In her small, two-room house close to the busy Saraib Road in Quetta, the dusty capital city of Pakistan's Balochistan Province, Raheela Bibi, 30, sits darning a child's tattered sweater.
Her six children, all aged under 10, dart in and out of the house, their bare feet pattering on the rough, brick floor. The youngest, a baby aged seven months, sits in the arms of his nine-year-old sister. None of the children go to school.
"We cannot afford it. We tried at least to send the three boys to school, but it was impossible," said Raheela quietly.
Asked why the poverty-stricken family, which survives on less than US$70 a month, had opted to have so many children whom they can barely feed and clothe, Raheela was philosophical: "Who knows how many [children] Allah will allow to live and grow up," she said.
Her answer provides insight into the alarmingly high child mortality rate in Balochistan and the lack of faith citizens have in the health care system there.
Sandra Bisin, a spokeswoman for the UN Children’s Fund (UNICEF) in the capital, Islamabad, told IRIN: "Child mortality is high in Balochistan, with about 16 out of 100 children dying before their fifth birthday." She explained that in the rest of Pakistan "it is nearly 10 out of 100 children that die" before reaching the age of five.
High infant mortality
Successive findings indicate infant mortality in Pakistan is the highest in South Asia and, according to Islamabad-based non-governmental organisation (NGO) Society for the Protection of the Rights of the Child, stands at 70 deaths per 1,000 live births.
Raheela's neighbour, Ameera Imdad, 40, has experienced such loss.
"Eight years ago, I had twin daughters. Both of them died after an attack of diarrhoea when they were two months old," she said.
Though Ameera's five other children all survived, she said: "The sight of a dead child is something a mother can never forget."
Balochistan, spread over 347,190 sqkm to the southwest of Pakistan, is the largest of the country's four provinces but has the smallest population (around 10 million).
Balochistan is also Pakistan's least developed province, with high rates of poverty, illiteracy and malnutrition, resulting in deep-rooted frustrations amongst people who believe they have been denied fair treatment by the government, despite the province’s vast energy reserves.
"The condition in which the Baloch people live and die in abject poverty, often with no help from government, is a key reason for the resentment that seethes here," said Fareed Ahmed, coordinator for the Human Rights Commission of Pakistan in Quetta. He said there was "good reason" for this anger, with people having limited access "to any kind of health care or other facility".
Lack of healthcare
The overall lack of infrastructure and facilities has a devastating impact on health, particularly that of women and children, say local residents. Almost every family seems to have a tale to tell.
"My brother's four-year-old son, Jamshed Ahmed, died in his village in Khuzdar District about 300km southeast of Quetta, just five months ago. His appendix had burst, but local doctors were unable to diagnose the problem in time," said Qadeer Baloch, 25, a law student.
Balochistan's health infrastructure is limited, and many people, living in villages and hamlets dotted across the vast province, have never met a health professional in their lives.
"I had never seen a doctor until my son brought me to Quetta for a cataract operation," explained Jamalullah Mengal, 75, who has spent most of his life in a remote village in the Chagai District along the border with Iran.
According to a 2006 report on the health infrastructure in Pakistan compiled by Heartfile, an NGO, which works with the Pakistan government on health-related issues, most of the government-run basic health units in Balochistan lack basic facilities. Sixty percent have no electricity and 70 percent no running water.
The consequence of these primitive conditions is highlighted by data, which show that the percentage of diarrhoea cases in children under five where a practitioner was consulted is lower in Balochistan than in any other provinces.
Greater awareness and efforts to extend health outreach, have brought about a marked improvement in such statistics over the decades. However, the fact remains that in many parts of Balochistan medical help still lies hours or even days away.
For children, who most often succumb to diarrhoea or other gastric complaints, the situation is aggravated by the scarcity of potable water. Piped water in many areas is still a luxury, and people walk miles to collect drinking water.
UNICEF confirms "lack of access to safe water and sanitation" is the main cause of child deaths, which are also closely linked to poverty and malnutrition.
The figures that show a child dies every minute in Pakistan seem particularly real in Balochistan. The rate of such deaths is highest here, and, as Ameera Imdad said, "thousands of mothers in this province have buried a child. That loss is something that defines the lives of women like us and reminds us how vulnerable our children are because of the conditions in which they must survive."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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