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Thirty-five-year-old Hasina, from the village of Khuda Bakhsh Dasti in Khairpur, suffered from severe lower abdominal pain, backaches, a burning sensation in her urinary tract, and vaginal itching. Her husband had spent a substantial amount of money taking her to clinics in Hyderabad and Larkana. Despite paying what were described as nominal fees to doctors and purchasing expensive medications from the clinics’ pharmacies, nothing seemed to work, even after multiple visits.

In late February 2024, Community World Service Asia (CWSA) and the Disasters Emergency Committee (DEC) launched their first medical health camp in their village. Dr Tayyaba Iqbal recalls how about two hundred villagers swarmed their vehicle. Although the team had enough time to treat only around 50 patients on the day, Dr Tayyaba and her assistant, Lady Health Visitor Mumtaz Kahlon, managed to attend to 95 people. Many unwell or healthy villagers came out of curiosity to witness the new “hospital in a van”.

Among the patients was Hasina, who had nearly lost faith in doctors. The camp’s doctors guided her to take a urine test that revealed a urinary tract infection (UTI), while an ultrasound ruled out the presence of kidney stones. Hasina was sent home with the appropriate antibiotics, finally on the path to recovery.

Twenty-one days later, Hasina returned to the second health camp in the village to report that the medication had worked perfectly and she was feeling well. However, during her third visit during Ramadan, she complained that she experienced burning again due to fasting regularly.

Dr Tayyaba prescribed oral rehydration salts (ORS) and advised Hasina to drink plenty of water. She also explained that maintaining her health by staying hydrated was important and that missing fasts due to illness was permissible.

Dr Tayyaba noted that the most common ailments in the village were scabies, malaria, asthma, and respiratory tract infections, with the prevalence of scabies and malaria attributed to stagnant water left behind by 2023’s floods. In addition to these recurring diseases, she observed that most patients were anaemic, likely due to iodine deficiency in their diet.

After holding just three medical camps, each lasting a single day with three weeks between them, the number of out-patients had dropped to fewer than 50 per day. This reduction indicated that villagers were more confident accessing regular medical care. More importantly, the effectiveness of the treatment provided by the mobile facility stood in stark contrast to the high-cost private clinics they had previously relied on.

Rukhsar is another woman from the same village, with a similarly challenging story. When the CWSA health camp first visited the village in late February 2024, she struggled to reach the facility, walking with great difficulty while carrying her daughter, who was too young to be left unsupervised. Although Rukhsar said her daughter was eighteen months old, the child appeared no older than six months and was so weak that she couldn’t even sit up on her own.

By late March, Rukhsar was full-term pregnant with her third child and was experiencing severe bleeding. The doctor diagnosed her with vaginal bleeding, leukorrhea, anaemia, malnutrition, and lower abdominal pain. This had been ongoing for over a month, during which her husband, Ghaffar, had sacrificed two days’ wages to take her by motorcycle to a private health facility in Khairpur, a two-and-a-half-hour journey. The doctor charged the couple PKR 1,000 (Approx 3.6 USD) for an ultrasound, PKR 1,000 (Approx 3.6 USD) for her consultation fee, and PKR 1,500 (Approx 5.4 USD) for medication from the clinic’s pharmacy. Additionally, the motorcycle fuel for the journey cost PKR 600 (Approx 2.2 USD).

Strangely, the medication Rukhsar received was prescribed for only three days, and when the dosage ended, she felt no better than before. The couple then tried the government health unit in nearby Thari Mirwah, where she was given medication for five days. Yet again, it had no effect.

The night before this interview, Rukhsar’s discomfort worsened, prompting her and Ghaffar to visit the Thari health unit. Upon arrival, she was kept waiting for over an hour while the doctor tried to determine if her abdominal pain was due to labour. After the wait, they sent her home, informing her that the baby was not yet due.

Having modest means, both Rukhsar and Ghaffar were deeply concerned. If the delivery required a caesarean, despite her first two children being born naturally, they didn’t know how they would arrange such a large sum of money at short notice. Seeking clarity, they returned to Thari the next morning. Rukhsar was given a blood test, which cost PKR 800 (Approx 8.9 USD), only to be told that her haemoglobin level was dangerously low at just nine and that she needed urgent treatment. Speaking in a barely audible voice, Rukhsar expressed her frustration that neither private nor government doctors had ever explained her condition or answered her questions.

When she first visited the CWSA health camp in February 2024, Rukhsar informed the doctor that, despite being eight months pregnant, she felt very weak foetal movements. After a thorough examination, she was given a prescription that stopped both her vaginal bleeding and leukorrhea, and she was also provided with dietary supplements. Upon her return in late March, she reported that all her symptoms had been resolved. A follow-up blood test confirmed that her haemoglobin levels had improved.

