The 2010 floods in Pakistan began as a result of unprecedented monsoon rains overwhelming the Indus basin. The ensuing floodwaters affected 78 out of 121 districts nationwide engulfing an area of 100,000 km2. The floods claimed 1985 lives, affected 20.2 million people, damaged 2.4 million hectares of agricultural land and damaged or destroyed 2.1 million houses and 515 health facilities.
ReliefWeb, an online database administered by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), provided humanitarian information to organisations and interventionists during the floods. The database was continuously updated with situational reports and bulletins by various stakeholders (e.g. UN agencies, NGOs) and enabled the humanitarian community to assess need and mobilise response to the disaster accordingly. However, much of the information published on the ReliefWeb database was fragmented and the number of summary reports documenting the floods in a holistic manner was limited. Furthermore many of these reports exhibited an inconsistency in format and content that did not follow a standardised method for reporting. Therefore their expediency to humanitarian organisation and interventions - although advantageous - can be probed.
Kulling et al. (2010) have proposed guidelines promoting a common structure and method for reporting health crises and critical health events. These guidelines require reports to include assessments of the status before the event, a description of the disaster and the subsequent damage, the relief and recovery responses to the events and identification of lessons that can inform preparations and interventions in future crises. Therefore a concise report on the Pakistan floods of 2010 based on key principles described by these guidelines can serve as a useful resource in analysing summary findings that may help to improve preparedness, planning and response for future crises whilst advancing international collaboration and learning.
This summary report is based on the key principles of health crisis reporting described by Kulling et al.
Inclusion and Exclusion criteria: All information from frontline sources involved in the Pakistan floods including UN organisation, governmental departments, non-governmental organisation and academic institutions were considered. However, newspaper and journalistic report articles were excluded.
This report forms part of a research project that I undertook as part my medical studies at Barts and The London School, University of London. I received supervision from Dr Paul Wilkinson of London School of Hygiene and Tropical Medicine and Professor Virginia Murray of Extreme Events and Health Protection at Health Protection Agency UK. This report was not funded or allied with any governmental or non-governmental organisation.
Pakistan covers an area of 796,096 km2 and stretches from the Himalayan Mountains in the north to the Arabian Sea to the south. The country shares borders with Afghanistan and Iran in the west, China in the north-east and India in the east; and is made up of four large provinces: Balochistan, Khyber Pakhtunkhwa, Punjab and Sindh; and also a small federal capital territory and a group of federally administered tribal areas. Pakistan has a total population of over 178 million people.
Pakistan’s climate is predominantly semi-arid to arid and is typically characterised by hot summers and cool or cold winters. The northern mountainous and hilly regions of the country are cooler than the warmer and topographically flat regions of the south. Pakistan, depending on geographical location, weathers four seasons: a cool and dry winter period (December to February), hot and dry spring (March to May), rainy summer or monsoon period (June to September) and a retreating monsoon period (October and November).
The Indus River originates in Tibet and travels westwards through India and Kashmir before entering Pakistan through the northern mountains. It then runs southwards through the centre of the country before emptying into the Arabian Sea. The basin stretches approximately 3,000 km in Pakistan and covers an area of 977,000 km2 (approximately 25% of total land mass). The river sources its water from annual rainfall, glacier melt from the northern mountains and a number of large tributaries including Shigar, Shyok, Gilgitm and Kabul rivers from the northern province and the larger Beas, Chenab, Ravi, Jhelum and Sutlej rivers from the Punjab province (Figure. 1).
The Hyogo Framework for Action (HFA) is a 10-year disaster risk reduction plan that has been adopted by 168 member states of the UN. It was established in 2005 and describes strategies aimed to reduce losses caused by disasters (e.g. lives, social, economic and environmental) by 2015. The guidelines list key activities to build national resilience and outline five priorities for action (PFA):
Pakistan became a signatory of the framework after the 2005 earthquake exposed vulnerabilities of the existing disaster risk management strategies adopted by the country. In 2006, the National Disaster Management Ordinance (NDMO) 2006 was introduced by the Government of Pakistan to provide a legal framework for disaster risk reduction at a federal, provincial and district level and included nine priority areas from the HFA. In 2010 the framework was enacted under the National Disaster Management Act 2010.
The NDMA, under the National Disaster Management Commission (NDMC), is responsible for devising guidelines and implementing programmes on disaster risk reduction, preparedness, capacity building, response and recovery. During disasters the NDMA acts a central hub for implementing, coordinating and monitoring disaster management. They communicate with all stakeholders to facilitate a collaborative response to the disaster (including Pakistan Disaster Management Authorities, Army, Governmental Ministries and Departments, NGOs).
Some of the key functions of the NDMA include:
Each province has a disaster management authority in the form of PDMA that operates under a Provincial Disaster Management Commission (PDMC).
Some of the key functions of the PDMA include:
The DDMA, under the District Disaster Management Commission, is involved in executing disaster risk reduction programmes at a district and tehsil level (second-lowest tier of local government).
Some of the key functions of the DDMA include:
The Federal Flood Commission (FFC) was created in 1977 in response to the severe floods of 1973 and 1976; which exposed vulnerabilities in existing disaster risk management and signified the importance for a national policy on the flood problem. In 1978, the FFC prepared the National Flood Protection Plan (NFPP) that set out to reduce flood losses, prioritise flood protection for areas of greatest economic risk, provide protection for areas outside the flood plains and improve existing flood protection facilities.
