A woman sleeps surrounded by floodwaters in Sohbat Pur city. Photo / AP
A woman sleeps surrounded by floodwaters in Sohbat Pur city. Photo / AP
The torrent of water sweeping through the village of Kalam was merciless, residents recall, killing six people and flattening dozens of buildings.
Eight months pregnant, Basra Bibi was fortunate to survive. But on returning to the village, the 25-year-old was horrified to see its health centre had been submerged by floodwater.
"I am so worried about my baby, as the only hospital here is now no longer offering the medical assistance that I desperately need," Bibi told the Telegraph, deep lines of worry etched upon her face. "Where should I go? All of the transport routes out of Kalam were destroyed by the flooding."
Over 1,100 people have died since June in floods described as "the worst in the history of Pakistan" by the country's prime minister, Shehbaz Sharif. One-third of Pakistan has been engulfed by flooding, over 30 million people are displaced, and millions of hectares of farmland have been washed away.
The authorities have cautioned the death toll will rise further once officials access remote villages, but there are growing fears of a secondary crisis triggered by the collapse of the country's healthcare system.
"I totally agree we will see more deaths from healthcare emergencies and disease than the [initial] floods unless we act now," said Gerida Birukila, Unicef's chief of the field office in the city of Quetta in Pakistan.
A pregnant woman is carried to the hospital for treatment. Photo / AP
'I am regularly hearing about deaths among mothers'
Flood waters have damaged 888 health facilities across the country, which already had one of the world's worst public healthcare systems, according to a World Health Organisation report on August 28.
The United Nations Population Fund reports that there are 650,000 pregnant women living in flood-affected areas, and up to 73,000 of those women, like Ms Bibi, are expected to give birth in the next month.
Many will be forced to give birth in partially flooded, unhygienic homes, in cramped refugee camps, or in makeshift tents. They will have no midwife or doctor present, and no access to essential medical equipment or life-saving medicines.
There has already been a surge in maternal and infant mortality since the onset of the floods, according to Dr Mubina Agboatwalla, the chairperson of Health Oriented Preventive Education (Hope), a Pakistani NGO working to improve the health of the country's poor.
"Initially, I was hearing about a couple of deaths in camps set up for those displaced by flooding, but now I am regularly hearing about deaths among mothers in all the flood-affected areas. The situation is terrible," said Dr Agboatwalla.
"Also, many of these babies are now being born without resuscitation facilities, and so if they survive they can suffer from birth hypoxia, where they have a disability or can be more vulnerable to a disease like meningitis."
Before the flooding, Pakistan already had one of the highest maternal mortality rates in Asia, with 186 deaths per 100,000 births, according to the Pakistan Maternal Mortality Survey in 2020.
One contributing factor was that over 50 per cent of babies were born to women suffering from anaemia, which several studies have suggested heightens the risk of an infant's death shortly after their birth.
While visiting villages in south Punjab, Dr Amtullah Zareen, a gynaecologist, witnessed pregnant women foregoing food for days on end to give the meagre food aid they had received to their own children, and believes anaemia will surely increase among pregnant women.
"I am very worried about women delivering babies safely," Dr Zareen said. "They are currently giving birth by the side of the road, and there is nothing they can do if they suffer a complication like excessive blood loss."
Risk of cholera, snakebites and dengue
Pakistan also faces a myriad of other healthcare challenges. Over six million people require emergency assistance, according to the World Health Organisation.
With people packed into overcrowded camps without waste disposal, infections that can prove particularly deadly among children, like cholera and dysentery, are spreading quickly.
Already, there have been over 18,000 reported cases of cholera in 110 camps for the displaced in Pakistan's northern Khyber Pakhtunkhwa province. Ten-year-old Jameel Shah is among them, battling for his life at a makeshift camp inside a school in Kalam after contracting cholera.
Wiping away tears, the boy's father, Johar, said his son began violently vomiting several days after arriving at the camp, and the family are trying to borrow money from relatives to airlift the boy to a hospital in the city of Peshawar.
"Our life was good but the floods have brought us so many miseries. My wife says she feels physical pain because of our son's condition; it is a horrific situation," said Shah.
As Shah was speaking, an angry camp resident filled up a murky, sediment-filled glass of tap water and showed it to the Telegraph.
Residents in the camp also worry about being bitten by one of Pakistan's three million stray dogs or a poisonous snake, with the rising floodwaters bringing reptiles into closer contact with humans than usual.
Longer-term, the country is likely to see a spike in vector-borne diseases like dengue fever or malaria. Stagnant floodwaters provide mosquitoes with the perfect breeding ground.
Affected families take refuge on the road after fleeing their flood-hit homes in Jaffarabad. Photo / AP
Little respite in sight
Heavy rainfall is expected to continue throughout September, according to Pakistan's climate minister, Sherry Rehman, offering little opportunity to dredge or repair healthcare centres.
It could take months before the floodwaters clear fully in some areas, and even then, it is unclear how Islamabad is going to fund the reconstruction of healthcare centres and purchase equipment and medicines.
Even before the floods, the country was enduring an economic crisis and had approached the International Monetary Fund for a bailout. Now, the Pakistani government has estimated that damage caused by flooding will cost £8.5 billion ($16bn).
The Al Khidmat Foundation, a leading Pakistani health NGO, said the country was already short of over £10 million of essential medicines and would require donations from abroad.
Aid is now slowly trickling into Pakistan. The United Nations has pledged £140 million of aid for the country, classifying it as the highest level of emergency, while many nations - including the United Kingdom, which has donated up to £15 million - are contributing to the relief effort.
An urgent donations appeal was launched by the Disasters Emergency Committee, an umbrella group of British charities: "Donations from the British public will make a huge difference in enabling them [NGOs] to reach more people," a statement read.
"We're urging everyone to give whatever they can at what we appreciate is a difficult time for us all."
The Pakistani government is attempting to use military helicopters to drop food, water and essential medicines to remote, flood-affected villages, although ongoing torrential rainfall is limiting relief operations.
NGOs are also running mobile medical clinics, while local doctors are attempting to reach cut-off areas by bike to carry out essential checkups, with mixed success.
However, the majority of people the Telegraph spoke to in the Khyber Pakhtunkhwa and Sindh provinces said they still had no access to aid or medical care, leaving them vulnerable.
And, back in Kalam, Bibi said she has no alternative but to turn to higher powers.
"I can do nothing apart from reciting verses from the Holy Quran to pray for a safe delivery," said Ms Bibi. "The destruction of the local hospital has totally dampened my hopes for my baby."