As they were preparing to leave, Ghaffar disclosed that their sickly daughter, who looks much younger than her age, had been diagnosed with a heart condition. He did not know the specifics, only that she had “holes in her heart”. A doctor from Thari had advised him to seek help from a primary health care unit in Sukkur, but that visit yielded no results. Ghaffar wonders whether the CWSA health camp can help his daughter, but fears that her condition might be beyond the scope of the facility. 

Although Ghaffar still doesn’t fully understand his daughter’s illness, he feels relieved and optimistic now that his wife, Rukhsar, is doing much better. The improvement in her health has eased his worries. 

As for Hasina, the proper medication and thorough check-up helped her fully recover from her infections and she can once again support her husband in the fields. 

Both families are living examples of how timely, effective medical care can transform lives in communities deprived of such services.

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Sawal and her husband Sikandar Ali, a driver, faced immense hardship when they lost their livestock and home during the torrential rains. For almost two months, the couple and their five-year-old daughter were forced to live in makeshift tents on higher grounds, on a sharing basis with other villagers. In June 2022, the rural areas of Sindh were severely impacted by heavy rains, devastating villages and leaving the residents in dire conditions. Subhan Panhyar village, located in Khairpur District, was among the hardest hit, with nearly everyone left without land and food.

The villagers had to ration food items among themselves for months, often finding it insufficient. There were days when the village elders went without food to ensure the younger children could eat. Sawal and her family endured this struggle for two months, compromising on food, shelter, and land. The rains took everyone’s possessions and destroyed the lands that provided a means of livelihood. In the villages of Khairpur, nearly every family worked in the fields and depended on agriculture, but the floods struck just as the land was ready for harvest. The rains ruined everything, leaving the villagers without crops to sell or consume, which severely worsened their situation.

Sawal, after having her daughter, tried to conceive another child many times, but nothing seemed to work. The long gap between having children was distressing for her family, who desperately desired a new family member. Sawal and Sikandar traveled from their small village to Ranipur in search of better clinics but their efforts were unsuccessful. Sikandar also took Sawal to a government hospital in Karachi, but they returned empty-handed.

“It used to cost us a lot,” Sawal said, “A trip to Sukkur would mean spending PKR 2000 (approx 7.2 USD) on commuting and another 1500 PKR (approx 5.4 USD) on prescribed medicines. When we went to Karachi, we ended up in extreme debt. I took a loan of PKR 20,000 (approx 72 USD) from my boss, where I work as a driver, but we had to return because we couldn’t afford the living expenses in a city like Karachi.” Despite their efforts and expenses, Sawal was still unable to conceive, leaving her devastated.

Community World Service Asia (CWSA) has been implementing flood response projects in flood affected districts of Sindh, including Khairpur. With the support of Disaster Emergency Committee (DEC) and CAFOD, CWSA launched a Flood Recovery Response that included the establishment of two Rural Health Clinics (RHC), the provision of two Mobile Health Units (MHU), and free medicines, awareness through medical camps and health sessions.

When a community mobiliser of CWSA held a health session in Subhan Panhyar, the villagers were informed about the visiting hours, location, and health facilities of the nearby Mobile Health Unit. Upon hearing this, Sawal wasted no time and decided to visit the clinic.

In January 2024, when Sawal visited the clinic for the first time, she was prescribed medications to improve her health, including calcium and vitamins. After just one month of consistent treatment, Sawal was able to conceive. “I could not believe it when the doctors gave me a strip test, and it came back positive,” Sawal said. “We had been trying for months with no success. It was the lady health workers and the medications from the health unit that made the difference. Previously, doctors had given me medications without explaining the problem. At the clinic, they told me my body was too weak to bear a child. Once my health improved, I conceived quickly.”

The medical staff guided her to maintain a healthy diet and lifestyle, ensuring both she and her baby received the necessary nutrients for a healthy pregnancy. Sawal is now three months pregnant. She has visited the clinic twice—once when she was upset about not being able to conceive, and the second time to inform the Lady Health Worker (LHW) and Lady Health Visitor (LHV) of her pregnancy. She continues to visit the clinic as needed, receiving medicines for her unborn child, herself, and occasionally for her daughter if she is unwell.

“We wasted so much money on city doctors and medicines. If only I had known earlier about this health clinic, we wouldn’t be in debt,” Sawal reflected. Currently, Sikandar owes his boss PKR 20,000, but Sawal is hopeful that they will repay it. With their desire for a new baby almost fulfilled, Sikandar is now free of stress and works day and night to earn more as their family will soon be expanding.