The Flood Forecasting Division (FFD) of the Metrological Department is the sole flood forecasting agency in Pakistan and is responsible for issuing forewarnings to relevant stakeholders (e.g. FFC, Provincial and National Disaster Management Authorities, Ministry of Water & Power, Combatant Generals' Headquarters (GHQ), Ministry of Defence) to prevent and mitigate damage to lives, property and infrastructure caused by floods. The FFD receive and process hydro-meteorological data from various national sources to prepare flood forecasts and warnings. The Water and Power Development Authority (WAPDA) and the Irrigation Department provide the FFD with rainfall and river flow data in the catchment areas of the river Indus and Jhelum and hydrometric flood data from the Tarbela, Chashma and Mangla dams.
The Pakistan Army’s Corps of Engineers have the responsibility of providing assistance to civil authorities by operating rescue and relief operations during national disasters. The Pakistan Army is involved in all phases of flood mitigation from pre-, during- and post-floods. During the pre-flood preparatory phase, the Commander Corps of Engineers make regular inspections of flood protection structures. During floods the Corps Engineers are stationed at the FFD to monitor the flood situation and provide regular situational updates, forecasts and warnings to the designated Director General (DG) and all other CC Corps of Engineers. Units of the Army are deployed to target areas to carry out rescue and relief operations. It is the responsibility of the PDMAs to provide the army equipment during disasters (e.g. boats, life-jackets, tents, vehicles). Further meetings are held post-floods to assess performance and identify lessons for the future.
In 2005, the UN’s Inter-Agency Standing Committee (IASC) established a ‘Cluster Approach’ to humanitarian assistance with the aim of improving predictability, timeliness and effectiveness of response and recovery. The initial nine clusters (Camp Coordination and Management, Early Recovery, Emergency Shelter, Emergency Telecommunications, Health, Hygiene, Logistics, Nutrition, Protection and Water Sanitation) with two added later (Education and Agriculture) consisted of groupings of UN agencies, non-governmental organisations (NGOs) and other international organisations and stakeholders around sectors and services that worked together to provide assistance during a humanitarian crisis.
The cluster approach was first implemented, in its elementary form, in the aftermath of the 2005 earthquake in Kashmir. Each cluster was designated a lead agency and made responsible for coordinating deliverance of humanitarian assistance within that sector. These clusters held intra-agency forums to share information; formulate joint strategic plans and partnerships; define roles , responsibilities and delicate activities in order to avoid gaps in coverage, duplication of aid and delay in assistance.
The Disease Early Warning System (DEWS) was setup in Pakistan by the World Health Organisation (WHO) in collaboration with the Ministry of Health after the Kashmir earthquake in 2005. Its goals include reducing mortality and morbidity through early detection and response to alerts and diseases outbreaks (e.g. acute watery diarrhoea, cholera, malaria). DEWS receives surveillance data from 490 fixed and 554 mobile outreach centres and has been instrumental in predicting and controlling epidemics in Pakistan through weekly reporting of disease trends and responding to health alerts within 24 hours.
Pakistan is prone to natural disasters including floods, earthquakes, landslides and tropical cyclones. Riverine floods are a common phenomenon in Pakistan and are predominantly caused by concentrated rainfall in river catchments areas during the monsoon season; that are sometimes compounded by increased glacier melt. Monsoon currents from the Bay of Bengal in India and the subsequent depressions can result in heavy rainfall in the Himalayan regions of northern Pakistan. Furthermore the weather systems originating from the Arabian and Mediterranean seas can compound the heavy downpours in the north and inundate the Indus River and its tributaries.
The Indus River has been responsible for 11 of the major floods in Pakistan including the floods of 1950, 1955, 1956, 1973, 1976, 1978, 1988, 1992, 1995, 1997 and 2005 (Figure 2).
The poor quality of housing stock in the rural areas of Pakistan makes them vulnerable to natural disasters. Houses in the northern mountainous regions are typically of kutcha (non-permanent) stock and constructed from mud or stone rubble making them feeble and unable to withstand extreme natural events. Even the pucca (permanent) are not exempt from these dangers due to poor structural design comprising heavy concrete slabs supported by thin walls constructed of sand and cement mortar.
Extensive deforestation, particularly in the northern mountainous regions around the Indus River, has resulted in soil erosion. The resulting reduction in vegetation has led to an increase in surface water run-off during monsoon seasons. Augmented by increased glacial melt, deforestation has resulted in the Indus River receiving a greater amount of water upstream.
Flash floods, as opposed to slow rising riverine floods, can cause considerable damage to lives, communities and property as they can present suddenly and without warnings. Flash floods in Pakistan have predominantly occurred in the mountainous ranges of the Himalayans, Kashmir and Gilgit-Baltistan due to steeply uneven topography and unpredictable climate; and in D.I. Khan, D.G. Khan and Kirther Ranges of Balochistan and Sindh Provinces as result of hill torrents and around the coastal areas of Sindh and Balochistan due to tropical cyclones.
The most prevalent communicable diseases in Pakistan include acute respiratory infection, diarrhoea, polio, tuberculosis, hepatitis B and C, measles and vector-borne disease including malaria, Leishmaniasis and haemorrhagic fever (CCHF). The prevalence of malaria is greater in the rural areas and risk reduction behaviour is low with only 6% of households owning mosquito nets. Pakistan has an endemic problem with tuberculosis (297,000 cases reported in 2008) and polio.
Pakistan has a high maternal mortality rate of 276 deaths per 100,000 women. Major causes of maternal death include haemorrhages and sepsis. Approximately 62% of all deliveries take place within the home and only 39% of deliveries have a skilled practitioner present. Child mortality rate (under 5 years old) is 94 per 1000 live births; infant mortality rate (under 1 year old) is 78 per 1000 live births; and neonatal mortality rate (under 28 days old) is 54 per 1000 live births. The main causes of infant death include pneumonia, sepsis, diarrhoea and meningitis.
