Sukkur, Pakistan: Frontline of the Flood (Part 1 of 2)

The pilot of our puddle-jumper, flight PK 532, adroitly maneuvers past the flood's residual cesspools and onto the tarmac of Sukkur's tiny domestic airport. The morning sun illuminates the nearby lagoons and reveals the yellowed stalks of submerged crops peeking through the fetid water. Ground zero of the floods, Sukkur is the third largest city in the Sindh province and situated on the west bank of the Indus River. The floods turned the city's lifeline, the mighty Indus, into a deathtrap (ironically, Sukkur's nickname in Sindhi is "Darya Din," which means "gift of the river"). The Pakistani army evacuated approximately 350,000 people from low-lying areas of the Indus basin where raging waters swallowed farmlands, knocked down buildings, and submerged entire villages.

Today, using Sukkur as a microcosm of Pakistan, I explore the impact of the flood on every facet of the city. Dotted with an estimated 200 camps for internally displaced people, Sukkur is a veritable refugee city. Doctors are struggling to quash a small-scale cholera outbreak, address chronic malnutrition, and curb the alarmingly high maternal mortality rate. Since the municipality requisitioned schools for IDP camps, thousands of students remain out of classes, their education interrupted indefinitely. The floods also disrupted the supply of fruits to Sukkur, from Peshwar peaches to Swat apples, and caused the price of milk to skyrocket since cattle were marooned in the hinterlands. No aspect of Sukkur remains unaffected by the floods, including the city's indigenous blind dolphin population.

My guide for the day is a local named Afzaal Shaikh, a wildlife photographer and dolphin conservationist who runs a construction business in Karachi. Shaikh, a burly man with a broad build and moon-shaped face, jumped into action when he learned the floodwaters were rapidly approaching his city. "We went through the streets with a loudspeaker announcing the water was coming, but people thought we were crazy," recollected Shaikh in his deep, guttural voice. "Then, when the waters came, there was such a huge panic. People were going from one side to the other.They were running in every direction and nobody knew what was happening. We used wooden boards as rafts to rescue the people and cattle. Our entire infrastructure network was destroyed by the flood."

Years earlier, Shaikh had envisioned starting a non-profit organization to bolster the infrastructure and health facilities in the Sindh province. After the floods, Shaikh refocused his nascent organization on flood relief efforts. "Our family came together and requested money from our closest friends because we have a personal connection to this city," explained Shaikh. "We know this city, we understand its layout, and we did not want to see it drown."

The organization, V Need U, defrayed the cost of Sukkur's main hospital and provided free food, medicine, and shelter for 3,000 people in an IDP camp that Shaik continues to run today off Airport Road in Sukkur. Shaikh, whose family owns a real estate business, says he raised Rupees 80,00 [USD $928] on the first day of his appeal. "We immediately started distributing [fortified] biscuits and milk to the children," said Shaik. "Today, fifty of our closest friends and family keep the [grassroots initiative] running."

Shaikh's organization also deploys ambulances to remote areas and transports flood victims to the main hospital in Sukkur. As we walk through the hospital, he points to medical gurneys stacked in the hallway and says, "Right after the flood, we had to set up extra beds and cots in the waiting room because there were too many people." He added, "many of these people were suffering from ordinary problems [not related to the flood] but the hospitals in their province or district were submerged so they all came here."

At its campsite, V Need U provides weekly rations, including wheat flour, rice, sugar, tea, cooking oil, and vegetables to the registered camp members. "We had to register everyone, because some [people] would put their name down with every camp and then collect multiple rations from two, three, four camps so they could sell the lentils and flour for profit," says Shaikh. "Some people were getting too much and others not anything at all." Selling food rations isn't the only way that people who have lost their possessions and livelihood are trying to make a little extra money and support their families. A doctor in Karachi, Rehan Mohsin, told me that displaced people sometimes requested medicine from the free clinics and then sold the medicine for cheap on the local black-market. "We used to give all the antibiotics [for the entire course] in one shot but then realized that people were selling the antibiotics," Mohsin had explained. "So, we broke the seal [of bottles] to stop them from selling the medicine."

