane are still erect. Sacks of wheat lie soaked and discarded in alleys. Piles of belongings — clothes, blankets, cushions — line the side of the road, pressed up against walls, pushed there by surging waters.

Water stains on the buildings show the level of the once raging and swollen river. The stains are above the tops of doors, many at least 12 feet above street level. But the Kabul River, which joins the Indus farther south near Attock, had actually risen much more. On August 14, the river looked like it had returned to its normal level but in fact in hadn’t: the river was still seven to eight feet above normal. Locals claim the river had risen 30 feet. Nearby, a local man says he only evacuated his family when the water started rising three feet per hour. The water-stained walls are proof of the seemingly impossible. As are the fallen buildings. So much water pushed through the narrow streets, razing homes, that now the area resembles an earthquake zone rather than a flood zone.

The world is now familiar with the tragic story. Beginning in July 2010, relentless monsoon downpours caused the most severe flooding in the history of Pakistan — a country already crippled by crises. The freak deluge displaced millions, washed away entire villages, broke the spines of bridges and devastated crops. Northern regions of the country were hit first. Torrential rains dumped almost one foot of water on Peshawar in 24 hours. In less than a week, Khyber Pakhtunkhwa received many times its annual average rainfall. And then, over the next month, bringing a new, perverse meaning to the term “trickle-down effect,” the deluge flowed south.

The images have been harrowing and the constantly ballooning statistics have been nearly impossible to comprehend: over 17 million people affected, with relief efforts spread out over one-fifth of the country, or 160,000 square kilometres, larger than the total area of either Nepal or Bangladesh. While estimated numbers of loss to life and property are impossibly high, official “reported” figures published by the Ministry of Water and Power’s Federal Flood Commission (FFC) are, for now, considerably lower. When the monsoon clouds finally dissipate, the floodwaters drain away, and the rivers shrink, more thorough assessments will be done and the gap between estimated and actual will also narrow. Whatever the final toll, the reported (not estimated) numbers are already huge. In KP alone, as of August 31, the FFC states that 544 villages have been hit, affecting over 1.5 million people. Over 108,000 homes have been completely destroyed, another 82,500 damaged. The death toll has been the worst here: 1,068 people have been killed by the floods — 63% of all flood-related deaths in the country.

After years of turmoil and pain, the people of Khyber Pakhtunkhwa have been dealt another blow — and have been let down by their government again.

Many survivors have seen their livelihoods swallowed up. “Rice was the most affected crop . . . followed by summer vegetables and maize,” said the UN’s Food and Agriculture Organization (FAO) after completing an agriculture damage assessment for KP. Seventy-one per cent of the cultivated rice paddies have been damaged in mid-August. In most areas, this translates to entire fields being wasted.

The situation for livestock is equally worrisome. Experts are warning that farmers could lose much more: remaining livestock can still die from disease and a lack of feed. The fallout could affect generations of cattle, goats and poultry. Livestock, what senior FAO officer David Doolan has described as “the poor people’s mobile ATM,” has already been devastated. Many people have seen their entire herds wiped out. Families could only save the livestock that they could carry away — the rest they had to watch drown.

Eventually, the whole country will suffer more and more, along with the small farmer. A devastating economic domino effect is in store.

Surging transportation costs have already put a dent into Support With Working Solution’s ability to get the most bang for its donated buck. The Peshawar-based poverty-alleviation NGO, known as SWWS, is finding it increasingly expensive to deliver the goods that are given to them for free. “We just sent three trucks to Upper Dir,” says Javed Akhtar, executive director. “It cost us 40,000 rupees per truck per trip.” A month ago, the same journey only cost 25,000 rupees. “The main routes are destroyed. Alternate routes are longer and slower.” Broken infrastructure, it seems, is already hobbling the economic legs of the nation. Islamabad is warning that the final economic impact may reach $43 billion.

Beyond the rising costs, the devastation has also brought increased security hazards. The route SWWS now takes to Upper Dir from Peshawar winds through areas that most Pakistanis are too scared to go to: Mohmand Agency and Bajaur Agency. When Akhtar and his team dispatch their trucks, they notify the Pakistan Army in Islamabad. “Our vehicles travel unmarked. There are no signs that we are a NGO or are carrying relief goods.” The plate numbers are the only markings, and these are circulated to the army in FATA for clearance and safety. Of course, the army has been doing more than keeping delivery trucks safe.