Since the project’s implementation in March 2023, a total of 40,556 patients have visited the Rural Health Clinics (RHCs) for the first time, and 48,945 patients have visited the MHUs for general OPD. At the RHCs in Nara Gate and Choondko, primary health care services are provided, including General OPD, Antenatal Care (ANC), Prenatal Care (PNC), and normal baby deliveries. Each day, the dedicated CWSA staff at these RHCs and Mobile Health Units (MHUs) accommodate up to 120 patients at each location, ensuring that vital healthcare services reach those in need.

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Widespread destruction of local infrastructure and agricultural lands has also been reported as a result of the floods.

Pakistan’s Indus River experienced a significant surge in water levels from upstream, resulting in severe riverine flooding in the kacha areas (riverine areas) as monsoon rains hit several provinces in full force this week. These riverines and flash floods have both caused wide spread damages in different areas of Pakistan. In Sindh province, district Khairpur is among the most severely hit, with one person reported dead, two seriously injured, and thousands affected, requiring urgent humanitarian assistance and rehabilitation efforts.

A total of 3700 hundred families in Khairpur alone have been affected by the torrential rains and subsequent floods, with 270 families (along with their livestock, for most families a sole livelihood source) left displaced, and temporarily relocated along the protective bands or with relatives. Local authorities and field teams report 28,969 people affected (11,060 men, 13,700 women, and 4,209 children) in 36 villages in the district.

Flood affected communities are suffering from water borne and climate induced diseases, such as malaria, diarrhea, scabies and gastroenteritis, while pregnant women and newborn babies are experiencing malnutrition due to limited food supply, low resources and lack of health facilities. With roads and communication channels temporarily lost, pregnant women have no access to quality delivery services leading to delayed, unhygienic and problematic labour cases. The animals in the communities are also suffering from waterborne diseases, with an acute shortage of fodder.

Extensive damage to local infrastructure and agricultural lands due to the floods have also been reported. Thousands of hectares of standing and prepared crops, including cotton, dates, bananas, jowar (Sorghum), and vegetables, have been destroyed. More than 25 primary, elementary, and high schools have also been partially damaged, ruining the educational infrastructure, furniture, and fixtures, and disrupting academic activities just when the schools had reopened for new term.

An emergency needs assessment has identified the following needs:

  • Evacuation, rescue, relief, and rehabilitation efforts
  • Food Support
  • Non Food Items (NFI)
  • Shelter Kits
  • Medical camps with medicines and ambulance services
  • Nutritional support for children
  • Tent-schools and child-friendly spaces
  • WASH support, including Hygiene kits, Dignity Kits and Pit toilets
  • Hand pumps and drinking water
  • Animal fodder, treatment, and vaccination

Homes have been destroyed, families displaced, and essential resources are scarce. Immediate support and action are urgently needed to provide relief and rebuild lives.

CWSA’s Mobile Health Units are active and are reaching affected communities in remote flood affected areas to meet their urgent health needs.
CWSA’s health teams are on the ground, providing essential primary care through our Mobile Health Units to meet the urgent needs of the affected population.
These mobile units are equipped with medicines, qualified doctors and equipment to reach and support remote and severely impacted communities
Health Education sessions are being held with affected communities in Khairpur.
Affected communities are using boats to reach the main roads, as the access routes are submerged in rainwater.
Health Education sessions are being held with affected communities in Khairpur.

Community World Service Asia’s Response: Community World Service Asia (CWSA) is in close coordination with the local government, affected communities and other stakeholders active in the region. To address the urgent health needs of the affected population, our health teams are on the ground, delivering essential primary healthcare services through our Mobile Health Units. These mobile units are equipped to reach remote and severely impacted areas, providing critical medical care, disease prevention awareness and medicines, and health education to those who have been displaced or are otherwise unable to access traditional healthcare facilities.

Contacts:

Shama Mall
Deputy Regional Director
Programs & Organisational Development
Email: shama.mall@communityworldservice.asia
Tele: 92-21-34390541-4

Palwashay Arbab
Head of Communication
Email: palwashay.arbab@communityworldservice.asia
Tele: 92-21-34390541-4

Sources:
Relief Web
NDMA
Pakistan Metrological department
Dawn

772
With the support of our partners, CWSA has initiated flood response in the most affected villages in Khairpur District of Sindh.

Latest monsoon rains in Pakistan have once again lead to widespread flooding, taking lives, damaging roads, and disrupting the lives of thousands of local communities that were already grappling with recovery from last year’s floods. The 2022 floods had a profound impact on a large population of Pakistan’s mostly rural community, affecting 33 million people across the country and claiming 1,739 lives1.

