Pakistan

WHO

Pakistan

People in need: 20.6 million¹
People targeted: 9.5 million
Requirements: 70.8 million

Context

Pakistan is prone to natural and manmade disasters, including flooding. In 2022, severe flooding resulted in the displacement of over 600 000 people and caused significant damage to houses and infrastructure, as well as 2 000 health facilities - 13% of all health facilities in the country. Three million acres of crops and over 1.2 million livestock were destroyed, thereby gravely affecting food supplies. As a result, at least 6.4 million people are in need of humanitarian assistance in flood-affected areas, access to health care is severely impeded and medicine stocks need to be entirely replenished. As water levels are receding, about 50% of the displaced population have returned to their places of origin but continue to suffer from poor access to safe water and sanitation, which exposes them to the risk of disease outbreaks.

Pakistan is currently seeing outbreaks of acute watery diarrhea (AWD), cholera, malaria, dengue and measles, whilst COVID-19 and diphtheria cases continue to be reported. Global acute malnutrition (GAM), which dangerously increases the risk of death, rates are above the emergency threshold of 15%, particularly among children. Pakistan also hosts over 2.6 million refugees from Afghanistan – accounting for the second largest refugee population in the world after Turkey – whose access to health care is poor.

Pakistan is one of only two remaining countries endemic to wild poliovirus, together with neighboring Afghanistan. Coordinated, cross-border activities are ongoing to urgently eradicate the disease. In 2022, 20 cases were reported nationally, all occurring in the same province; however, the risk of renewed spread nationally and internationally is magnified due to the recent floods affecting the country. Polio infrastructure continues to support flood relief efforts, while polio operations are being adapted in response to the crisis.

WHO
Flood affected population.

WHO
Flood affected population.

Emergency response

The response to this humanitarian crisis will be implemented either directly by the WHO Country Office (WCO), or through the Ministry of National Health Services, Regulation and Coordination (MoNHSR&C) and with the support of implementing partners such as NGOs, academic institutions, and others. WHO is the co-chair of the Health Sector Coordination (HSC), with the Ministry of National Health Services, Regulation and Coordination. WHO is contributing to the provision of essential services for displaced populations through static and mobile camps and procuring and distributing medicines and medical supplies to address the impact on health. WHO also provides a platform for daily coordination meetings, enabling national level planning and has put in place ten Emergency Operations Centres (EOCs) and three operational hubs in Sukkur, Naseerabad and Hyderabad.

Strategic objectives

Key activities

Improve access to health care for the Afghan refugee population, hosting communities, flood-affected populations and internally displaced persons (IDPs). This will involve the provision of human resource, medicines and other medical supplies, training of health care workers, targeted rehabilitation of health facilities, monitoring of disease trends through the establishment of an Emergency Disease Surveillance System (EDSS) and rolling out the Integrated Disease Surveillance and Response (IDSR) system in affected districts.
Address malnutrition among children in the flood-affected provinces of Sindh and Balochistan. This will be achieved through creating additional nutrition stabilization centers and the provision of nutrition supplies, medical equipment and medicines, human resources and training.
Strengthen disease surveillance and response to disease outbreaks in all areas, including the flood-affected areas of Sindh and Balochistan. This will be achieved through training of surveillance and laboratory officers, provision of surveillance tools, supporting disease outbreak investigation and strengthening referral laboratories.
Strengthen the government’s capacity to prepare for and respond to other emergencies. This will be achieved through training government counterparts in emergency coordination, response plan development, assessments, provision of emergency supplies and full implementation of national polio emergency action plans.

Funding requirements

Overall country funding requirements, including COVID-19, by pillar (US $ '000)

Success stories

Heath Emergency and Polio eradication staff working together responding to health needs among flood affected populations in Pakistan

In 2022, severe flooding resulted in the displacement of over 600 000 people and caused significant damage to houses and infrastructure, as well as 2 000 health facilities - 13% of all health facilities in the country. Despite 50% of displaced populations having returned to their places of origin, they continue to suffer from poor access to safe water and sanitation, exposing them to the risk of disease outbreaks.

As part of the WHO’s Pakistan Country Office’s core work, the polio eradication program has been implemented in health camps following large scale immunization campaigns on a regular basis. This year, the program coincides with the health response following the devastating flooding.

Responsible for its implementation, the Heath Emergency and Polio eradication teams took the opportunity to collaborate on their work in these health camps. The teams have worked to provide free basic health services to the flood-affected populations in 37 flood-affected districts of Pakistan through fixed and mobile health camps.

In consultation with the provincial and district authorities, two health camps (one mobile and one static) were installed for 25 days in each of 37 flood-affected districts. With the guidance of the district authorities, the locations for health camps in each district were selected. The health camps have provided vital, life-saving medical services for maternal and child health, skin diseases and vector-borne and water-borne diseases (diarrhea and enteric fever).

Establishing Emergency Disease Surveillance System (EDSS) to enhance early detection and response to epidemic-prone diseases among flood-affected population in Pakistan

Since June 2022, Pakistan has experienced heavy monsoon rains, affecting 8 million people and causing widespread destruction across the country, especially in Sindh and Balochistan provinces.

WHO, in collaboration with the Federal Health Ministry, National Institute of Health (NIH) and provincial health departments, have developed the Emergency Disease Surveillance System (EDSS) to sharpen the Integrated Disease Surveillance and Response (IDSR) ability to detect and respond to public health alerts.

The NIH and WHO jointly selected 17 districts from the most affected provinces (11 in Sindh, five in Balochistan and one in Punjab) to host the launch of the EDSS. The health staff in the selected districts have been trained and equipped with the appropriate software to report on 12 different health events from the BHU level. WHO has recruited additional staff to provide field technical support to EDSS.

WHO has also deployed 26 surveillance officers and 14 data analysts in close liaison with the concerned provincial health departments. Officers and analysts are responsible for monitoring the situation in their respective districts and visiting the areas where an increased number of cases for any disease has been reported. Since mid-September, provincial health departments and the NIH have been enabled to better monitor epidemic-prone diseases enhanced by availing laboratory supplies and establishing sample transport mechanisms.