On 20th July 2010, the FFD issued the first of a series of flood warnings to low lying areas and districts of Punjab as result of widespread thunderstorms and heavy downpours generated by the annual monsoon season. The FFD advised all concerned authorities to take precautionary measures to protect human lives, infrastructure and property. Similar warnings were issued on almost a daily basis; however, the amount of time given between the issuance of the warning and the expected time for flooding varied and ranged from zero to several hours in the northern regions (KPK and Punjab) and a maximum of around 2 days for the southern regions (Appendix 1).
On 22nd July, the first of the heavy monsoon rains hit the north-eastern regions of Balochistan causing flash floods and affecting 50,000 people. A second spell of heavy rains, which lasted for two months, followed on 27th July and resulted in the FFD issuing high flood level warnings along the River Chenab in Punjab and River Kabul in Khyber Pakhtonkhwa. On 28th July the FFD issued further warnings of heavy flooding in the Kalat, Sibi, Naseerabad and Zhob districts of Balochistan and DG Khan and Rajanpur districts and river Tarbella in Punjab and northern Khyber Pakhtonkhwa provinces.
On 29th July, the Swat and Kabul rivers burst their banks resulting in the flooding of Nowshera and Charsadda districts and parts of Peshawar in Khyber Pakhtonkhwa. Furthermore, on-going rains in the northern regions caused landslides and further flash flooding in Khyber Pakhtonkhwa, Gilgit Baltistan and Pakistan-administered Kashmir causing loss of life and significant damage to property and infrastructure. By the morning of 31st July the upper regions of River Indus around the Chashma district of Punjab had been flooded. As the floodwaters headed southwards, floods continued to devastate low-lying district surrounding the Indus basin (i.e. Bhakkar, Layyah, Muzaffargarh, DG Khan and Rajanpur). The total rainfall within the month of July was exceptionally high for the annual monsoon season with recordings of: up to 257mm in districts of Punjab; up to 280mm in Khyber Pakhtonkhwa; up to 58mm in Balochistan and up to 189mm in Gilgit Baltistan & Azad Kashmir.
By 5th August, as red alerted by the FFD two days earlier, the floodwaters reached the Sindh Province and drowned the district of Guddu. The FFD issued further red alerts of exceptionally high flooding in Sindh to the districts of Khairpur, Jacobabad, Sadiqabad, Shikarpur, Ghotki of Dadu Sukkur, Larkana, Nawabshah, Hyderabad and Naushehroferoze. By 7th August, the floods had affected 15 million people nationwide.
On 9th August, the Indus River overflowed its banks in Sindh causing wide scale destruction. By 26th August, more river breeches had occurred in the district of Thatta and further flood warnings were issued for the district of Kotri. By 30th August, more villages were submerged under water and approximately 1 million people fled from the floods in Sindh. On 13th September, the large Manchar Lake breached its bank and overflowed causing serious flooding of the Jamshoro district (Figure 3).
The impact of the floods varied amongst the provinces depending on the nature of the floods (i.e. flash flood versus slow-rising riverine floods), the topography of each affected area and the different levels of preparedness measures. Where Khyber Pakhtunkhwa was only affected by flash floods, the provinces of Punjab and Balochistan were exposed to both flash and riverine floods and the Sindh province to mainly slow-rising riverine floods. Furthermore, the receding of floodwaters also varied depending on the topography of the region. In the topographically hilly Khyber Pakhtunkhwa and Balochistan floodwaters started to recede within days of their onset, however it took several weeks until mid-September in Punjab and several months in some areas of the flat plains of Sindh for the waters to completely clear.
The Pakistan floods of 2010 have caused unprecedented damage to livelihoods, property, infrastructure and economy in the history of the country. The floods claimed 1985 lives, injured 2946 people and affected over 20.2 million people nationwide. Around 11 million people were displaced nationwide; with 7 million people from Sindh alone.
Province
Worst Affected District
Jacobabad, Kashmore, Shikarpur, Gotki and Qambar Shahdad Kot ,Dadu, Jamshoro and Thatta
Jaffarabad, Nasirabad and Sibi
Nowshera, Charshada, Swat, Kohistan and Shangla
DG Khan, Rahim Yar Khan, Layyah, Rajanpur and Bhakkar
The floods caused 1985 deaths and injured 2946 people. Majority of deaths occurred in Khyber Pakhtunkhwa Province (1156; 58%), followed by Sindh (411; 20%), Punjab (110; 5.5%), Balochistan (183; 0.02%). The remainder of deaths occurred in the smaller tribal and administrated areas. Furthermore, the majority of deaths had occurred within the first 14 days with official data reporting 1271 deaths and 1334 injuries by 10th August 2010.
From 29th July 2010 to 21st July 2011 DEWS reported 37,391,802 medical consultations in flood affected districts. The most common illnesses included: acute respiratory infection (23%), skin diseases (11%), acute diarrhoea (9%) and suspected malaria (6%) (Figure 6).
The incidence of acute respiratory infection increased within two weeks after the onset of the floods and reached a peak in early February 2011. The incidence of acute diarrhoea (AD) increased immediately after the floods and peaked towards the end of August 2010. After a falling trend from September 2010 to late February 2011 the incidence of AD began to climb again around mid-March 2011. The incidence of bloody diarrhoea (BD) remained generally low but constant with a slight increase between late August to mid-October. The number of suspected malaria cases increased between late-August 2010 till early January 2011 peaking in October 2010 (Figure 7).