Shaikh's organization benefits from 18 staff members, 2 doctors, and 2 teachers who visit the campsite routinely. V Need U also provides literacy classes for the children for 2 hours each day. "The kids come to class because that's when we distribute the cookies and sweets," explains Shaikh. "We also arrange volleyball, soccer, and carom for the children." Most of the children say they are happy to have a coveted spot in the V need U camp. A shy 7-year-old girl with large, green eyes tells me she was scared when the floods came to her village. "I did not know how to swim," said Farida Kharapour in a barely audible whisper while fiddling with the maroon scarf draping her henna-streaked hair. "I am happy we came here." Nearby, a pile of cow dung used to light a cooking fire is attracting gigantic flies with metallic-blue bodies.

Walking through the camp, I speak with several refugees including a young mother who picks up her skeleton-thin boy with a bulbous cranium. "He is sick," she says stoically. The woman then clinically removes her child's shirt to reveal a turgid belly protruding from malnutrition. Another mother shows me her 8-month-old baby, Azizlal, whose blood-shot eyes suggest he's contracted conjunctivitis. The child next to Azizlal is bowlegged and seems to suffer from rickets or another form of vitamin deficiency. A woman named Razia Ghulam rocks her newborn in her arms and explains, "When the water came for us, it was the height of man so we were very scared." Ghulam continues, "My husband and I lost two children already. They were born dead." Gesturing to the infant in her arms, she said, "When the floods came, we were scared we would lose this one too." While working in the IDP camps, relief workers such as Shaikh say they slowly realized that Pakistan's child malnutrition rate was dismal long before the monsoon rains arrived. "We have doctors, including eye-specialists, who visit routinely, but we need a nutritionist," says Shaikh.

With downcast eyes and noticeable pain, many of the adults in the camp speak of watching their livestock, their sole asset, drown during the floods. "We could not save our buffalo," said Ghulam, the new mother. "We could not save our cattle, donkeys, or bull . . . so, now we have nothing." According to Shaikh, in the weeks following the floods, the few families able to save their livestock, especially water buffalos, sold them for 20 percent their worth. "People especially needed quick cash because the price of food and milk skyrocketed," said Shaikh. "Many times, the livestock was sick or starved, and died shortly after the sale." I later spoke with Farooq Hashmi of Engro Foods at the Olpers Factory in Sukkur who confirmed, "Our production [of milk] dropped by half because the cattle were stranded in the highland." He added, "Our juice production was affected because no fruits were available." Shaikh says the migrant laborers who came to Sukkur to pick prunes and dates also suffered a loss in crop yield.

After leaving the V Need U encampment, we visit a mobile cholera clinic that was started by Canadian doctors with specialties in water-born diseases. The medical staff at Indus Hospital now runs the clinic. "The Canadians brought everything we needed and worked nonstop in the extreme summer heat," said Raheel Ahmed, a field worker affiliated with Indus Hospital. "They did a lot of good work and helped the ordinary people so we are very grateful for them. They treated us with respect and were not condescending. We are so happy they came to train us how to treat cholera." Ahmed says the camp has 12 cholera patients right now and only one patient, a 7-month-old infant, has died so far. "We are very worried we will have more cholera cases if the water situation does not improve," said Ahmed. He noted that the medical camp also treats patients for malaria, dysentery, cholera, acute gastroenteritis, conjunctivitis, anemia, ulcers, and water-born skin diseases.

Dr. Umair Umair, a field medic who works in the ICU at Indus Hospital, notes that providing pre-natal and post-natal care in the camps is extremely difficult. "Our biggest challenge is the high maternal mortality rate," explains Umair. "We just don't have the property facilities out here. Every third or fourth woman is pregnant." The United Nations Population Fund (UNFPA) estimates there are 400,000 pregnant women among the 20 million flood-affected people in Pakistan. The U.N. humanitarian office says that UNFPA has assisted in delivering an estimated 5,600 babies since the floods began, but the relief camps remain in dire need of gynecologists and pediatricians to help displaced mothers and their newborns.

This post was updated on October 18, 2010.