Small Farmers Feeling Climate Change Heat Find Little Support From the State

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Food and Agriculture

The extreme heat adversely affected the milk production of the over 800,000 cattle in Karachi. Credit: Zofeen Ebrahim/IPS

The extreme heat adversely affected the milk production of the over 800,000 cattle in Karachi. Credit: Zofeen Ebrahim/IPS

KARACHI, Pakistan, Aug 9 2024 (IPS) – The over 20 million residents of Pakistan’s port city of Karachi, in Sindh province in particular, have been experiencing brutal heat since May. But they are not the only ones bearing the brunt of high temperatures and humidity.

Up to 15,000 cattle died due to scorching heat mixed with high humidity which Shakir Umar Gujjar, president of the Cattle and Dairy Farmers Association, Pakistan, said was “no joke”.

Mubashir Abbas, owner of 170 heads, lost eight cows and five buffaloes to the “extreme heat” in the last week of June, which translates to a loss of Rs 5.5 million (USD 19,800) for him.

“Three more are running high fever and I will have to sell them to cut my losses,” he told IPS over phone from Bhains Colony, in Karachi’s Landhi district. “I will fetch no more than Rs 40,000 (USD 143) a piece, when the market rate for each healthy one is valued between Rs 1.5 and 2 million (USD 5,300–7,000),” he estimated. Every now and then, in the last 23 years, he would lose a few to disease, but he had never “seen a healthy animal dying from heat.”

Livestock, the largest sub-sector in agriculture, contributed 60.84 percent to agriculture and 14.63 percent to the country’s GDP during 2023-2024, according to the Pakistan Economic Survey. More than eight million rural families are engaged in livestock production, accounting for 35-40 percent of their total income.

About 15,000 cattle died due scorching heat mixed with high humidity in Sindh province, Pakistan. Credit: Zofeen Ebrahim/IPS

About 15,000 cattle died due scorching heat mixed with high humidity in Sindh province, Pakistan. Credit: Zofeen Ebrahim/IPS

“From June 23 to 30, Karachi experienced a heatwave with temperatures ranging between 40 and 42 °C. The ‘feel-like’ temperature went up to 54 °C due to high humidity,” said Dr. Sardar Sarfaraz, chief meteorologist at the Pakistan Meteorological Department.

Dr. Nazeer Hussain Kalhoro, director general at the government’s Sindh Institute of Animal Health in the Livestock and Fisheries Department in Karachi, attributed extreme heat to the death of livestock, especially exotic and crossed breeds.

The temperature was still lower than the deadly 2015 heatwave temperature of 44.8 °C that claimed over 2,000 human lives when the feel-like heat index exceeded 60 °C, said Sarfaraz. “A much bigger number of animals died then, and many young animals had to be slaughtered,” said Gujjar.

The heat had adversely affected the milk production of the over 800,000 cattle in Karachi, said Gujjar. “When an animal is in stress and discomfort, due to extreme heat, its intake of regular amount of fodder decreases, which can result in decrease in milk production,” said Kalhoro.

“I was getting between 1,400 and 1,480 kg in a day; it is not more than 960 kg now. I lose 0.11 million rupees (USD 400) daily,” said Abbas.

Communication Gap

The lack of engagement with the farmer by the government was the reason. Gujjar said the communication gap between the ministry of national food security and research at the federal level and the livestock departments at the provincial departments meant the uneducated farmer was on his own.

“The biggest tragedy is that our farmer is not educated and also unaware of how to prepare or protect the animal from the vagaries of climate,” said Gujjar, adding: “They do their own traditional treatment of their animals, which results in even more avoidable deaths.”

Similar is the plight of small farmers who remain in the eye of the climate storm. “They are continuously in a reactive mode,” said Mahmood Nawaz Shah, president of a farmers’ group, the Sindh Abadgar Board, with “government policies not conducive to them”.

Giving examples, Shah said the minimum price of cotton was fixed and notified at Rs 8,500/kg (UAD 30) but growers received Rs 5,200/kg (USD 18); a 50-kilo bag of urea increased from Rs 1,700 to Rs 4,600 (USD 6 to 16) in just three years; and the artificial shortage for the same last year meant the farmer had to pay Rs 5,500 for the same bag from the black market.

“We had recommended to the government to develop a climate endowment fund and compensate small farmers by involving insurance companies as soon as extreme events lead to crop and livestock losses,” said Shah.

Both the farmers, Gujjar and Shah, have hit the nail on the head on why Pakistan, one of the most vulnerable to climate crises, is unable to manage it effectively. The disconnect and lack of coordination between different federal and their related provincial government bodies is found across the spectrum and is highlighted in the 2024 Climate Change Performance Index (CCPI) as a major reason that hampered policy implementation, placing Pakistan on the 30th position among 63 countries and the EU, which collectively account for over 90 percent of global greenhouse gas (GHG) emissions. “Improved cooperation between different levels of government would be a step in the right direction,” it concluded.

Similarly, the 2024 Environmental Performance Index that assesses the progress of effectiveness of 180 countries in mitigating climate change, relying on historical greenhouse gas emissions data, put Pakistan three rungs down at 179th rank this year from the 176th position it held in 2022.

Indifference and Apathy

Both the CCPI and the EPI are a clear giveaway of government’s nonchalance. The latter index has especially pointed to areas like air pollution, wastewater treatment, protected areas management and climate mitigation.

“The country is slipping on most environmental indicators,” agreed former climate change minister, Malik Amin Aslam, pointing to the weak air pollution control measures, non-adherence to the electric vehicles transition and failure to promote renewables.  From being a country championing the global green cause in 2022 to now “ignominiously slipping down the environmental performance ladder” should certainly raise alarm bells for our current green policy makers, warned Aslam.

The 2022 floods, which should have acted as a wake-up call for the government, he said, failed to move the government towards preparedness and improving the health of the environment.

Maha Qasim, CEO of Zero-Point Partners, an environmental management and consulting firm, said: “No significant effort had been made in building climate-resilient infrastructure like roads, drainage systems and flood management facilities like levees or reservoirs.

The EPI has pointed towards Pakistan’s use of coal as a driver.

Putting things in perspective, Qasim said that in 2021, only around 14% of Pakistan’s energy mix was based on coal, while it figured 45 percent and 63 percent in India’s and Estonia’s energy mix. But in the last two years, Pakistan’s overall GHG emissions as well as CO2 have declined, due to “Pakistan’s overall performance capita emissions from fossil fuels and industry have declined due to stagnant economic growth,” she said.

Thus, Pakistan is well within its carbon budget and has met its Nationally Determined Contribution commitments to the UNFCCC.

The updated NDCs of 2021 have pledged to reduce emissions by 50%, shifting to renewable energy by 60 percent and 30 percent to electric vehicles by 2030, and a complete ban on importing coal.

Poor transport fuel regulations, old and inefficient vehicles on the road, mass cutting down of trees to make way for rapid urbanization, burning of agricultural residue and poor solid waste management have also been mentioned for Pakistan’s poor score.

Aslam, however, said the index failed to “register or recognize” Pakistan’s efforts on reforestation—the Billion Tree Tsunami Afforestation Project in Khyber Pakhtunkhwa province, followed by 10 Billion Tree Tsunami Programme across the country. “The EPI ranking can certainly enhance its acceptability and credibility by improving these areas,” he said.

Weak Governance

Sobia Kapadia, a humanitarian aid practitioner, added factors like “weak governance, turning to fire-fighting and ad-hoc measures” whenever a climate crisis arises, thereby destroying the symbiosis.

“Heat, rain and floods are all connected to the core issue of human-induced development; but blaming heat and humidity on climate change is like blaming the naughtiest child,” said Kapadia, citing resorts being constructed in the mountains by cutting trees.

In yet another recent report that gives insights to investors and helps governments in setting carbon market-friendly policies, Pakistan comes 39th out of 40 countries.

Khalid Waleed, an energy economics expert at the Sustainable Development Policy Institute (SDPI), was quoted by media saying “for the first time in budget history, the government has tagged projects worth Rs53 billion under climate change adaptation and Rs225 billion under climate change mitigation,” referring to the budget presented earlier this month. However, he added that the budget was not climate change project-specific but had been tagged for their climate benefits.

Zia ul Islam finds the budget allocation “rather tricky” to understand as it not only indicates development projects from the Ministry of Planning Development & Special Initiatives, but foreign-funded projects and projects under various ministries and provinces.

Environmental and public policy analyst Dawar Butt, comparing the country’s miniscule environmental spending to India and Bangladesh, said climate did not seem to be a priority. He further added that the climate change allocation has been “cut down by one billion rupees from what finally got approved in this year’s budget.”

Handling Climate Change on Piecemeal Basis

But it is not just how the government is handling climate change. Referring to a climate risk awareness survey conducted by GIZ Pakistan, Qasim highlighted that while many organizations are beginning to acknowledge the impact of climate change on their business models, their approach towards dealing with it was “incomplete and fragmented with a focus on climate mitigation” to meet external requirements of clients or regulators rather than on long-term business sustainability.

Due to the funding fatigue, Zia ul Islam suggested the “begging attitude” may be replaced by capacity building of concerned authorities, bringing in necessary improvements in the legal instruments and effective implementation.”

Good News

If Pakistan can somehow link smooth governance with climate finance and showcase to the world that it can fund its own climate solutions, it will give local and international companies the confidence to invest in the country. This year’s Financing Climate Action  report by Transparency International states Pakistan has a huge potential to “dollarize climate adaptive and mitigative projects” provided climate governance is improved.

Flood insurance initiatives for farmers, for example, said Qasim, at very low markup rates, have the potential to be “scaled up across the country to increase flood resilience.”

IPS UN Bureau Report

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Transgender Health Rights Boosted by Hospitals’ ‘Separate Room’ Policy

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Asia-Pacific, Civil Society, Development & Aid, Featured, Gender, Gender Identity, Headlines, Health, Human Rights, Humanitarian Emergencies, LGBTQ, Sustainable Development Goals, TerraViva United Nations

Health

The community frequently targets transgender people. Now they are able to welcome new measures that mean they will be able to safely access health care. Credit: Yusufzai Ashfaq/IPS

The community frequently targets transgender people. Now they are able to welcome new measures that mean they will be able to safely access health care. Credit: Yusufzai Ashfaq/IPS

PESHAWAR, Pakistan, Apr 30 2024 (IPS) – Transgender people and civil society organizations have welcomed the decision of the chief minister in Khyber Pakhtunkhwa, Pakistan, to allocate separate rooms in hospitals for the transgender community so they can avail themselves of uninterrupted healthcare.

“We demand that all provinces follow suit and announce facilities for more than 500,000 transgender people in the country,” Farzana Shah, president of the Khyber Pakhtunkhwa (KP) Transgender Association, told IPS.

On April 6, KP Chief Minister Ali Amin Khan Gandapur announced separate rooms for transgender persons in public hospitals after complaints that they aren’t getting admissions because they face violence in the facilities.

“In the last year, about 47 transgender people have died because of violence, and 90 have been injured. Many injured transgender people die due to delayed treatment. In most cases, we can’t get healthcare at hospitals,” Shah, 40, said.

The Chief Minister’s directives to reserve rooms have received a positive response.

Members of a delegation of transgender people who recently met him quoted Gandapur as saying, “Provision of better health facilities to transgender persons in the province is our priority. We will help the underprivileged community.”

Arzoo Khan, a social activist, is overwhelmed.

“In all 38 district-level hospitals, we now have a separate room. Previously, the hospitals denied admission to our colleagues,” Khan said.

“The problem we face is that most transgender people have been deserted by their families because of social repercussions. People look down on transgender people.”

“We don’t have anyone to help us; therefore, the government’s support is a highly welcome step,” Khan said.

In addition to the allocation of space, the government also provided land for a separate graveyard for transgender people.

Civil society activist Jamal Khan said that there are several instances when the local communities have denied the burial of eunuchs because they don’t consider them Muslims.

“They earn their livelihoods through dancing at marriage parties and on other festive occasions where they have social acceptability,” he said. “The allocation of separate hospitals’ rooms and land for graveyards are really commendable measures that will lead to the protection and respect of transpeople.”

Transgender people are often deprived of last rituals, like giving them baths and performing their funerals after deaths.

Sobia Khan, another leader, said they are deeply vulnerable and subject to abuse and violent attacks, despite being a cheap source of entertainment.

“Some transgender people also have HIV/AIDS and other potentially fatal diseases for which they need continuous medication,” Sobia said.

The attitude of the police towards the group was also bad, she added

“More often than not, police beat up our members; they pull them by their collars and drag them into the streets.”

Khan claimed that her parents have been excluding her for the past ten years.

“Peshawar, the capital of KP, is home to 9,000 transgender persons; most of them have lost connections with their families and they were regarded as sinners and hence ditched by near and dear ones,” Sobia said.

Where the group was targeted by violence, the perpetrators were seldom brought to justice, which emboldens others to mistreat transgender people.

“Sexual harassment of trans people is a common sight. Everyone thinks that we are sex workers, which is untrue because we only dance. Many are raped,” she said.

Police officer Rahim Shah told IPS that many transgender people were invited to marriage parties where they danced for money.

Shah claimed that upon their return from the performance at night, robbers targeted them and killed or injured those who attempted to resist.

“In cases of murder or transgender injuries, their family members don’t come to receive dead bodies for burial or look after the wounded in hospitals,” he said. Their problems are complex, as they neither enjoyed respect in the community nor in their families.

Sumaira Shah, 29, narrates her ordeal after running away from home.

“My family was staunchly opposed to dancing and my father and brothers used to beat me every day, forcing me to quit dancing as it was a source of dishonoring the family but it was my fashion,” she said.

“Sick of daily taunts and beatings, I ran away from my native Swat district to Peshawar when I was just 14,” she said. Since then, I haven’t seen any of my relatives. Shah said she welcomed the hospital room policy.

“A month ago, a hospital in Peshawar sent me back home with some medicines despite having a high fever,” she said.

She said, “People frequently threaten me when I decline their offer for sex relations, and I’m afraid because many of our seniors have died at the hands of gangsters when they didn’t comply with their demand for illicit relations.”

Social rights activist Pervez Ahmed appreciates the government’s new initiatives.

He claimed that this was the first time the government had made an effort to safeguard the health of those who had lost their parents’ support and faced harsh rejection from the community.

Ahmed said that the government has already included transgender people in a free health insurance program, under which they can avail themselves of USD 12,000 per year.

IPS UN Bureau Report

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Hindu Woman Doctor Confident of Election In Pakistan Polls

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Asia-Pacific, Democracy, Editors’ Choice, Education, Featured, Freedom of Expression, Gender, Headlines, Human Rights, Population, Religion, TerraViva United Nations, Women in Politics, Women’s Health

Women in Politics

On the campaign trail: Dr Saveera Parkash, a nominee for the Pakistan People’s Party. She is the first Hindu woman to run in Pakistan's general election Credit: Ashfaq Yusufzai/IPS

On the campaign trail: Dr Saveera Parkash, a nominee for the Pakistan People’s Party. She is the first Hindu woman to run in Pakistan’s general election Credit: Ashfaq Yusufzai/IPS

PESHAWAR, Jan 18 2024 (IPS) – A woman medical graduate from the Hindu community is making waves, as she is the first minority woman to contest the Pakistan Parliamentary election for a general seat, and she does so in the face of deep-rooted religious traditions and wealthy political opponents.

Dr Saveera Parkash, a nominee of the Pakistan People’s Party (PPP) for the February 8 polls, is sure of her victory despite her religion.

“I have been witnessing the support that I am getting from the Muslim-dominated district of Buner in Khyber Pakhtunkhwa province,” Parkash told IPS in an interview. 

“My slogan is addressing issues of pollution, women’s empowerment, gender equality, female representation, and their health issues, in addition to ensuring respect for all religions,” she elaborated.

Born to a Christian mother and Hindu father, she has lived in a Muslim-dominated community; therefore, interfaith harmony is on her wishlist.

“Interfaith harmony is extremely significant because we have seen enmity among different religious sects on flimsy grounds.”

“We have to inculcate a sense of brotherhood among all schools of thought and pave the way for lasting peace in the area. We have to respect our religious places and shun differences, as all religions advocate peace and harmony,” she says.

Candidates in Buner, one of the 36 districts of Khyber Pakhtunkhwa that remained thick with militants from 2007 to 2010, are likely to witness a hard contest as the women and youngsters have shown support for the first-ever minority female candidate.

The Khyber Pakhtunkhwa Assembly, one of Pakistan’s four provinces, has 145 elected members, 115 regular seats, 26 reserved for women, and 4 for non-Muslims.

Pakistan is home to 4.4 million Hindus, which is 2.4 percent of the total population.

Her father, a medical doctor and late leader of the PPP and twice Prime Minister Benazir Bhutto, who was assassinated by militants in December 2007 in the garrison city of Rawalpindi, inspire her, she says.

“While my ideal is Mother Teresa, my main focus will be women’s education. The overall literacy rate is 48 percent, but only 25 percent of females are literate; therefore, I want to spread awareness about the importance of women’s education,” she says.

Additionally, it is very important to end favoritism and nepotism and ensure merit in the appointment of teachers, especially women.

After completing medical education in July 2022, she saw the issues women visiting hospitals faced and decided to enter politics instead of continuing her career as a doctor, as she believed issues needed to be resolved at the policy level.

“We need more women doctors, nurses, and paramedics to encourage female patients to visit hospitals. Currently, the number of female health workers is extremely low, due to which most of the women don’t come to hospitals because they don’t want to be seen by male doctors,” she says.

“My big advantage is that I belong to a middle-class family, and the people will vote for me because I am approachable to my electorate.”

The promotion of women’s rights is her main objective.

“We have to scale up awareness regarding women’s rights to property inheritance and their right to education. I sense victory in the polls, as I know the people listen to me and would reject opponents for their bright future.”

So, how does she feel the run-up to the election is going?

“In our district, 75 percent of voters are under 30, and they are well-informed about the issues they are facing. I may be lacking wisdom and knowledge compared to senior politicians, but my sincerity will lead to my success,” says the 25-year-old, who routinely wears a headscarf.

Because she is trying to reach a young electorate, her campaigning includes the wide use of social media, apart from the traditional approaches of public meetings and house-to-house canvassing.

Highlighting corruption is also part of her election campaign.

At the moment, she is concentrating on a smooth run-up so she can win popular support in her constituency

“Voters in my constituency call me ‘sister’ and ‘daughter,’ which gives me immense strength,” she said.

Parkash said she wanted to follow in the footsteps of her father, Oam Prakash, a retired doctor, and serve the people.

Securing a space for women is vital for development, as they have been suppressed and neglected in all areas.

She said “serving humanity is in my blood” due to her medical background, highlighting that her dream to become an elected legislator stemmed from having experienced poor management and helplessness in government hospitals as a doctor.

Most people in the area endorse her candidacy, regardless of her Hinduism or political affiliation. Voters appreciate her bravery for challenging traditional policies

The Election Commission of Pakistan makes it mandatory for all political parties to award 5 percent of seats to women in general seats.

Political analyst Muhammad Zahir Shah, at the University of Peshawar, said that Parkash has created history by contesting the general election.

“We have been seeing women becoming members of the assembly on reserved seats. They don’t contest elections but are nominated by parties on the basis of the seats they win in the election,” Shah said.

In the past, some women have fought elections, but they were Muslim; therefore, they don’t draw as much media and public attention, but the case of Parkash is unprecedented.

She is well educated and belongs to the Hindu community while standing for vote in an area where 95 percent of the voters are Muslims.

“She is contesting on the PPP’s ticket, which isn’t a popular political party, but it seems that she will make her presence felt during the electioneering,” Shah said. Already, she has hit headlines, and if the election takes place in a fair and transparent manner, there is a greater likelihood that she will emerge victorious,” he said.

IPS UN Bureau Report

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Transgender People Face Growing Violence, Discrimination in Pakistan

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Transgender people often entertain at weddings and other events, but they increasingly face violent acts, especially since part of an Act ensuring their rights was recently struck down. Credit: Ashfaq Yusufzai/IPS

Transgender people often entertain at weddings and other events, but they increasingly face violent acts, especially since part of an Act ensuring their rights was recently struck down. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Jul 24 2023 (IPS)

“The problems transgender people face start from their homes as their parents, especially fathers and brothers, look them down upon and disrespect them,” says 20-year-old Pari Gul.

Gul, a resident of Charsadda district in Khyber Pakhtunkhwa (KP), left her house at 16 when her mother asked her to or face being killed by her father.

“I was born as a boy, and my name was Abdul Wahid, but when I came to Peshawar and joined a transgender group, I got a female name, Pari Gul. Since then, I have been going to weddings and other festive ceremonies to dance,” she says. “Dance is my passion.”

However, she has often been the brunt of discrimination and violence.

“During my five-year career, people have beaten me more than 20 times. Each time the perpetrators went unpunished,” she told IPS in an interview.

Trans people are often targeted in KP, one of Pakistan’s four provinces.

On March 28, a man shot dead a transgender person in Peshawar. It was the third incident targeting transgender persons in the province in less than a week. Despite the violence, violent attacks on transgender people aren’t considered a major crime.

Khushi Khan, a senior transgender person, says lack of protection is the main problem.

“People have developed a disdain for us. They consider us non-Muslims because we dance at marriages and other ceremonies,” she says.

“We had lodged at least a dozen complaints with police in the past three months when our colleagues were robbed of money, molested and raped but to no avail,” Khan, 30, says.

Last month, clerics in the Khyber district decided they wouldn’t offer funerals to transgender persons and asked people to boycott them.

Rafiq Shah, a social worker, says that people attack the houses of transgender, kill, injure and rob them, but the police remain silent “spectators”.

“We have been protesting against violence frequently, but the situation remains unchanged,” Shah said.

Qamar Naseem, head of Blue Veins, a national NGO working to promote and protect transgender people, isn’t happy over the treatment meted out to the group.

“Security is the main issue of transgender persons. About 84 transgender persons have been killed in Pakistan since 2015 while another 2,000 have faced violence, but no one has been punished so far,” Naseem says.

The lack of action by the police has emboldened the people.

“Health, transportation, livelihoods and employment issues have hit the transgender (community) hard. Most of the time, they remained confined to their homes, located inside the city,” he says.

There are no data regarding the number of transgender in the country because the government doesn’t take them seriously, he says.

In May 2023, the Federal Shariat Court (FSC) dealt a severe blow when it suspended the implementation rules of the Protection of Transgender Persons Protection of Rights Act.

Farzana Jan, president of TransAction Alliance, says that FSC’s declaration that individuals cannot alter their gender at their own discretion, asserting that specific clauses within the Transgender Persons (Protection of Rights) Act, 2018 contradict Islamic law, has disappointed us.

The FSC declared un-Islamic sections 3 and 7 and two sub-sections of Section 2 of the Transgender Persons (Protection of Rights) Act, 2018, five years after the law was passed, the FSC rolled back key provisions granting rights to Pakistan’s transgender community.

Some right-wing political parties had previously voiced concerns over the bill as a promoter of “homosexuality,” leading to “new social problems”.

The Transgender Persons (Protection of Rights) Act, 2018, is against the injunctions of Islam as laid down in the Holy Quran and Sunnah of the Holy Prophet (PBUH) and will cease to have any legal effect immediately, the verdict stated.

Amnesty International said the verdict was a blow to the rights of the already beleaguered group of transgender and gender-diverse people in Pakistan. It said some of the FSC’s observations were based on presumptive scenarios rather than empirical evidence. The denial of essential rights of transgender and gender-diverse persons should not be guided by assumptions rooted in prejudice, fear and discrimination, AI said.

“Any steps taken by the government of Pakistan to deny transgender and gender-diverse people the right to gender identity is in contravention of their obligations under international human rights law, namely the International Covenant on Civil and Political Rights (ICCPR) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) to which they are a state party,” it said.

The government should take immediate steps to stop the reversal of essential protections, without which transgender and gender-diverse people will be even more at risk of harassment, discrimination and violence, AI added.

On July 12, 2023, transgender representatives from all provinces held a press conference at Lahore Press Club, where they vehemently condemned the recent decision by the FSC against the Transgender Persons (Protection of Rights) Act, 2018.

Arzoo Bibi, who was at a press conference, said it was time to stand united for justice and equality.

“Militants don’t threaten us, but our biggest concern is the attitude of the society and police,” said Arzoo.
IPS UN Bureau Report

 


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Vaccination Is the Best Bet Against Drug-Resistant Superbugs — Experts

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Experts encourage parents to vaccinate their children against typhoid to ensure that the child has access to clean drinking water. Credit: Zofeen Ebrahim/IPS

Experts encourage parents to vaccinate their children against typhoid to ensure that the child has access to clean drinking water. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Jul 6 2023 (IPS)

The first thing you notice about eight-month-old Manahil Zeeshan is how tiny she looks on the adult-size hospital bed at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi.

Her right foot is taped with a cannula, and she whimpers incessantly. “I have been in and out of the hospital for the last seven days,” said Uzma Mohammad, Zeeshan’s mom, with worry lines on her forehead. “High fever that refused to come down, severe cough for days and breathlessness,” were some of the symptoms Mohammad described. She was convinced someone had “put a spell” on her daughter.

The doctors, however, suspected she had typhoid.

Salmonella Typhi bacteria cause typhoid fever, and Salmonella Paratyphi bacteria cause paratyphoid fever. According to the US-based public health agency, Centers for Disease Control and Prevention, along with a fever that can be as high as 103 to 104°F (39 to 40°C), the sick person can have weakness, stomach pain, headache, diarrhoea or constipation, cough, and loss of appetite. Some people have a rash of flat, rose-coloured spots.  Internal bleeding and death can occur but are rare. It affects between 11 and 20 million people each year, leading to 128,000 to 161,000 deaths, according to the World Health Organization (WHO). The highest fatality rates are reported in children under four years of age.

While Zeeshan’s blood culture report had yet to come to ascertain the cause of her sickness, she needed urgent medical care, said Dr Shabita Bai, who had admitted her.

“We could not wait for five days for the blood culture report as she was not doing well. And because she had already been given an antibiotic (a medicine used to kill bacteria) from outside, our chances of finding if the baby had typhoid for sure were slim, and we had to rely on the history,” justified Bai.

Decisions had to be made. Based on her condition, symptoms, and clinical diagnosis, the baby was given Ceftriaxone, an intravenous antibiotic, but she showed no improvement. The doctors then administered the stronger Meropeneme intravenously, a last-resort antibiotic.

Manahil Zeeshan's foot has a drip in an effort to bring her temperature down and fight suspected typhoid. Credit: Zofeen Ebrahim/IPS

Manahil Zeeshan’s foot has a drip in an effort to bring her temperature down and fight suspected typhoid. Credit: Zofeen Ebrahim/IPS

Battling the Superbug

But even if she had typhoid, the bacteria in her body had taken on the form of a superbug — the extensively drug-resistant (XDR) typhoid and the current antimicrobials had become ineffective, said paediatrician Dr Jamal Raza, the executive director of the SICHN.

According to a Lancet study published in 2022, multidrug-resistant (MDR) typhoid has been seen in Pakistan, while typhoid bacteria resistant to the widely-used antibiotic azithromycin have been found in Bangladesh, Nepal and India. “Our analysis revealed a declining trend of MDR typhoid in south Asia, except for Pakistan, where XDR S Typhi emerged in 2016 and rapidly replaced less-resistant strains,” stated the study, which researchers claim is the largest ever examination of the S.Typhi bacterium.

The reason why antibiotics are losing their punch against some types of bacteria, said Raza, was the “indiscriminate use of antibiotics” that health practitioners prescribe to provide immediate relief. Another big problem was self-medication by people. “I know people often use an old prescription by a doctor to get the same medicine if they feel they have the same symptoms, thinking they do not need to visit the doctor.”

But he pointed out viruses, which are also small germs like bacteria, are causing bacteria-like infections, like a cold or the flu.

“Taking an antibiotic for the latter does not treat the disease; it only leads to antibiotic resistance,” said Raza.

A study conducted by researchers from three medical institutions, namely, the Aga Khan University (AKU) in Karachi, the Armed Forces Institute of Pathology (AFIP) in Rawalpindi, and the Shaukat Khanum Memorial Cancer Hospital & Research Center (SKH) in Lahore in 2018, found indiscriminate use of antibiotics to be causing new drug-resistant “superbugs.”

It found a high prevalence of multidrug and fluoroquinolone resistance for both S.Typhi and S. Paratyphi strains of typhoid bacteria. From 20% in 1992, the resistance was found to have increased to around 50% in 2015. The stubborn bacteria were resistant to antibiotics like ampicillin, chloramphenicol (and co-trimoxazole), as well as fluoroquinolone (ciprofloxacin and/or ofloxacin).

“The situation is quite grim,” said Dr Mashal Khan, chairperson of the government-run paediatric medicine department at Karachi’s National Institute of Child Health, referring to the increase in the number of children developing resistance to typhoid drugs. His worry is not that the bacteria has spread; his concern is the bacteria has mutated and become resistant to the drug.

“We’re running out of new antibiotics to treat bacterial infections; Meropeneme is the last one, and a very expensive one too,” he said resignedly, adding: “Although the development of newer antibiotics is the need of the day, I must emphasise the rational use of the ones being used is more urgent.”

Developing new drugs is challenging, and antibiotics more so, as the science is tricky.

“Antibiotics are not the most lucrative drugs to develop for pharmaceuticals as their utility is limited in the future due to the bacteria developing the ability to resist them,” said Infectious Diseases specialist and epidemiologist Dr Faisal Mahmood at the Aga Khan University Hospital in Karachi. “A lot of money goes into developing new drugs, and since most of the funding is from the global north, they prefer to work on infections which concern them directly. Typhoid is unfortunately endemic in the low and middle-income countries in the South, which have poorer water quality and have warmer, more humid climates.”

And that is why the only sure-shot way of reducing the disease burden of typhoid is to vaccinate the children.

In 2019, Pakistan became the first country to get the World Health Organization (WHO)-recommended single-dose typhoid conjugate vaccine (TCV) injected intramuscularly, added to its routine immunisation (RI) regime. This is given to babies at nine months, alongside measles-rubella vaccinations, without impacting either vaccine.

“Childhood vaccination complemented with clean drinking water and improved hygiene practices is the much more cost-effective way of eradicating typhoid than pumping antibiotics in a child,” said Raza. Meropenem costs as much as Rs. 30,000 (USD 105) for a 10-day course, and if hospitalisation is included, it can go up to Rs 100,000 ($349), said the doctor. Being in a government hospital, Zeeshan is treated free of cost.

Eight-month-old Manahil Zeeshan is treated for typhoid at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi. Credit: Zofeen Ebrahim/IPS

Eight-month-old Manahil Zeeshan is treated for typhoid at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi. Credit: Zofeen Ebrahim/IPS

Typhoid Vaccine Launch Hits a Snag as Covid-19 Surfaces

The 2019 TCV campaign was first launched in the two cities of Sindh – Karachi and Hyderabad (children up to 15 years of age were also given a shot), which reported the highest number of typhoid cases among children. There was a pause when Covid-19 hit the world. But by 2022, TCV had been launched across Pakistan, and 35.5 million children were vaccinated, after which it was added to the government-run Expanded Programme on Immunisation (EPI) programme.

“Many parents do not know that the TCV is a more effective vaccine but only available at government vaccination centres, and not at private clinics and hospitals as Gavi has only given it to the government of Pakistan,” said paediatrician Dr D.S. Akram.

“There is another typhoid vaccine available in the private sector (typhoid polysaccharide vaccine), but it can only be given to children over two years of age, and it needs boosters every three years. My advice to parents is to vaccinate their kids against typhoid bacteria at nine months,” she said.

But it is still a drop in the ocean, and the fight against typhoid and other childhood diseases continues. The WHO places Pakistan among the ten countries that account for almost two-thirds of the world’s unimmunised children.

When Covid-19 hit the country’s already crumbling health system, it also brought the country’s immunisation programme to a halt too. An estimated 1.5 million children across Pakistan missed out on basic vaccines from March to May 2020, according to Gavi.

For Pakistan, which already has low immunisation coverage (the percentage of fully immunised children aged 12-23 months is just 66%), it meant a further dip in coverage which led to an unprecedented rise in the number of zero-dose children (those that have not received any routine vaccine). Add to these were the almost 19,000 new births every day. But when the lockdown eased and vaccinators returned to work, there was less demand for vaccination, having been replaced by fear of the new virus.

While Pakistan has yet to reach the optimal immunisation coverage of 90%, during Covid-19, Pakistan’s EPI received plaudits internationally for taking both vaccine coverage and the number of zero-dose children close to pre-pandemic levels in 2021. “What Pakistan achieved needs to be celebrated. In fact, Pakistan and Chad are used as examples internationally of how to get it right in an emergency,” said Huma Khawar, an immunisation and child health advocate working closely with EPI.

“Despite a year’s delay due to Covid-19, which was unforeseen, I think it is the best thing that the government has done for its country’s children,” said Khawar. She credited the RI programme that bounced back to the pre-pandemic level in 2021.

Clean water, Good Hygiene Key to Preventing typhoid

While immunisation can protect children from getting infected, clean drinking water and improved hygiene practices can reduce the risk of catching the disease to a great extent.

“Vaccines provide immunity when there is exposure to the bacteria,” agreed Dr Jai Das, assistant director at the Institute for Global Health and Development at the Aga Khan University and one of the co-authors of the 2018 report on typhoid, but emphasised the need for improved water and sanitation, a situation that continues to remain dismal and compromised in Pakistan.

The same study not only found a strong correlation between water and sanitation but to literacy levels as well. In addition, it stressed improving the country’s food safety protocols and implementing regulations.

While Mohammad believes that her daughter is under a curse, one reason could be that the unpasteurised cow’s milk she gives her daughter may not be properly boiled at home. “I was unable to breastfeed her,” she said. Further, she confessed to diluting it with unboiled tap water to make it last longer.

Doctors say giving Pakistani babies a lease of life is simple and costs nothing. “Exclusive breastfeeding up to at least six months of age (right now it is only 43%), attaining 90% coverage of RI across Pakistan and improving water and sanitation quality,” according to Dr Akram.

Bacteria Don’t Respect Geographic Borders

The XDR typhoid bacteria propagating in Pakistan has crossed borders and reached as far as the UK, Canada and the US. Earlier this year, a team of Pakistani and US researchers published their findings in the American Journal of Tropical Medicine and Hygiene, stating that with numerous typhoid bacteria variants circulating in Pakistan have also been identified in Southeast Asia and Eastern and Southern Africa and have been introduced into the United Kingdom, Canada, and the United States by travellers.

The Lancet study said strains from South Asia had spread 200 times to other countries since 1990. When these superbugs grow and spread, they can cause infections that are hard to treat. Sometimes they can even spread the resistance to other bacteria they meet.

The future looks frightening. While the need for improving water and sanitation cannot be overemphasised, along with the need for vaccinating children, newer and stronger antibiotics need to be developed and fast as typhoid may surface in deadlier ways than now since very few antibiotics remain effective against the bacteria.

Note: This story was supported by the Sabin Vaccine Institute and Internews

IPS UN Bureau Report

 


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Excerpt:

Childhood vaccination, complemented with clean drinking water and improved hygiene practices, are the key to eradication of typhoid XDR, not indiscriminate use of antibiotics, say Pakistan health experts. