1. Home
  2. Asia
  3. Pakistan

The limits of loss and damage: A cautionary tale from Pakistan

This year’s historic floods exposed just how much women and the poor have been systematically ignored.

A woman displaced by this year's catastrophic flooding in Pakistan's Sindh province wades through the floodwater carrying a water pot, on 16 September 2022. Akhtar Soomro/REUTERS
A woman displaced by this year's catastrophic flooding in Pakistan's Sindh province wades through the floodwater carrying a water pot, on 16 September 2022.

The landmark agreement struck this weekend in Egypt that will see rich nations pay into a “loss and damage” fund to help poorer, disaster-affected parts of the world rebuild and recover is as welcome as it is belated: It’s clearer than ever that countries with higher emissions have a responsibility to contribute to climate justice through reparations. 

But governments of countries with low emissions, such as Pakistan, have their responsibilities too. They must build resilience by enhancing development so there are higher baselines from which to rebuild lives. As we collectively reflect on the outcomes of COP27, it’s important to ground our understanding in people’s lived experiences and centre our analysis around those most affected by – and in need of – climate justice. 

Pakistan’s recent floods impacted some 33 million people and inundated one third of the country. But this isn’t a Pakistan-specific problem. Without global collective action, experts warn of catastrophic climate breakdown.

In September, eight weeks after the floods hit, a few friends and I organised a medical camp for flood-affected communities in Sindh, the province I call home, and which was the worst hit, suffering close to 70% of the overall damages and losses.

With roads, schools, and hospitals still underwater or unusable, the floods have exposed the state’s sustained failure to fulfil its basic responsibilities. Many of the issues we encountered were symptomatic of widespread and longstanding governance failures in the areas of gender equality and healthcare. 

“There is no dry ground… I have nowhere to bury my children.”

Aid, as ever, was concentrated in urban centres, with rural areas continuing to suffer. 

In the plains of Sindh, where rivers ran where villages used to be, one woman told me: “There is no dry ground… I have nowhere to bury my children.”

On both sides of the main highways, I saw stagnant water with people living on any elevated piece of land they could find – crammed into tents or makeshift structures with small solar panels for necessities such as charging phones and running fans. 

While travelling through Sindh, I saw a mass exodus of families. Boats, rickshaws, tractors and other forms of transport were exorbitantly priced by disaster profiteers. Families were selling animals, their most prized possessions, to take rescue boats to safety for five times the pre-flood price.

Some were so desperate they began moving to Thar district, without any arrangements for shelter. Thar residents couldn’t understand why. The district is a barren desert and one of the most underdeveloped places in Pakistan. It has become a sanctuary simply because it is dry. 

Few women to help women

As the Sindh provincial government set up shelters in government buildings, survivors instinctively went to their nearest school when the rain wouldn’t stop – they said they learned this protocol during the floods in 2010 that left almost 2,000 people dead.

Other communities I met didn’t want to move to government shelters, telling me: “the food is inedible”; “people are kept like animals”; “it’s completely dark”; “it is not safe for our women”. 

Women’s safety became a critical issue as we set up our medical camp. Many female doctors told us they were concerned about their security. The camp’s location in Larkana district was hard to reach as roads were badly maintained even prior to the floods. With high rates of gender-based violence in Pakistan – over 5,000 rapes registered in 2021, including rapes on highways – women here are justifiably afraid.

In the end, only one female doctor agreed to accompany us. Without her, we would have been unable to serve half the community. In six hours, she saw 180 patients: one patient every 2 minutes.

It was difficult to explain medicine dosages as the majority of patients couldn’t read or write, having never finished basic formal education. In Sindh, four in five rural women have no education, and only 46% of women in the entire province are literate.

The province has largely failed its women – a situation reflective of larger issues in Pakistan. Though 70% of medical students are women, it’s estimated that half won’t pursue medicine following graduation. With just 1.1 physicians per 1,000 people in Pakistan, the situation is markedly worse for female patients. This is particularly true in rural Sindh, where there are few female doctors and it’s regarded as largely unacceptable for women to be seen by a male doctor. 

It wasn’t just a problem for our camp: There was a lack of women more broadly in the response teams on the ground. One local volunteer group called me to ask: “How do we support women? We have no women in our team. We didn’t know who to ask.”

The situation is dire. Without women’s participation and leadership, we are failing to provide flood-affected women with the services that meet their needs and those of their families. 

At our medical camp, every mother had several children with interconnected medical issues. The majority of women I saw were pregnant, a result of both lack of belief in and access to birth control.

The fertility rate in Sindh is 3.6, more than 50% higher than the average for South Asia, which is 2.3. Only 24% of women aged 15-49 use a modern method of family planning, compared to 52% in South Asia.

‘They don’t know how to give aid’

Hunger is a growing concern. Our patients told us it’s not just them, their animals – the ones that survived – are malnourished too.

Most women and children are malnourished, a condition pre-dating the floods. In Sindh, 50% of children under five are stunted in their growth, which is an indication of chronic undernutrition, and the highest level in the country. 

Medical concerns range from some which are chronic and worsened after the floods, such as gastrointestinal issues and severe malnutrition, to those which have developed post-floods, such as severe skin diseases. Dengue, malaria, and pneumonia continue to spread. Women consistently speak of migraines, insomnia, and anxiety. Many mention their inability to sleep, think, move, function, and are battling debilitating depression. 

It quickly became evident to me that the government fails to provide basic services within the shelters. NGOs say that government employees want a share of any food or aid provided to IDPs, with the justification that the floods spared no one.

Government employees told me their own homes had drowned. They said they faced salary cuts, and they wondered who their salaries are now feeding: the people they see starving in their shelters, or the officials sitting in Karachi. 

The arrival of a military truck carrying aid sparked scenes of desperation: Survivors attacked it, hanging off it, throwing rocks at it. Officers threw food in the air and people scrambled to catch it. Eventually, the truck hurried away again, sending people diving out of the way.

The relief worker I was with cursed the officers: “They don’t know how to give aid… this is not how things are done.”

But it’s the military, which has by far the largest resources in the country, that’s running the flood relief operation. Without basic training or understanding of how to provide aid to communities and engage in humanitarian interventions, many of their efforts appeared to be inefficient or wasted.  

And where the establishment does intervene, it’s often counter-productive. Many of the international NGOs that had provided key services during the 2010 floods have since had to close their offices in Pakistan.

Since 2011, the security establishment has set up a highly regulated regime for NGOs with several levels of interior ministry approval. NGOs with any international links are heavily scrutinised and operationally restricted. As a result, Pakistan had lost trained manpower, infrastructure, funding, and expertise by the time it was most needed. And even the local organisations still engaged in flood response continue to have to fulfil onerous verification requirements during this emergency.

What I witnessed in Sindh – the scale of Pakistan’s recent floods and a wholesale inability to respond – must be a wake-up call to the state to address structural and systemic problems. 

Loss and damage funding – if indeed the money is forthcoming – is all well and good, but it can only go so far. Unless the government grabs hold of its responsibility to improve baseline development, flood response, and emergency aid, the inevitable disasters of the future will continue to see needless pain and loss of life.

Edited by Abby Seiff.

Share this article

Get the day’s top headlines in your inbox every morning

Starting at just $5 a month, you can become a member of The New Humanitarian and receive our premium newsletter, DAWNS Digest.

DAWNS Digest has been the trusted essential morning read for global aid and foreign policy professionals for more than 10 years.

Government, media, global governance organisations, NGOs, academics, and more subscribe to DAWNS to receive the day’s top global headlines of news and analysis in their inboxes every weekday morning.

It’s the perfect way to start your day.

Become a member of The New Humanitarian today and you’ll automatically be subscribed to DAWNS Digest – free of charge.

Become a member of The New Humanitarian

Support our journalism and become more involved in our community. Help us deliver informative, accessible, independent journalism that you can trust and provides accountability to the millions of people affected by crises worldwide.