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Pakistan: lives and livelihoods at stake

08-09-2010 Interview

Five weeks after floods first struck Pakistan at the end of July – and with millions of victims still in need – Pascal Cuttat, head of the ICRC delegation in Islamabad, talks about current priorities and some of the ongoing challenges to the relief effort.

  ©ICRC / J. Tanner / pk-e-00965    
Muzzafargarh, Punjab Province. Families displaced by the floods seek food and shelter in a school.    

  ©ICRC / J. Tanner / pk-e-00956    
Nowshera, Nowshera District, Khyber-Pakhtunkhwa Province. A woman and her one-year-old daughter take refuge in the classroom of a technical college.    

  ©ICRC / J. Tanner / pk-e-00957    
Azel Khel, Nowshera District, Khyber-Pakhtunkhwa Proince. Displaced families in a makeshift camp. The sanitary conditions are dire.    

  ©ICRC / J. Tanner / pk-e-00959    
Gujrat, Muzzafargarh District, Punjab Province. This old man is blind and handicapped. He was rescued by helicopter, but now finds himself in a camp where there is no shelter, no toilets, no electricity and no drinking water.    

  ©ICRC / J. Tanner / pk-e-00963    
Taga Khuh, Muzzafargarh District, Punjab Province. Families displaced by floods sleep beside the road. 

  ©ICRC / J. Tanner / pk-e-00964    
Muzzafargarh District Hospital. Punjab Province. This three-month-old baby is suffering from diarrhoea, vomiting and fever but is now receiving antibiotics intravenously. The baby and family were evacauated on account of the floods that have devastated Gujrat.    
Pascal Cuttat, head of the ICRC delegation in Pakistan    
     Can you sum up briefly the situation on the ground today in the areas where the ICRC and the Pakistan Red Crescent Society are working?  

The stunning thing, the really stunning thing, is that we are now about five weeks on from the beginning of this crisis and we still have people who are having to run away from the advancing floods. Hundreds of thousands in Sindh, for example, are still on the run.

The floods in the north are finally receding – which is good news – but they are still rising in the south, so it is still an ongoing disaster.

Coupled with this, getting help to the victims is still difficult, be it because of damaged bridges and roads, security constraints, or simply because of the magnitude of the task. The ICRC is providing support for 100,000 Pakistan Red Crescent volunteers who are getting food, household supplies and hygiene items to the flood-affected, and they are doing a fantastic job, but this is a disaster of unprecedented magnitude and the challenges are huge.

 There has been a lot of attention in the media recently about the politicization of aid and about lack of access to flood-stricken areas because of the security situation. What are your feelings about that?  

Our reason for being in Pakistan is to assist people who are affected by fighting. Helping the victims of armed violence is what we do, on the basis of our mandate, wherever we work in the world. Only last year more than one million people were displaced by fighting within Malakand Division. They were assisted by the Pakistan Red Crescent and the ICRC. Many of them are still displaced, even now, and our support to them continues. The floods have come on top of that, and tens of thousands of people are suffering from a combination of armed violence and floods.

For example, take Balochistan. Balochistan is affected both by armed violence and, now, by flooding. Helping the people affected in the rural areas of Balochistan, people who are already displaced by armed violence and are now also hit very hard by the floods, has to be one of our priorities.

The ICRC works independently of all other organizations, although we coordinate our actions with all parties to ensure transparency and to avoid duplication of effort. Since the start of the floods, the ICRC, working in support of the Pakistan Red Crescent, has been able to provide food and other essentials for over half a million flood victims. Our goal is to support the Pakistan Red Crescent in its efforts to provide emergency assistance for up to 1.4 million people over the coming three months and to restore the livelihoods of 350,000 people over the longer term.

Any attempt to deny access to the victims, whether by threatening to attack aid workers or by other means, would only hinder a massive humanitarian response to one of the biggest natural disasters in the history of Pakistan. The ICRC believes that its neutral, independent and humanitarian mandate is well known throughout the areas of the country where it has worked for almost 30 years, and that any attempt to curtail its operations for security reasons would only result in more suffering for the victims, who need support.

