Health officials have warned of large-scale outbreaks in Pakistan after severe flooding displaced millions.
A rise in cases of diarrhea and malaria have been reported after months of heavy rains that left people stranded and without access to clean water.
Authorities say they are concerned that the spread of waterborne diseases after the floods, which killed nearly 1,200 people, will put further strain on health facilities. More than 880 clinics were damaged, according to the World Health Organisation, which has allocated $10m (£8.6m) for emergency relief efforts.
Tedros Adhanom Ghebreyesus, director-general of the WHO, said on Wednesday the agency had classified the flooding as the highest level of emergency. He said the threat of waterborne diseases meant that access to health services and disease surveillance and control were a “key priority”.
Arif Jabbar Khan, director of WaterAid Pakistan, visited Sindh province, the province worst affected by the rains, which started in June. He said there was a serious risk of diarrhea and dysentery due to the lack of clean water.
“Families now live beside overflowing canals and rivers in dilapidated huts made of bamboo and plastic. They even drank flood water because there is no other option – a recipe for large-scale epidemics. We are doing everything we can to achieve them,” Khan said.
At least 33 million people have been affected by the floods, which contaminated water sources and rendered latrines unusable.
Sindh Health Minister Dr Azra Fazal Pechuho said the government has set up 4,210 medical camps for people suffering from skin conditions and waterborne diseases.
In the northwestern province of Khyber Pakhtunkhwa, a doctor, Farhad Khan, told The Associated Press that patients initially arrived with wounds from the floods, but diarrhea was now common.
A provincial government spokesman, Kamran Bangash, said hundreds of people had contracted waterborne diseases. With evacuation operations nearing completion, authorities will focus on providing clean water and food, he added.
“In recent weeks, the floods have seriously affected hundreds of thousands of people. We don’t want them to suffer again, this time because of the lack of drinking water. It can be avoided,” Bangash said.
The UN and Pakistan have requested $160 million to provide emergency assistance to 5 million people, including food, water, sanitation and shelter.
The WHO said it was working with the Pakistani government to respond to outbreaks of diarrhoea, cholera and other diseases. He said the floods had aggravated existing problems with malaria and dengue fever.
He also warned of the impact of the floods on the fight against other diseases, such as measles and poliomyelitis. Pakistan and Afghanistan are the only countries where poliomyelitis is still endemic.
Mustafa Khan, a British-Pakistani who was on vacation in Karachi when the rains arrived, said residents of Khokhrapar, an informal settlement on the outskirts of the port city, had no access to toilets. Khan, who volunteers with a charity to help with relief, added that hygiene conditions were clearly deteriorating, with many children suffering from eye infections.
“Everyone’s clothes were pretty dirty because there’s no water, so they’re not going to prioritize washing over drinking. Whatever fresh water they have , they will use it to cook,” he said.
“It was pretty dark, but because it [settlement] was closer to Karachi, there are road links and people get their supplies there. It’s not such a dire condition as those villages completely surrounded by water where it’s obviously really, really bad.
Sadiqa Salahuddin, who heads a girls’ education group, Indus Resource Centre, said many schools she helped run in Sindh province were now hosting displaced people but lacked space.
She said her team was trying to build a temporary toilet, but building materials were hard to come by.
Ashfaque Soomro, who heads the Foundation for Research and Development, a Sindhi charity, said the many makeshift roadside camps that had emerged had non-existent or inadequate sanitation facilities.
“The response from NGOs is not well organised. This aspect therefore remains intact. In government-designated camps, such as schools and technical establishments, toilets are available, but we do not know how functional they are. The influx of displaced people [internally displaced people] is huge, so even if these were functional on normal days, that may not be the case now.
Aid agencies have also warned that pregnant and menstruating women and girls face increased challenges. The United Nations reproductive health agency, UNFPA, estimates that there are 650,000 pregnant women in flood-affected areas, and up to 73,000 are expected to give birth in the next month.
Salahuddin said she struggled to provide women with sanitary pads because the village where she usually buys them was flooded.
“Women sitting by the side of the road are the worst off. They wait for the late sunset before relieving themselves. And those who are menstruating usually wear dark colored clothes shalwars [loose pleated trousers] so it doesn’t show they’re bleeding,” she said.