Pakistani Prime Minister Shehbaz Sharif recently warned that his country needs “infinite amounts of money” to support flood relief efforts. Torrential rains and severe flooding have killed more than 1,550 people and displaced millions. The challenge is compounded by Pakistan’s deepening food and health crises as flood-borne diseases rise and nearly two-thirds of the country’s food basket has been destroyed.
Getting a grip on Pakistan’s health crisis
A lack of health care in hard-hit southern provinces threatens to expose millions of malnourished children and women to infectious diseases, with fears of further spread. According to the United Nations International Children’s Fund (UNICEF), an estimated 16 million children have already been affected by the floods, and millions remain in need of life-saving assistance. Providing this support is an enormous task. Cases of malaria, dengue fever and skin diseases continue to rise, and water-borne diseases have seen the daily number of patients in Sindh increase to as many as 90,000. The situation in neighboring provinces offers little consolation: Makeshift health facilities are becoming more common as dwindling finances and limited expertise hamper relief efforts in flood-ravaged areas.
As Pakistan braces for more flooding, a fragile health system is unlikely to last long. On the financial side, just over 1% of Pakistan’s total GDP goes to public health spending, and even supporting large relief camps relies on international aid. Depletion of foreign reserves and record-breaking inflation have put huge pressure on long-term spending, suggesting there could be delays in efforts to rebuild lost infrastructure.
Disastrous flooding has already damaged over 1,460 healthcare facilities in sensitive areas, exacerbating logistical challenges and erecting new barriers to access healthcare. With much of Pakistan still under water, life-saving supplies risk delays and future displacement complicates aid delivery.
Pakistan’s growing reliance on makeshift facilities poses another problem: it creates urgent demand for climate-proof infrastructure that could take years to build. In Sindh, Pakistan’s hardest-hit province, authorities fear damage to health facilities has reached a point where many are unable to “provide services” to flood victims. These restrictions come at a time when malaria cases are rising rapidly and a deadly surge in dengue fever is raising alarm in other provinces. Over half a million pregnant women are also in need of maternal health services in the flood-ravaged areas, increasing pressure on Islamabad to step up emergency response and prevent vulnerable populations from sliding into acute hunger.
A worsening of the food crisis
Extreme flooding has destroyed over 800,000 hectares of farmland and damaged around 80-90% of crops. This includes crops that are vital to Pakistan’s food supply chain. Key export commodities, including rice, wheat and cotton, also risk future shortages as the extent of damage spreads to key agricultural belts. This includes Pakistan’s southernmost province of Sindh, where an estimated 90% of crops have been ruined. Sindh is responsible for producing half of the country’s food.
The resultant constraints on Pakistan’s agricultural sector are enough to push double-digit inflation to new highs if supply shortages extend long-term and future floods compound damage. There is also a growing likelihood that the government will increase its reliance on agricultural imports to meet short-term deficits.
Early signs include Pakistan’s engagement with the Asian Development Bank in hopes of using flexible financing of food imports to meet domestic demand. But Islamabad’s shaky foreign exchange reserves make it difficult to scale imports and continue food sourcing over the long term. This puts the government in distress when the threat of acute hunger rapidly increases.
The International Committee of the Red Cross has already warned of a significant increase in acute hunger in the future, as at least 43% of Pakistan was food insecure before the floods. Heavy rain damage to key areas of agricultural production has further weakened the prospect of a productive rice and wheat crop this fall, a key factor in strengthening nationwide supplies. Much of Sindh and Balochistan’s floodwaters are refusing to recede quickly, putting pressure on resource-rich Punjab to ramp up production and absorb the blow of long-term price shocks.
As Pakistan stares at the specter of increasing famine, a change of course remains elusive. Extreme flooding has pushed legions of children to the brink of starvation and increased their exposure to contaminated drinking water. The possibility of further flooding increases fears of future displacement and resettlement. Millions of floods are still confined to the open skies with limited funds to offset lost farming and farming income. This income has played a vital role in sustaining the livelihood of the community for years and has helped others lift themselves out of absolute poverty. With millions of people dependent on humanitarian assistance to survive, regaining their livelihoods will be a daunting challenge.
Hopes for an economic recovery are also bleak due to slowing growth and potential future borrowing. About 21 million acres of farmland are still under water, complicating the logistics of getting food supplies at a time when extreme weather events are likely to become more frequent in Pakistan.
governance issues
Islamabad’s ruling coalition has limited options. Billions of dollars in flood damage could cut projected GDP growth, making it crucial to use international climate finance to support relief efforts in hunger hotspots. On the domestic front, the government is under intense pressure to deliver long-due economic relief. Promised service delivery reforms have yet to be fully implemented, while soaring food and energy prices are adding to public discontent. Rapid food imports from neighboring countries are also encountering headwinds: the sharp devaluation of the rupee has complicated trade agreements with Afghanistan and Iran and threatens to exacerbate an acute shortage of tomatoes, onions and potatoes.
To be clear, despite long-standing frictions between Pakistan’s Tehreek-i-Insaf and the ruling coalition, leaders continue to lobby for urgent flood donations and support international appeals.
But restoring nearly two-thirds of the country’s food basket will prove much more difficult.
Damage Control: Options for Pakistan
Pakistan should prioritize early evacuation efforts in high-risk areas where the threat of rising water levels is greatest. The lack of early evacuation contributed to the post-flood sheltering that left millions homeless. As an encouraging sign, local authorities have begun early rehabilitation work in densely populated areas and continue to facilitate the return of flood-affected populations once water levels recede. Islamabad urgently needs to work with the United Nations on a post-disaster recovery plan, with a particular focus on ending illegal development on Pakistan’s riverbeds.
The survival of important crops in Punjab should form the core of the government’s food procurement in the near future. Priority supplies can be sent to makeshift camps where the risk of starvation is most pronounced, with enough of the fall harvest to limit the possibility of a major price hike.
State governments should also ensure that any converted healthcare facility is registered as a “panel facility” in counties. Panel facilities represent a predefined list of hospitals and serve as the first point of care for one or more districts. This gives flood victims more than one access point for treatment and prevents makeshift camps from taking on an excessive treatment burden in the future. Early evidence from Pakistan’s “Sehat Sahulat” health insurance reforms in the north supports a similar logic: empaneled facilities played a crucial role in expanding access to health care to numerous underdeveloped districts.
But given the sheer severity of the health and food crisis in Pakistan, one thing is clear: damage control alone will not be enough.
Hannan Hussain is an international affairs commentator, author, and recipient of the Fulbright Award in Public Policy at the University of Maryland. You can follow him on Twitter @hannanhussain7. The opinions expressed in this piece are his own.
Photo by HUSNAIN ALI/AFP via Getty Images
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