In Nowshera district, nearby PAF Risalpur, in the Cantonment area, six schools have been converted into relief camps for flood-hit IDPs. The six schools house approximately 6,000 people and are being run by the army. When Newsline visited Presentation Convent High School in Risalpur Cantonment on August 14, the atmosphere was, remarkably, not squalid. The army engineer corps there had set up clean drinking water. About 1,440 people were housed at this one school alone. But as most families didn’t have pots, stoves or any cooking utensils, the army set up a kitchen to cook for the IDPs. These IDPs had secure, non-leaking roofs over their heads, working toilets nearby and a well-stocked medical clinic where both female and male doctors were accessible (though the clinic was not manned by both at all times).

Photo: Talib Qizilbash

But the IDPs will not be able to stay forever: their time to depart may come sooner than later as educators push to get their classrooms back. Getting families to leave, however, may be difficult as people have lost their homes and livelihoods: they have nowhere to go.

By the first week in August, there were already concerns about outbreaks of disease in KP. Zamena Alibhai heard them firsthand at a camp in Charsadda. “There was no running water, no toilets, and people were living in crowded tents with their animals.” The combination of filthy conditions and no clean drinking water had people fearing an outbreak of cholera, an infection spread via contaminated water or food that triggers severe watery diarrhoea and vomiting and is still a major cause of death around the world. By mid-August, the first case of flood-related cholera was confirmed in Swat. However around KP, it did not spread like was initially feared.

When it comes to government action, fighting cholera may be the only area where the provincial government is getting credit. Akhtar says that the World Health Organization has set up a surveillance system and posted surveillance officers who generate daily health reports and share this data with KP authorities. As soon as cases of cholera are identified, government medical teams are put into action. Unfortunately, the state’s absence in almost all other areas has caused deep pain — its apathy, the biggest disease.

The biggest reason for the containment of disease has been the speedy relief work by NGOs. Alibhai had come from Dubai to volunteer with CDRS (Comprehensive Disaster Response Services), a healthcare-focused non-profit organisation. Alibhai says that when CDRS saw the conditions in the camp, its team immediately arranged for a huge tent to be set-up, specifically for livestock. “It seemed like there were about 200 animals, a mix of all kinds: cows, goats, chickens.”

Todd Shea, a burly red-haired musician turned relief worker and the executive director of CDRS, says the livestock tent was an example of indirect healthcare. It is not what people think of in terms of health and medicine, he says, but it is an important part of prevention. In August, CDRS had been running medical clinics across KP, shifting locations daily.

The need was huge. “Many hadn’t received any medical help at all since fleeing their homes,” says Dr Zahra Shah, a recent medical school graduate from King’s College in the UK, who was also volunteering with CDRS. The 24-year-old doctor worked as an assistant to the male doctors on staff, but her help was invaluable. At first, she was the only female doctor with them. And while she saw the female patients in a separate tent, being fresh out of school, she still had to call for a senior male doctor frequently. “There’s a really huge need for female doctors,” she says. As CDRS moved around KP, they treated 200-300 patients a day. Meanwhile, in the city, the number of sick was soaring. “The main hospital in Charsadda normally sees 20,000 patients a day — that has risen to 50,000 after the floods,” says Shea.

The doctors at CDRS found allergic rashes, upper respiratory problems and scabies to be the top three health issues. Other NGOs are discovering, more or less, the same situation. The Omar Asghar Khan Development Foundation (OAKDF), which has been carrying out different types of relief work across KP, found scabies to be the most common affliction at a recent clinic set up in Charsadda. Out of 250 patients, 70% were women and children, and scabies was so prevalent that the four-doctor medical team ran out of medicine to treat the parasitic skin infection.

Photo: Talib Qizilbash

That children are the most at risk of disease from the floods is obvious. In the humid afternoon summer, children jump, dive and play in new neighbourhood ‘lakes’ left behind by 2010’s great flood: dirty, stagnant water does not a hygienic pool make. A lack of clean water to drink, and cook and wash with, has only compounded the problem. In Dir, a region where 49,353 households have been affected by flash floods, children comprise the biggest group of patients treated by SWWS. Akhtar has sent his medical team to five locations and has treated 6,261 people: 57% have been children. Acute diarrhoea, a typical symptom of gastroenteritis, has been prevalent.

At a camp filled with Afghan refugees, there was another problem. “There was this stench and there were eye infections everywhere,” remembers Dr Shah. Conjunctivitis had spread across the filthy camp, as the disease is highly contagious: simply touching a normal eye after rubbing an infected eye with the same hand can transfer the disease. Besides seeing the patients one by one and prescribing chloramphenicol for the bacteria-infected eyes, the doctors provided the patients with some basic hygiene lessons. “We mass distributed soap, and gave rose water as a cheap form of eyewash.” Shah returned to the Charsadda-area camp a few days later with CDRS. There was widespread improvement; everyone’s eyes were better. “I was very proud,” says Dr Shah.

