November 17, 2022
Environmental Health Risks in the Philippines
The extreme floods that Pakistan experienced at the end of summer continue to spell disaster for much of the population. Entire homes, families, and livelihoods disappeared in a blink of an eye and addressing such a disaster takes a lot of time and determination. Wafaa Al Saidy is the General Coordinator for Doctors of the World (DotW) in Pakistan. She is currently managing DoTW response in affected areas and has shared her experience so far on this crisis.
There are huge areas that have been affected by flash floods which have washed away everything. There are areas which are still literally under water, especially in Sindh and some parts in South Punjab, and the population has been completely displaced. The needs are huge in the displacement areas, but this is also the case in the areas where people return from their temporary settlements.
So many people must start from scratch, but they don’t have livelihood and they are afraid to sleep under a roof because there have been incidents where partially affected houses have collapsed on people even after the rains stopped.
When this disaster started, Doctors of the World was already working in KP (Khyber Pakhtunkhwa), which is in the north-west of the country, in the provision of essential health services for Afghan refugees and host communities. This province is categorized as being the first one hosting Afghan refugees. When the flood started, we launched a flood response in Khyber Pakhtunkhwa in the most affected areas.
Currently we are working in Khyber Pakhtunkhwa in 13 Afghan refugee community health facilities. We also have 3 mobile teams, which are fully operational and currently in two districts in KP dedicated to the flood response. Our teams are directly providing services, medicines, ante-natal care, postnatal care, screening of children for the affected population in the areas which were hit by the floods.
The main obstacles we are facing is that the needs are huge, and our capacity is limited, same as for other actors. For the population, the situation was not great to begin with, even before the floods. There was an ongoing economic crisis that was hitting Pakistan, mostly vulnerable populations like the poor and the Afghan refugees. With the floods, many people lost literally everything.
Now one of the challenges is that we are receiving the cases in advanced stage: during emergencies, even the health seeking behavior in the communities changed. For example, parents don’t bring their child in at the beginning of an illness, like in the first days of a fever. They wait. Not because they are bad parents but because they have other priorities: “Where can we get our next meal? Where can we sleep tonight? What can we do to restore our lives?”. Consequently, we receive children in bad conditions.
So in general, we have logistic challenges and infrastructural challenges in the health facilities, but we are improving that and we are working on it with the government hand by hand. We need to rehabilitate the health structures to make them an environment to provide not only health care but also health education in the waiting area, to do the triage and make sure we don’t miss the more critical cases.
Our main concern is that we don’t want to have a massive loss of lives after the floods due to unmanageable outbreaks or due to malnutrition in the upcoming few months. We are also worried about pregnant women who are expecting their babies while the health system is overwhelmed.
We want people to have access to health on the short, medium and long term but much more funding is needed. At the same time, we need more partners to expand our operational capacities and we need to do a lot of preventive measures. Many of the communicable infections are preventable. But if we don’t offer community awareness activities and health education and instead just keep the focus on medicine and the direct service delivery, we are missing a lot by not engaging with the communities.
Another important point: as a humanitarian organization we have to keep also a focus on psychosocial support for patients who have been traumatized during those events.
Of course, there are hundreds of these cases where we helped as many patients as we could treat in the field. Every child we can consult, treat and screen for malnutrition is a success. It is a success story to have access even to this basic health care. I have seen a woman in an Afghan refugee health facility and when I was talking to her, I felt so happy for this young lady: she was pregnant, had already two or three children, and was at the health center for ante-natal care. It was her fourth visit. I was so glad to see this woman, who trusted the clinic, despite the floods, despite everything, and she keeps coming for her pregnancy follow-up. I considered this really a success story: it is the continuum of care that we want to focus on. We don’t want to miss all those cases and especially not the most urgent ones.
© Artze der Welt
© Katrijn Van Giel