Months after historic flooding that killed more than 1,700 people, Pakistan is still struggling to recover. The UN is warning it might suspend its food support program for flood victims because it is running out of money. Fred de Sam Lazaro reports from Sindh, one of the hardest-hit provinces. This story is part of the series Agents for Change and produced in partnership with the Pulitzer Center.
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Amna Nawaz: Months after Pakistan's historic flooding that killed more than 1,700 people, the South Asian nation is still struggling to recover.
And the United Nations is warning it might soon have to suspend its food support program for flood victims because it's running out of money.
Fred de Sam Lazaro has the latest from one of the hardest-hit provinces of Sindh.
This story is produced in partnership with the Pulitzer Center and part of Fred's series Agents for Change.
Fred de Sam Lazaro: Pakistan is no stranger to flooding. But, this time, the water never left. Huge swathes of land, farms and towns, remain underwater.
Four months after the flood, this school in the Dadu district, like so many others, remains inaccessible to students, its first floor still completely inundated. The building used to be surrounded by rice fields. It's now surrounded by a lake. The school community is now scattered among some of the five million people still living in flimsy shelters like these.
Sumar Machhi, Flood Victim (through translator): Our house is broken. Our animal livestock has been lost. Our homes have collapsed. My son died. We have nothing. We're just sitting here helpless.
Farzana Machhi, Flood Victim (through translator): Our house fell down. My brother died in the flood. He fell in the river and died.
Fred de Sam Lazaro: Scientists blame a cataclysmic combination of glacier melts and monsoon rains, both intensified by climate change. It poured without interruption for days in a row, overwhelming a country that was ill-prepared and under-resourced.
Simi Kamal, Hisaar Foundation: When we have these climate calamities, everyone's affected, but women and children are affected in particular.
Fred de Sam Lazaro: Simi Kamal heads a Karachi-based foundation focused on development issues.
Simi Kamal: In a society where social services are almost completely absent, and a lot of people survive on philanthropy and charity.
Fred de Sam Lazaro: The school in Dadu is one example, one of 1,800 run by a private charity called The Citizens Foundation. Before the flood, some 700 children attended the school. Now only about half the students have returned to a makeshift, mostly outdoor facility in a community center.
Shabroz Mirani, The Citizens Foundation (through translator): The children are in extreme trauma. They're suffering from lots of difficulties. They don't have proper homes or food to achieve their goals.
Fred de Sam Lazaro: Principals Shabroz Mirani and Abrim Babar (ph) no longer have access to the library, school records or electricity, but they persist, trying to bring some stability to the children's lives.
How many children in the school today have eaten lunch?
Shabroz Mirani: So, we have lots of — a lot of students that don't have — don't eat anything.
Fred de Sam Lazaro: Malnutrition is made that much worse by living conditions. Standing water has drowned crops and spawned pathogens. Malaria, dengue skin and diarrheal diseases have all soared.
About 500 children are brought into the pediatric emergency room at this hospital every single. That's more than double the number prior to the flood. And they are coming in far sicker.
This E.R. in the town of Larkana is run by the ChildLife Foundation, a separate charity that partners with struggling public hospitals to modernize pediatric emergency care across the country.
Dr. M. Sohail Akbar, ChildLife Foundation: During flood, we have seen gastroenteritis, pneumonia, and malaria. That was common.
Fred de Sam Lazaro: Dr. Sohail Akbar works in the labor and delivery and neonatal units.
Dr. M. Sohail Akbar: But now malaria number is increased, and now also have malnutrition, and also the preterm babies, because preterm…
Fred de Sam Lazaro: Preterm babies.
Dr. M. Sohail Akbar: Yes, preterm babies, because the mother, pregnant female, she is not having enough nutrition.
Fred de Sam Lazaro: On this day, Dr. Akbar was discharging 4-month-old baby Mohammed Bilal (ph), who was rushed here by his parents in severe breathing distress.
A day later, with antibiotics and oxygen therapy, he was stabilized, able to breast-feed and breathe on his own. The care package of nutrition supplements will help a bit, but young Bilal seriously underweight at just 4.5 pounds, was hardly in good health as his family brought him home from the hospital to a tent that sits amid the rubble of the home they lost.
It collapsed on the second day of the rains. Already deep in debt for a motorcycle taxi business, Bilal's father, Izhar Ul Haq, has no idea how they will rebuild.
Izhar Ul Haq, Flood Victim (through translator): The doctor has said that we have to be very careful of cleanliness. We have to keep the child warm. We have to ensure the child has medication.
Fred de Sam Lazaro: Doctor's instructions they're not sure they can afford; 2-year-old daughter Tanzila (ph) has also had health problems, including malaria, says grandmother Musrat Khatoon who lives with the young family.
Musrat Khatoon, Flood Victim (through translator): It's been a very tough time. I'm a mother. My prayers are that my daughter has a good life, but she does not. We now will pray that our grandchildren will have better lives than their mother dies.
Fred de Sam Lazaro: Whether that generational cycle of hope and despair for millions of families will be broken this time is an open question.
Simi Kamal is skeptical.
Simi Kamal: We had horrible floods 10 years ago. We never learned anything from it. No, we don't have the political will to actually build the kind of local government we need and government at every tier to be able to tackle these problems.
And they are going to keep happening. But that doesn't mean we don't take action. So, each one of us has to take action by speaking up, by writing, by supporting or lobbying for change.
Fred de Sam Lazaro: Officials say it may take until the early weeks of this year for the remaining water to disappear, for farmland to be farmed again.
For the "PBS NewsHour," I'm Fred de Sam Lazaro in Sindh Province, Pakistan.
Amna Nawaz: Tomorrow, Fred's next report will explore some of the reasons why the flooding has been so bad and what could have been done to prevent another disaster.
And a reminder, Fred's reporting is a partnership with the Under-Told Stories Project at the University of St. Thomas in Minnesota.