Outside Nowshera city, another makeshift camp has been set up by Afghan refugees. Their previous camp, Azhakhel Afghan Refugee Camp, was inundated. So the families moved across the railway tracks to an empty plot on higher ground closer to GT Road. Newsline arrived there on August 15 to find 20 tents set up. But the residents had little else besides a few belongings — though one man had many books. It turns out he was the religious leader for the community. Interestingly, he wasn’t Afghan — he hailed from Mohmand Agency.

The Afghan refugees were not alone in the area. There were tents all along GT Road in Azhakhel and down the median. Gauging the need of everyone was difficult for volunteer relief workers who had arrived to do good. Some IDPs had managed to carry tons of belongings with them: bedding, charpoys, pots. An officer from the nearby ASC centre in Nowshera Cantonment cautioned that many who have parked themselves here were not flood affectees at all, but fraudsters looking for handouts. Moreover, the attitude in KP towards Afghan refugees was harsh. One volunteer handing out food packages was adamant about not giving them anything. “The UN already looks after them.” Dr Shah encountered this same feeling in Charsadda. “They have been here for decades but are still ostracised. They have no ID cards, and so receive no help from the government.” The UNHCR is their only lifeline in bad times.

As more health relief comes to KP, CDRS is moving out to more neglected areas, including Kohistan, Shangla and Swat. There are so many places that are completely cut off, says Shea. “They are just living off whatever stores they had.” In Swat, Shea has seen roads that just disappear. “North of Bagh Deri, there is a road that runs alongside the river, but then it just ends at a cliff.” Elsewhere, he has seen towns so devastated that there is no rubble left behind. “The flood wiped it off the planet.”

In Kohistan, another town faced a similar fate. The town of Dubair was almost entirely washed away by the floods that destroyed its bazaar and main bridge that connected the area to the main Karakorum highway. OAKDF has been working hard to re-establish some links. A suspension bridge is being built, reconnecting the town to other areas and facilitating the transport of cement and labour for reconstruction. The NGO is also building mechanised cable cars to take people from Shangla to Battagram. Access has become a huge issue: too many people who require medical aid are not getting it.

While food and medicine are still the priority in most areas, the priorities are starting to shift. As people return to their villages and homes in an attempt to start anew, there is a growing need for household items: bedding, basic kitchen items. Around Nowshera district and elsewhere, many of the buildings that have been left standing may have to be knocked down anyway. They have suffered more than watermarked walls. Too much water has seeped into many foundations, too many load-bearing walls have been weakened. A KP Provincial Disaster Management Authority report says the housing sector alone needs Rs 78 billion (about $922 million).

Almost five years after the earthquake that shook Pakistan’s north, the state seems to have learned little and was caught ill-prepared. There is no basic plan, says Rashida Dohad of the Omar Asghar Khan Foundation. “What should a citizen expect? Where are the policy guidelines?” Even now the state is absent. The government is not on the ground and compensation schemes in the north are still not finalised. It took until August 23 for the provincial government to approve a cash grant of Rs 20,000 to each affected household, and it still has not released the final compensation packages for fully and partially damaged houses; it says it must first complete a detailed damage assessment.

The only redeeming part of the state is the military. Their resources and expertise in logistics have proven them to be the only strong and reliable part of the state machinery. Citizens and the media are openly crediting them for their relief work. But some are cautious about praising the army. One journalist, who saw their work firsthand and wishes to remain anonymous, remarked, “If they hear it too much, they may mistake it for an invitation to take over the government.”

Military or otherwise, a drastic change is desired by people across the country. Todd Shea described the people he met across KP as resilient. “It is hard to imagine what they have been through. And they have not given up.” But that does not mean they are content. “I do see anger,” says Shea. “Many people I’ve met do not think things have moved fast enough.”

How they channel that anger may have a bearing on the future of the civilian government, and the country. For how long will the battered poor of Khyber Pakhtunkhwa accept the neglect that Pakistan heaps on them, day in and day out?

Related articles:

Apocalypse Now by Sairah Irshad Khan
The floods have stripped bare the ugly face of a feudal-sardari system and its umbilical connect with politics and bureaucracy that have together created an underclass so wretched that it has nothing left to lose.

Who’s to Blame? by Abdul Wahab
Official inaction and haste to secure agricultural land in Balochistan has drowned cities and rendered millions homeless.

Religious Mission or Political Ambition? by Shahzada Irfan Ahmed and Ayesha Siddiqa
With their well-organised relief efforts, the religious and militants outfits pose the threat of making significant inroads in the flood-affected regions.

Disastrous Winds of Change? by Afia Salam
Are the floods in Pakistan a result of climate change or are they human-induced?

Technology to the Rescue by Sana Saleem
ICT and social media tools are being used to map and garner support for individual relief efforts.