With regard to the alleged politicization of aid, let me simply say that when there is a critical need for humanitarian aid – as there is right now, on an unprecedented scale, over huge areas of the country – the whole relief effort needs to be focused on mounting a purely humanitarian response. I am speaking of the efforts of everyone – the authorities, the army, the international community and the local NGOs, to say nothing of the generous outpouring of support being shown by ordinary people to help their brothers and sisters who are in need. There is no room for politics when people's lives and livelihoods are at stake.


 Everyone agrees that food and shelter are critically needed, but what are the other priorities for the ICRC, for example with respect to health, and water?  


We are still very worried about the health situation. It stems directly from the fact that millions of the displaced lack access to clean water, and thus from the potential spread of water-borne diseases, such as diarrhoea, and vector-borne diseases, such as malaria.

We are positively surprised and relieved that there haven't been any major outbreaks of contagious, water-borne diseases so far, but we are still very worried that we are going to witness such an outbreak at some point if the situation on the ground does not improve.

The ICRC is taking a preventive approach to health, an approach that involves delivering clean water to the affected communities and distributing soap and other hygiene items.

ICRC water engineers and field officers together with local communities have so far cleaned some 75 contaminated wells in Khyber Pakhtunkhwa. They have also identified clean water sources, drilled bore holes, started to repair water systems and trucked water to thousands of displaced people living in camps or on the sides of roads around Dera Ismail Khan. Pakistan Red Crescent volunteers supported by the ICRC have also given tens of thousands of bottles of mineral water to people who have no safe water to drink in several flood-stricken areas of the country.

The preventive health measures we have taken include the setting up of two diarrhoea treatment centres: one in Paroa, outside Dera Ismail Khan, and the other in Hangu. Another two diarrhoea treatment centres are currently being established in Dera Ismail Khan district hospital and in the nearby town of Tank. Dera Ismail Khan seems to be one of the worst-affected areas of Khyber Pakhtunkhwa province with respect to watery diarrhoea – the Paroa diarrhoea treatment centre has treated over 1,000 patients since it opened on 13 August. Not all of those, however, have been severe cases.

The importance of looking at preventive health from a holistic perspective, combining initiatives aimed at improving both the water situation and public health, cannot be over-emphasized. For example, we have been able to determine where the greatest number of people have diarrhoea in the area around Dera Ismail Khan. When we identify a particularly hard-hit village or town, we send our water engineers there to look at the water situation and make improvements. This is what happened recently in Mehra, a town of over 50,000 people, for example.

What we have also done is to provide tens of thousands of packets of oral rehydration salts for our medical colleagues in the Pakistan Red Crescent. Their use of the packets in their basic health units, in the Larkana district of Sindh province for example, has proven to be very effective as a means of preventing people presenting symptoms of diarrhoea from becoming seriously ill.

In addition to the support we provide for the Pakistan Red Crescent, for example by delivering medicines and supplies to their basic health units and mobile clinics, we are also providing medicines for district hospitals and government-run basic health units upon request.

Skin diseases such as scabies are currently among the most common health problems apart from diarrhoea. As the floodwaters recede, leaving stagnant water behind, malaria will also be a serious risk while the weather remains warm.

 What is the ICRC planning to do in the future, once the flood threat recedes and people start preparing to go home?  

The rebuilding, or the building from scratch, of a health system for millions of people in the poorest areas of Pakistan is something that will occupy the governmen t and the international community not just for months but probably for years. There will have to be a massive development and reconstruction effort by the government and the international community, but as the ICRC has relatively little expertise in this area, it is not our primary focus.

As far as the ICRC is concerned, much of what we are doing now will determine what we do during the months to come. So, are we going to continue to support Red Crescent basic health units in the future? Absolutely. Are we planning to go on helping communities affected by armed violence and by floods to improve their water systems? Absolutely. But we also plan to help people to regain their livelihoods and become self-sufficient again, rather than depend on food handouts. We will do this through the timely distribution of seed, fertilizer and tools so that those who normally earn their living through agriculture can get back on their feet as quickly as possible.

To attempt anything more would exceed our mandate and go beyond what we are actually capable of doing. And I must say, once again, that our focus is twofold, firstly to support our colleagues in the Pakistan Red Crescent and their network of 100,000 volunteers, and secondly to focus our activities on the areas of the country where we have already been working for decades in behalf of victims of the fighting.