The damage inflicted on the country’s public health infrastructure was considered to be mild to moderate with basic health units and medical dispensaries mostly affected. From a total of 9721 health facilities in Pakistan, 2957 were situated in flood-affected districts of which 515 were either damaged or destroyed by the floods.
The World Food Programme Flood Impact Assessment reported that at least 10.1 million people required emergency assistance with food of which about 3.6 million people would require long-term assistance. Risks of diarrhoeal outbreaks caused by water borne diseases, poor feeding and loss of livelihoods predisposed the displaced and affected population to acute and chronic malnutrition.
The pre-existing levels of malnutrition in the population (13.2% of Global Acute Malnutrition (GAM) and 3% of Severe Acute Malnutrition (SAM)) had been exacerbated by the floods. Provincial surveys showed that the level of GAM in northern Sindh had increased to 22.9% and 26% in southern Sindh. A total of 13.2 million people required nutritional attention following the floods. Furthermore, about 2.8 million (14%) children under the age of 5 years old and 1.6 million (8%) pregnant and lactating women formed part of the total affected population
The floods affected 78 out the 121 districts of Pakistan inundating over 160,000 km2 of land mass causing unprecedented damage to housing, educational and health facilities, communication networks, power and energy plants and grids, irrigation channels, agricultural land and livestock (Figure 9). The total cost of damage was estimated to be around US$ 10 billion. Sindh suffered the most damage estimated to be around US$ 4.3 billion, followed by Punjab at US$ 2.5 billion, KPK at US$ 1.7 billion and Balochistan at US$ 620 million (Figure 10).
Over 1.6 million houses were either damaged or destroyed by the floods. Approximately 1.45 million of the affected houses were of
The severity of damage caused to water supply and sanitation infrastructure varied across the provinces. Flash floods in Khyber Pakhtunkhwa caused most structural damage to water supply networks and infrastructure including pump houses, store tanks and water pipes. Whereas the slow-rising riverine floods in Sindh caused more damage to electrical and mechanical components, pump houses and machinery. Sanitation infrastructure was most affected in the south with extensive damage inflicted on sewerage and drainage systems.
Severe damage was caused to the country’s 50 years old irrigation system that included irrigation channels, canals, drains and public tube wells. The Sindh province suffered most damage costing around $136.9 million followed by Khyber Pakhtunkhwa at around $68 million.
The floods caused indiscriminate damage to educational facilities that account for 6.2% of total institutions in Pakistan. A total of 10,407 educational institutions were severely affected by the floods of which 6,666 fully destroyed and 3,741 partially damaged. A total of 18.5% of total educational institutions were either damaged or destroyed in the Sindh province and a further 8.8% in Punjab, 12.9% in Balochistan and 5.6% Khyber Pakhtunkhwa.
The damage incurred to the transport and communication networks (including roads, bridges, railways, airports and telecommunication infrastructure) have had multiple implications ranging from mobility of the affected population to access to basic services (e.g. health, education, public services and markets). Approximately 25,000 km (10%) of road networks and 1,225 km (16%) of railways have been damaged by landslides and floods, incurring losses of $1.2 billion and $60 million, respectively. Damage to the telecommunications infrastructure, which includes cables, transmission towers and optic fibre networks is estimated around $35 million. The total damage incurred by this sector has been estimated to be $1.3 billion.
Agriculture, livestock and fisheries have been the most severely affected sector accounting for 44% of total damage inflicted by the floods. The damage caused to agriculture and livestock varied in each province according the nature of the flood. The unexpected flash floods in the mountainous areas of Balochistan, Khyber Pakhtunkhwa, Pakistan-administrated Kashmir and Gilgit-Baltistan overwhelmed the local population and resulted in the sweeping away of people, houses, livestock, feed stores and food. The slow-riverine floods in the topographically flat plains of Sindh and Punjab together with longer advance warnings by the FFD enabled the population to relocate and save most of their livestock. In total about 1.5 million animals and 10 million poultry birds were lost to the floods.
Waterlogging and siltation of agricultural lands caused great destruction to crops. According to the Preliminary Damage and Needs Assessment report, damage to crops accounted for 89% (i.e. 2.1 million hectares of mostly cotton, rice, sugarcane and vegetables) and live stock 11% of the overall losses.
Forests, wetlands and other natural systems have suffered damages of around $12 million.
Pakistan's electricity sector suffered major damages to hydroelectric power generation stations, distribution grid and networks. About 3.5 million people, predominately from Sindh and Khyber Pakhtunkhwa, were left without power. The total damage to the electricity sector was estimated to be around $155 million. Pakistan’s petroleum sector, although representing only 1% of the annual oil imports, also suffered damages totalling around $155 million. Over 240,000 people were cut off from gas supplies, and a number of power generation facilities were temporarily suspended following shortages of oil. Total damage to the energy sector is estimated around $309 million.
Whilst the major industrial centres of the country were spared, the floods severely affected small and medium business enterprises. Shops, industrial factories and workhouses received the largest share of the damage estimated at around $282 million. Sindh and Punjab suffered most damage to commercial, agricultural and farming sectors (i.e. cotton, sugar, rice and flourmills). Losses of around 2 million bales of cotton had knock-on effects on the textile industry; which forms one third of the country’s manufacturing sector. Khyber Pakhtunkhwa suffered most damage to its marble, mining, silk, furniture manufacturing and tourism sectors.
The initial response to the floods was coordinated by the NDMA and carried out by PDMAs, DDMAs, local population, philanthropist and the army. Much experience and capacity had already been formed following the Pakistan earthquake of 2005 that allowed for early mobilisation of response; particularly in KPK where the recovery phase was still in progress following the earthquake. However, as the floods continued to overwhelm and exhaust the country’s resources and capacity, the Government of Pakistan sought help from the international community. By early August 2010 the UN appealed for $459 million through the Pakistan Initial Floods Emergency Response Plan (PIFERP) to cover the immediate relief period and at the heed of the Pakistan government prioritised four clusters (Food, Health, Shelter and Water, Sanitation and Hygiene (WASH)).
The Rescue and Relief Phase started immediately after the onset of the floods in July 2010 and aimed to reduce mortality, morbidities, disease and malnutrition in the affected population.
A total of 88 helicopters (including 48 from friendly countries), 4 hovercrafts and 1238 boats were deployed during the initial rescue operation. A total of 5928 relief camps were established nationwide that sheltered over 3 million people at the peak of the disaster. These had decreased to 103 relief camps and 91,773 people by 31st December 2010 (Table 3).
Achievements
Number
Food items
0.41 million tons
Ready to eat meals
10.76 million
Tents
489,177
Tarpaulin
931,317
Blankets
1,918,483
Plastic mats
129,537
Mosquito nets
290, 262
Kitchen sets
412,401
Medicines
428 tons
Hygiene kits
160,470
Water purification tablets
250 million
Medical consultations
20.11 million
Water purification kits/buckets
11,341
Water purification plants/units
3896
De-watering pumps
45
No. of Relief Camps
No. of People in Relief Camps
% of Returning People by 31/12/10
Province
During Peak
On 31/12/10
During Peak
On 31/12/10
Punjab
327
0
116,295
0
100%
Sindh
4,682
73
1,815,961
76,421
96%
KP
825
0
915,463
0
100%
Balochistan
67
30
150,343
15,352
90%
AJ&K
2
0
900
0
100%
The relief efforts were further augmented with the formation of clusters that initially prioritised food, health, shelter and WASH but were later rolled out to include other sectors (Appendix 2). This paper will summarise the response of clusters directly related to human health: Health, Food, Nutritional, WASH and Shelter.
The health cluster led by WHO and the Ministry of Health had the objective of providing emergency health assistance in the flood-affected areas of KPK, Balochistan, Punjab, Sindh, the small tribal areas and the state of AJK. During the initial Rescue and Relief phase a total of over 11.8 million medical consultations were reported from 29th July to 30th December 2010.
Within one year from the onset of the floods over 37 million medical consultations were reported by DEWS, between July 29th July 2010 to 21st July 2011, from 73 out of 78 flood affected districts.
The movement of people from flood-affected districts led to the establishment of 5928 relief camps to shelter displaced communities. By 31st December this number had reduced to 103 as about 97% of people returned homes with 91,773 people remaining in the camps.
About 10.1 million people were in need of food following the floods. By December 2011, the food cluster, headed by the World Food Programme (WFP), distributed over 350,000 metric tonnes (mt) of food.
The Nutrition Cluster established 625 therapeutic centres that comprised of 597 outpatients therapeutic clinics and 28 stabilisation centres. By March 2011, the Nutrition Cluster had screened over 1.29 million children under the age of 5 years and over 492,000 pregnant and lactating women for malnutrition.
Approximately 13.1 million flood-affected individuals required the provisions or services of the WASH cluster. Key priorities included installing permanent WASH facilities (e.g. safe disposal of excreta), restoring and exceeding pre-flood WASH coverage in the affected districts and hygiene education to promote sustainability.
The Early Recovery Phase started in parallel to the initial relief phase and was included in the Pakistan Flood Relief and Early Recovery Plan in November.
The Health and Nutrition SWG focused on screening and providing nutritional support for moderate to severely malnourished children and pregnant and lactating women in 29 priority districts. The Health and Nutrition SWG identified 8 million people, including 1.4 million children under 5 years old and 1.4 million women who needing access to health care. Capacity was also developed through the restoration and rehabilitation of healthcare facilities. Temporary structures, medical supplies, and human resource support (e.g. female staff) was provided to manage with the increased number of patients.
Up and until October 2011, 685 Outpatient Therapeutic Program (OTP) and Stabilization Centers (SC) had been established. Over 5.28 million children under the age of 5 years had been screened of which 127435,589 were included in OTP/SC and 4.3 million admitted in the Supplementary Feeding Program (SFP). Over 1.6 million pregnant lactating women had been screened for malnutrition of which 2.52 million were admitted in the Supplementary Feeding Program (Table 4).
0
63726
7696
0
21613
99722
25257
29
1058805
12190
29
62806
372567
33093
203
1841895
69685
202
223466
568594
119550
453
2325459
37488
453
127704
573301
74780
685
5289885
127059
685
435589
1614184
252680
With the passing of the initial relief and recue phase, the emphasis shifted onto recovery and strengthening of institutional capacity to achieve long term health and development goals and supporting the return of displaced people.
The Agriculture and Food Security Sectorial Working Group led by the World Food Programme has been involved in ensuring food security for the affected population and building agricultural assets of local communities. From February 2011 to July 2011 food and cash for work initiatives were introduced to enable affected communities to rebuild agricultural infrastructure. About 100,300 households have benefitted from the cash for work initiative. About 768,680 households were provided with crop/vegetable packages and 327,340 households with livestock.
On 31st March 2011 the Shelter Cluster was handed over to the Housing Early Recovery Group (HERG) after being led by the International Organisation for Migration (IOM) during the Rescue and Relief Phase. The main strategy has been to focus exclusively on houses that were completely destroyed by building cost-effective and durable one-room shelters made from mud and brick per destroyed house. Up and until August 2011 453,293 one room shelter units have been constructed and around 63,700 transitional shelters have been completed.
The Government of Pakistan established the Watan Card Scheme to enable the delivery of cash directly to the flood affected families. ATM cash cards were registered and distributed to affected families who were then able to obtain cash from ATM machines. Around 1.5 million households benefited from the scheme receiving sums of approximately £150 each. This scheme also allowed for money to be injected directly into the local economy.
At the time of completing this report, the new onset of floods in the southern regions of Pakistan in 2011 had undoubtedly compromised the recovery and rehabilitation phase following the floods of 2010.
The floods of 2010 in Pakistan have caused unprecedented damage and affected over 20 million people, however the impact on health (i.e. mortality and morbidity rates) has been relatively low when compared to other natural disasters in recent history (e.g. Asian Tsunami in 2004 Hurricane Katrina in 2005). This could be attributed to three factors: the early warning system by FFD; the type of floods (flash floods versus slow-rising riverine floods); and the timing and dispatch of early response and recovery efforts to the disaster.
Flash floods that devastated the northern mountainous regions of KPK were responsible for more deaths (1,156) than the slow-rising riverine floods in the south. Furthermore, the number of deaths in Punjab (110) and Sindh Province (411) were remarkably low despite having a larger affected population. This discrepancy in mortality rates could be attributed to range of advance warning given by the FFD. The southern provinces benefitted from longer advance warnings compared to the northern regions. This supports the importance of an effective and timely advance flood warning system to allow people adequate time to prepare and relocate. The NDMA concedes that the current early warning system in Pakistan is of limited nature and can provide a forecast range of 3-4 days; however, coverage is almost non-existent in the north-western region and around the coastal belt of Balochistan.
The sudden and violent nature of flash floods, as seen in the northern mountainous region of KPK and Balochistan, have been responsible for more deaths - to both humans and livestock - than the slow-rising riverine floods that devastated Sindh and most of Punjab. The exact cause of death has been difficult to verify during the course of this report - as the information is not readily available - however review papers show that the leading cause of death by flash floods is drowning.
The swift and immediate responses by the NDMA and the military, especially in KPK, may have saved lives that may have been otherwise been lost. The capacity to respond to natural disasters had already been developed by the PDMAs of the northern regions following the 2005 earthquake in Kashmir. This gained knowledge and experience was reflected in the relief efforts during the July 2010 floods. It was felt by stakeholders (e.g. NGOs) that the deployment of relief response was quicker in the northern regions than in the southern provinces where sufficient warning time had been issued in advance of the floods. This shows that much more capacity building is required at a national and provincial level to ensure response is equal, measured and effective.
The United Nations led health cluster approach to coordinating humanitarian assistance to disaster victims has had mixed reactions from stakeholder groups. Although it is generally accepted that the approach had improved since the earthquake in 2005, it was commented that some clusters – which comprised over 600 agencies - lacked experienced leadership. This impacted on cluster meetings, which, rather than being utilised as a forum to coordinate assistance served as platform to share information. As a result of communication failure there were gaps in coverage, duplication of aid in certain areas and delays in assistance.
An overwhelming case has been made for further investment in disaster preparedness and risk reduction. Pakistan needs to continue implementing strategies of the Hyogo Framework for Action (HFA). Although much progress has been achieved through institutional commitments, the Government of Pakistan needs to invest in emergency preparedness, response and recovery programmes.
The NDMA have been central to coordinating response to the floods of 2010. The NDMA initial rescue operation pays testament to the value of local capacity and leadership. However, where response coordinated by NDMA was swift in the northern regions of Pakistan, the response in Sindh was much slower despite adequate early warnings issued by the FFD. The NDMA need to invest in building capacity in Sindh and Punjab and disaster risk reduction measures in all provinces.
The Watan scheme was an innovative idea that helped to put cash directly in the hands of those in need. However, the scheme was fraught with bureaucracies and red tape that delayed the money reaching its intended beneficiaries. The registration system relied on presenting a national identity card on application. As majority of the people affected were poor and did not own an identity card they were excluded from being enrolled on to the scheme. The scheme could be enhanced by removing some of these barriers to make it more equitable. The government should carry out a registration process of all the people in the area as a preparedness measure for future floods.
The Clusters have achieved varying levels of success. There seems to have been a lack of clear leadership amongst the clusters, especially when some clusters have more than 600 humanitarian agencies grouped together. Initiatives that can rank agencies according to their leadership strengths and experiences should be explored and also structure the size of the meetings to allow for efficient communication and information sharing.
The Pakistan floods of 2010 affected over 20.2 million and claimed the lives of 1985 and injured 2946 people. The floods affected 78 out of 121 districts and at one stage submerged 20% of country total landmass underwater causing total damage of over $10 billion. KPK and Balochistan suffered predominantly from flash floods; whereas Punjab and Sindh suffered mainly from slow-rising riverine floods. The amount of fore warning disseminated to vulnerable communities was inconsistent throughout the country. The northern provinces of Pakistan were disadvantaged with shorter advance warnings than the southern provinces. However, response to the floods was much swifter in the northern regions as compared to the southern regions. The NDMA coordinated all response efforts and the UN Cluster approach was adopted to provide humanitarian assistance to affected communities. The initial Rescue and Relief Phase was discontinued on 31st January 2011; except in 27 most affected districts where eight Sectorial Working Groups (SWG) were established in April 2011 to start the Early Recovery Phase. Unfortunately, recovery and rehabilitation efforts have been hampered by the recent floods of 2011 that have affected 5.2 million people and destroyed over 1 million houses in Sindh. The floods of 2010, and indeed 2011, have exposed vulnerabilities in the country disaster risk reduction system where further investment is required in emergency preparedness, response and recovery programme.
Email: [email protected]
A special thank you to Dr Paul Wilkinson and Professor Virginia Murray for kindly supervising me during the course of writing this report. I would also like to thank Ms. Carla Stanke for her invaluable support and contribution during the editing process.
[1] Pakistan Metrological Depart. Government of Pakistan. Rainfall statement July 2010 Accessed on 21st June 2011 via: https://www.pakmet.com.pk/FFD/index_files/rainfalljuly10.htm [online].
Date
Time
Hours notice
Forecast /Warning
Regions/Areas Affected
14:00
Widespread thunderstorm/rain at times heavy that may cause flash flooding in low lying areas
Lahore, Gujranwala, Sialkot, Rawalpindi, Peshawar, Kohat and Mardan (Kalpani Nullah) divisions of Punjab Province.
13:20
1:40
River Chenab expected to attain High Flood levels of at: Marala (15:00 hrs on 22/07/10 to 0300 hrs to 23/07/10), at Khanki (0100 hrs on 23/07/10 to 1400 hrs on 23/07/10) and at Qadirabad (0700 hrs of 23/07/10 to 20:00 hrs on 23/07/10
Riverbeds in Gujranwala, Sialkot, Gujrat, Hafizabad, Mandibahauddin districts of Punjab to be inundated.
15:30
12:00
River Chenab expected to attain High Flood levels of at: Khanki (03:00 hrs on 28/07/2010 to 15:00 hrs on 28/07/2010); Qadirabad (09:00 hrs on 28/07/2010 to 21:00 hrs on 28/07/2010)
Riverbeds in Gujranwala, Sialkot, Gujrat, Hafizabad, Mandibahauddin districts of Punjab to be inundated.
19:42
1:18
Moderate flooding likely in hill torrents (21:00 hrs on 27/07/2010 to 08:00 on 28/07/2010)
DG Khan and Rajanpur Districts of Punjab Province
08:30
00:30
Likely Heavy flooding in Hill Torrents (09:00 on 28/07/10 to 09:00 on 29/07/10)
Kalat, Naseerabad, Sibbi and Zhob division of Balochistan
08:30
00:30
Likely Moderate to Heavy flooding in Hill Torrents (09:00 hrs on 28/07/2010 to 09:00 hrs. on 29/07/2010)
DG Khan and Rajanpur Districts of Punjab.
14:50
02:10
Heavy rainfall expected in upper areas of River Jhelum. River Jhelum at Mangla is likely to attain High to Very High flood level (17:00 hrs. on 28/07/10 to 0800 hrs. on 29/07/10)
Mangla district of Punjab.
16:00
24:00
Heavy rainfall recorded in upper Khyber Pakhtunkhwa.Flash flooding expected in River Kabul and its tributaries during the next 24-36 hours.
Khyber Pakhtunkhwa.
19:00
00:30
Heavy rainfall expected in upper catchment of River Indus.River Indus at Tarbela region likely to attain Medium to High Flood levels (19:30 hrs on 28/07/10 to 10:00 hrs on 29/07/10).
Khyber Pakhtunkhwa
22:00
06:00
Heavy rainfall expected in upper catchment of River Indus. River Indus expected at Kalabagh likely to attain medium to high flood levels (04:00 hrs. on 29/07/10 to 22:00 hrs. on 29/07/10).
Kalabagh district of Punjab.
12:30
05:30
River Chenab at Trimu likely to attain medium flood level (18:00 on 31/07/10 to 08:00 on 02/07/10)
Expected riverine flooding in low lying areas of Districts Mandibahuddin, Chiniot, Jhang, Khanewal, Multan & Muzaffargarh districts of Punjab.
12:45
41:15
River Indus at Tanusa likely to attain high to very high flood level (06:00 on 31/07/10 to 06:00 on 01/08/10).
Expected riverine flooding in low lying areas of Districts Bhakkar, Layyah, Muzaffargarh, DG Khan and Rajanpur of Punjab
19:30
00:30
Heavy rainfall expected in upper catchment of River Jhelum.River Jhelum at Mangla likely to attain high to very high to exceptionally high flood level (20:00 on 29/07/10 to 08:00 on 30/07/10)
Mangla district of Punjab.
10:30
5:30
River Indus at Kalabagh likely to attain a very high to exceptionally high flood level (16:00 on 30/07/10 to 18:00 on 31/07/10)
Kalabagh district of Punjab.
10:40
17:20
River Indus at Chashma likely to attain a very high to exceptionally high flood level (04:00 on 31/07/10 to 20:00 on 31/07/10)
Mianwali district of Punjab.
13:40
29:20
River Indus at Taunsa likely to attain exceptionally high flood level (18:00 on 01/08/2010 to 18:00 on 03/08/10).
Expected riverine flooding in low lying areas of Districts Bhakkar, Layyah, Muzaffargarh, DG Khan and Rajanpur districts of Punjab.
10:15
~48:00
River Indus at Guddu likely to high flood level (on 03/08/10) and exceptionally high flood level (on 06/08/10). River Indus at Sukkur likely to attain high flood level (on 04/08/10) and exceptionally high flood level (on 07/08/10)
Riverine flooding expected in low-lying areas of Ghotki and Sukkur Districts in Sindh. Riverine flooding expected in low-lying areas of Sukkur, Larkana, Nawabshah, Hyderabad, Nosheroferoz Districts in Sindh.
15:40
1:20
Moderate flooding likely in Hill Torrents (17:00 on 01/08/10 to 08:00 on 02/08/10).
DG Khan and Rajanpur Districts of Punjab.
14:30
1:30
Moderate to heavy flooding likely in Hill Torrents (16:00 on 02/08/10 to 08:00 on 03/08/10).
DG Khan and Rajanpur Districts of Punjab.
10:00
00:30
Moderate to heavy flooding likely in Hill Torrents (10:30 on 03/08/10 to 23:00 on 03/08/10)
DG Khan and Rajanpur Districts of Punjab.
13:45
~36:00 ~10:15
River Indus at Guddu likely to exceptionally high flood level (on 05/08/10) and exceptionally high flood level (on 06/08/10). River Indus at Sukkur likely to attain high flood level (on 04/08/10) and exceptionally high flood level (on 07/08/10)
Riverine flooding expected in low-lying areas of Ghotki and Sukkur Districts in Sindh. Riverine flooding expected in low-lying areas of Sukkur, Larkana, Nawabshah, Hyderabad, Nosheroferoz Districts in Sindh.
21:00
Moderate to heavy rainfall in Khyber Pakhtunkhwa.Flash flooding is expected in River Kabul and its tributaries during next 24 hours.
Khyber Pakhtunkhwa
22:00
00:30
Moderate to heavy flooding likely in Hill Torrents (22:30 on 03/08/10 to 12:00 on 04/08/10)
DG Khan and Rajanpur Districts of Punjab.
11:30
00:30
Moderate to heavy flooding likely in Hill Torrents (12:00 on 04/08/10 to 24:00 on 04/08/10)
DG Khan and Rajanpur Districts of Punjab.
01:00
04:00
Moderate to heavy flooding likely in Hill Torrents due to rain in Suleman range (05:00 on 05/08/10 to 17:00 on 05/08/10)
DG Khan and Rajanpur Districts of Punjab.
11:00
24:00
RED ALERT: River Indus at Guddu likely to attain high to exceptionally high flood level (on 05/08/10 to 06/08/10). RED ALERT: River Indus at Sukkur likely to attain high flood level (on 06/08/10) and exceptionally high flood level (on 07/08/10 to 08/08/10)
Riverine flooding expected in low-lying areas of Khairpur, Jacobabad, Sadiqabad, Shikarpur, Ghotki, Sukkur in Sindh. Riverine flooding expected in low lying areas of Dadu Sukkur, Larkana, Nawabshah, Hyderabad, Nosheroferoz Districts in Sindh.
11.30
~06:00 156:30
River Indus at Sukkur likely to attain exceptionally high flood level (on evening of 06/08/10 to 07/08/10). River Indus at Kotri likely to attain a very high to exceptionally high flood-level (on 10/08/10 to 11/08/10).
Riverine flooding expected in low lying areas of Dadu Sukkur, Larkana, Nawabshah, Hyderabad, Nosheroferoz Districts in Sindh. Riverine flooding expected in low-lying areas of Thatta district and adjoining areas of the riverbed in Sindh.
14:00
01:00
River Chenab likely to attain high flood level (15:00 on 06/08/10 to 08:00 on 07/08/10).High flood is expected in River Chenab in Khanki area (22:00 on 06/08/10 to 13:00 on 07/08/10)
Low-lying areas of Gujranawala, Sialkot, Gujrat, Hafizabad, and Mandibahauddin districts on Punjab.
20:00
07:00
River Chenab likely to attain high flood level (03:00 on 07/08/10 to 15:00 on 07/08/10).
Low-lying areas of Hafizabad, Mandibahauddin, Chiniot and Jhang.
11:30
00:00
Heavy rainfall has been recorded in the upper catchment of river Kabul its tributaries and more rainfall is expected.Flash flooding (high to Very High) is expected in River Kabul and its tributaries during the next 24-36 hours.Flash flooding is expected in Kurrum and Gambila rivers.
Low-lying areas of Sawat, Kalpani, Panjkora, Jindi, Adezai, Naugaman, Khiali, Shahalam, Chitral)
16:00
01:00
Moderate to heavy flooding likely in Hill torrents due to heavy rain in Suleman range (17:00 on 07/08/10 to 05:00 on 08/08/110)
DG Khan and Rajanpur Districts of Punjab.
Agriculture
Ministry of Agriculture
FAO
Camp management/ Camp
National Disaster Management Authority and Provincial Disaster Management Authorities
UNHCR
Coordination
National Disaster Management Authority and Provincial Disaster Management Authorities
UNDP
Community Restoration
National Disaster Management Authority and Provincial Disaster Management Authorities
UNDP
Education
Ministry of Education
UNICEF/Save the Children
Food
National Disaster Management Authority and Provincial Disaster Management Authorities
WFP
Health
Ministry of Health
WHO
Logistics, Emergency Telecommunications
National Disaster Management Authority and Provincial Disaster Management Authorities
WFP
Nutrition
Ministry of Health
UNICEF
Protection
Ministry of Social Welfare
UNHCR
Shelter & NFIs
National Disaster Management Authority and Provincial Disaster Management Authorities
Ministry of Social Welfare
WASH
Ministry of Environment, Provincial Public Health Engineering Departments
UNICEF