CWSA’s health team conducted health consultations and sessions in Ghulam Shabbir Kalhoro village in Taluka Kingri.

In initial response to the current floods, Community World Service Asia’s emergency team has conducted assessments in twenty-five villages, which were previously affected by last year’s floods, within the Khairpur district. This new wave of floods has again ravaged agricultural lands, livestock, and infrastructure of communities living in Taluka2 Sobhodero and Kingri.

The Mobile Health Unit visited different villages to provide primary healthcare to flood affected communities in Khairpur District.

More than 5,600 people and a total of 1,149 households in the two talukas have been severely affected by the latest round of floods. Many affected families have sought refuge on higher grounds. Some women and children have decided to stay in their homes, with the men of the families venturing out in search of daily wages and essential supplies to ensure basic survival at this time of crisis. As connecting roads to this part of the district remain submerged, affected communities have again resorted to using boats to access main roads.

Affected communities in Jummo Panhiyar village were provided with OPD consultations and free medicines.

Community World Service Asia, with the support of its partners, has launched immediate humanitarian response activities to support affected communities in Taluka Sobhodero and Kingri. Through our response, we are providing essential health services through mobile health units, offering curative and preventive consultations, outpatient care, antenatal care, postnatal care, health counseling, and health awareness sessions. The awareness sessions focus on preventive diseases, maternal and neonatal healthcare, and hygiene. Affected communities are in urgent need of food, healthcare services, veterinary support for their livestock, and assistance with transportation through boats to meet their survival needs during this crisis.

Affected communities have again resorted to using boats to access main roads.
The floods have again ravaged agricultural lands, livestock, and infrastructure of communities in Khairpur.

Note: Situation Update 1 on this emergency can be read here.

Contacts:

Shama Mall
Deputy Regional Director
Programs & Organisational Development
Email: shama.mall@communityworldservice.asia
Tele: +92-21-34390541-4

Palwashay Arbab
Head of Communication
Email: palwashay.arbab@communityworldservice.asia
Tele: +92-21-34390541

Sources:
www.ndma.gov.pk
www.arabnews.pk
https://pdma.gos.pk
https://reliefweb.int
www.nation.com.pk

1. National Disaster Management Authority (NDMA)
2. In Pakistan, a tehsil or (taluka) is an administrative sub-division of a District.

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As a child Falak Sher dreamt of completing high school and joining the army. That was only natural for a child physically fit who from age ten was a kabaddi player. Though a contact sport, kabaddi is non-violent involving tagging and tackling and serious injuries are rare. However, that rarity struck Falak Sher when he was about twelve and in grade 4 of primary school.

During a match, he was tackled and brought down as had happened several times before. But this time the pang of shooting pain told him something had gone terribly wrong. Though his village Mehr Veesar lay some 50 kilometres southwest of Khairpur town, there were nearby hospitals as well. But Falak Sher was carried home rather than being taken to a proper medical centre.

His family called in the local bone-setter, an untrained potter who boasted knowledge passed down to him through several generations of bone-setters. Using splints and bandages, the man claimed to have set the bone right, but when two months later the dressing was removed, the leg was deformed. For the next five years, Falak Sher was bed-ridden because of persistent pain and inability to walk without support.

For the youngster the dream of being in military uniform faded away and even education seemed to have come to an end at grade 4. Time heals all, however, even badly set bones. After a break of five years, Falak Sher was able to walk back to school with the help of a staff. Though the military career was out of the question, yet the young man continued his schooling to complete matriculation. In a society where able-bodied men with degrees sometimes spend years seeking suitable jobs, there was no opening for a matriculate with a disability.

Already in his twenty-fourth year, Falak Sher apprenticed himself to a master weaver of the charpoy, the wooden bedstead. Within a year, he was sufficiently trained to independently turn an empty frame into a proper bed in under five hours. In 2023, at age thirty-eight, he was a highly proficient charpoy weaver who got calls on his cell phone when there was work.

“Life was getting along all right and I would get three to four charpoys every day,” said Falak Sher. That was enough work to keep him busy through the day and at Rs 400 per frame, he was a satisfied man.

Then came the floods of the summer of 2022. Whole communities lost everything they had and if Falak Sher’s house collapsed, he could hardly say Nature had singled him out for punishment. Flood-affected or not, people needed furniture to sleep on and if he thought that the broken charpoy frames would be repaired and he would be called to do the weaving, he was mistaken. No one had the money even to procure food for their families, and getting their bedsteads repaired was a very distant priority.

