Tharparkar: a forgotten disaster
Authors: Roshane Shahid Rana, Huda Naim
Journal: The Lancet Global Health (2014)

The sandy dune area of Thar and the marshy lands of Parkar, covering an area of 19 638 km,1Thardeep Rural Development ProgrameTharparker region.http://www.thardeep.org/thardeep/tharparker.htmlGoogle Scholar lie to the southeast of Sindh province, Pakistan.2Sahni P Ariyabandu MM Disaster risk reduction in South Asia. Prentice-Hall of India, Delhi2003: 260Google Scholar Thar is one of the most densely populated desert areas in the world. The population of 914 0001Thardeep Rural Development ProgrameTharparker region.http://www.thardeep.org/thardeep/tharparker.htmlGoogle Scholar subsists on rain-dependent agriculture and animal husbandry.2Sahni P Ariyabandu MM Disaster risk reduction in South Asia. Prentice-Hall of India, Delhi2003: 260Google Scholar The region faces adverse climatic conditions, with droughts every 4–5 years bringing devastation to socioeconomic conditions.2Sahni P Ariyabandu MM Disaster risk reduction in South Asia. Prentice-Hall of India, Delhi2003: 260Google Scholar Rainfall is irregular, with an annual average of 50–300 mm.2Sahni P Ariyabandu MM Disaster risk reduction in South Asia. Prentice-Hall of India, Delhi2003: 260Google Scholar Between March, 2013, and February, 2014, there was a rainwater shortfall of 30%.3Pakistan Metrological DepartmentMeteorological report for Tharparkar.http://pdma.gos.pk/advisorydThar2.pdfDate: March 7, 2014Google Scholar 128 children and 105 adults succumbed to the disaster.4Provincial Disaster Management AuthorityDrought condition status report.http://pdma.gos.pk/new/Docs/Drought/22.04.2014%202200%20hrs%20Drought%20SitRep..pdfDate: April 22, 2014Google Scholar Pneumonia, acute respiratory infection, and diarrhoea were among the major reported illnesses in children.5Thardeep Rural Development ProgrammeDrought-like situation in Tharparkar.http://thardeep.org/thardeep/ckfinder/uploads/Situation%20Report%20(18%20April%202014).pdfGoogle Scholar Malnutrition is another serious health burden. 60% of the children admitted at the District Headquarter Hospital are malnourished, 54% moderately and 9% severely.6WHOPakistan-Tharparkar crisis: overview, responses, damages as of March 13, 2014.http://58.65.177.14/who-pak/Sindh%20Maps/Tharparkar%20Overview,%20Response,%20Damages%20as%20of%20March%2013,%202014.pdfGoogle Scholar The region is also suffering from administrative negligence, extreme poverty, lack of basic health facilities, and weak infrastructure, which have increased its vulnerability to the climatic misery. Travel time to the nearest health facility is 2–4 h,6WHOPakistan-Tharparkar crisis: overview, responses, damages as of March 13, 2014.http://58.65.177.14/who-pak/Sindh%20Maps/Tharparkar%20Overview,%20Response,%20Damages%20as%20of%20March%2013,%202014.pdfGoogle Scholar at a cost of PKR 1000–4000 (US$10–40) in a region with an average monthly income of PKR 4391 ($44).7Thardeep Rural Development ProgrammeInnocence childhood with miserable atmosphere: a rapid assessment 2007.http://www.thardeep.org/thardeep/Publication/PubFiles/tjx8w088wnx6child%20labor%20rapid%20assesment%20report07.pdfGoogle Scholar Women's health is neglected, as it is in many remote villages of Pakistan. The problems are rooted in cultural beliefs and lack of reproductive heath facilities. Only 14% of births are attended by skilled birth attendants,8Ministry of PlanningDevelopment and ReformsPakistan Millennium Developmental Goals report 2013.http://www.pk.undp.org/content/dam/pakistan/docs/MDGs/MDG2013Report/UNDP-Report13.pdfGoogle Scholar and among women who conceived in the past 3 years, fewer than half made one antenatal visit.8Ministry of PlanningDevelopment and ReformsPakistan Millennium Developmental Goals report 2013.http://www.pk.undp.org/content/dam/pakistan/docs/MDGs/MDG2013Report/UNDP-Report13.pdfGoogle Scholar The district ranks last in Sindh province in terms of access to improved drinking water and sanitation.8Ministry of PlanningDevelopment and ReformsPakistan Millennium Developmental Goals report 2013.http://www.pk.undp.org/content/dam/pakistan/docs/MDGs/MDG2013Report/UNDP-Report13.pdfGoogle Scholar Fewer than half of the children are fully immunised and only 60% children younger than 1 year are immunised against measles.8Ministry of PlanningDevelopment and ReformsPakistan Millennium Developmental Goals report 2013.http://www.pk.undp.org/content/dam/pakistan/docs/MDGs/MDG2013Report/UNDP-Report13.pdfGoogle Scholar The infant mortality rate is 87 per 1000 livebirths and maternal mortality rate 297 per 100 000 livebirths.1Thardeep Rural Development ProgrameTharparker region.http://www.thardeep.org/thardeep/tharparker.htmlGoogle Scholar The health sector in the region is facing a dearth of doctors, paramedics, medicines, and equipment. There are 150 doctors, eight lady health visitors, 32 midwives, and almost no paramedics.9Bureau of StatisticsDevelopment statistics of Sindh 2011.http://sindhbos.gov.pk/wp-content/uploads/2013/12/Develpment-Statistics-2011-with-Graph.pdfGoogle Scholar There are only three hospitals and 32 basic health units for a population of almost a million.9Bureau of StatisticsDevelopment statistics of Sindh 2011.http://sindhbos.gov.pk/wp-content/uploads/2013/12/Develpment-Statistics-2011-with-Graph.pdfGoogle Scholar We cannot expect the situation to change overnight. Continuous and collaborative efforts at the regional, national, and international level are required. Endeavours should be preventive and not just curative. Coordinated ministries, and proper documentation of records and of available facilities are immensely important to foresee an eminent crisis and for its timely management. Establishing a resilient infrastructure should be the first priority. Developing a permanent source of water, improving sanitation, and building a road network are among the major requirements. Creating employment opportunities will help to eradicate the endemic poverty. A paucity of veterinary doctors and resources in veterinary units must be taken seriously, along with the blanket vaccination of animals, given the huge impact of livestock on the economy. Because of the harsh living conditions, doctors are not willing to work; incentives should be given to deal with this issue. The availability of female doctors and specialist doctors, particularly paediatricians, gynaecologists, and physicians must be made possible. Programmes of immunisation, antenatal care, and child care should be introduced. Public sector dispensaries and maternity clinics should be set up to provide easier access. Improving health is tied to public awareness; hence the importance of antenatal care and complications associated with untrained deliveries must be explained. Parents must be educated regarding paediatric nutrition and childcare. The need for reforms is dire. This region may suffer for the next 100 years unless we all join hands with a will to upgrade this misery-struck region. This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on Sept 25, 2014 This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on Sept 25, 2014 We declare no competing interests. Correction to Lancet Glob Health 2014; 2: e508Naim H, Rana RS. Tharparkar: a forgotten disaster. Lancet Glob Health 2014; 2: e508—In this Correspondence (September 2014), the order of authors was incorrect. The order should have been “Rana RS, Naim H.” This correction has been made as of Sept 25 2014. Full-Text PDF Open Access