“For four months, it was a very difficult time because there was no work. In this village and a couple of other nearby ones, there are four other weavers like me, and we were all without anything to do,” reported Falak Sher.

Like many others, Falak Sher and his family lived by the generosity of a kind landlord who provided flood-affected families with one meal a day. Those were three months when he, the sole bread winner for his family, forewent meals so that his two year-old son was fed. His wife too needed to be fed as she was nursing an infant daughter. It was a very hard time.

Slowly work began to trickle in. However, because of his disability, Falak Sher had to hire a motorbike taxi to take him to the work site. That cost money. For short trips the fare was PKR 30, but longer ones set him back by PKR 100 (Approx. USD 0.3). Unlike the old days when he would get three to five pieces to work on in a day, now there was never more than one and subtracting the fare from his wage of PKR 400 (Approx., USD 1.4) hurt. But the man never gave up and assiduously kept at it.

In January 2023, Falak Sher received the first instalment of Cash for Food from Community World Service Asia (CWSA) with the support of Presbyterian World Service & Development(PWS&) and Canadian Foodgrains Bank (CFGB). Falak Sher spent the entire sum of PKR 12,000 on the purchase of food rations. For the first time in four months, he had a square meal, said the man. The following three months were the same pattern.

Being a talented craftsman, Falak Sher had not lost hope. And that paid off for in February he worked on twelve charpoys netting PKR 4800 (Approx. USD 15). The Cash for Food aid bolstered his hope and his ability to provide for his family. With work slowly picking up pace, the man was thinking of beginning to rebuild his collapsed home.

Asked how he would have fared without the cash grant, he remained silent. He had no idea how he and his family would have survived the hard months when there was so little work to be had.

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Pakistan’s 2022 monsoon season produced significant rainfall, devastating floods and landslides, affecting millions of people. At the beginning of 2023 and several months after one of the worst flooding experienced in the country, an estimated 4.5 million people remain exposed to or are living close to flooded areas. Displaced people have started to return to their places of origin, but they are returning to challenging situations and almost zero infrastructure.

During these floods, Hafiza Bibi, a single mother of four children, not only saw her home crumbling down in front of her eyes but also experienced the grief of two dear family members passing away. “My husband was suffering from cancer. We could barely afford his medicines. He passed away in August during the middle of all the heavy rains. While I was struggling to get over the loss of my husband, my daughter also suffered from a nervous breakdown in October due to the trauma and stress of the floods. It took us a whole day just to reach to the nearest hospital when she fell to the ground. She stayed in the hospital for ten days but did not survive. She was only 21years old.”

Hafiza’s husband worked as a farmer and a labourer. Hafiza stayed at home, taking care of her four children, dedicated to household and care-taking chores. She watched water daily and ensured the family consumed their meals. “Our relatives would sometimes help us by giving wheat or money as charity. However, after the floods everyone suffered badly and no one we know was in a position to help.”

Many homes were washed away in Muhammad Fazal Khokar village where Hafiza lived. And her house was one of the many totally destroyed. She now lives with her brother-in-law in the same village but she knows that this living situation cannot not be continued for a long time. “I live in a makeshift tent just outside the house. It scares me that one day my brother-in-law will ask me to leave his place. This thought terrifies me as I have no money to build a place of my own”. Hafiza and her children have struggled to survive and slept for days on an empty stomach since everything she once owned had vanished within a blink of an eye.

“We went door to door assessing flood affected people who were in dire need during our visits to the most remote villages of Khairpur district. That is when we came across Hafiza Bibi. Members of the village committee were kind enough to inform us that a widow with four young children was in urgent need of money and assistance,” shared Hassan, Community Mobiliser in Community World Service Asia.

Community World Service Asia (CWSA) with the support of Canadian Foodgrains Bank(CFGB) and Presbyterian World Service & Development (PWS&D) is supporting flood affected families with Cash for Food (CFF) in some of the most remote and climatically vulnerable villages of Khairpur district in Sindh, Pakistan. Under the initiative, flood survivors are provided cash to meet their immediate food and other essential needs.

Hafiza Bibi received PKR 12,000 in three tranches under the project so far(a total of PKR 36,000). “I bought essential food items such as wheat flour, rice, sugar, tea, milk and vegetables. This assistance has provided me some relief and allowed me to put food on the table for my children. At least for now. The rising prices are a huge concern and we do not know how we are going to make ends meets with no source of livelihood. I wanted to save some amount in case of emergency but I could not. A small packet of rice costs in hundreds these days. We need opportunities to revive our livelihoods.”

© Community World Service Asia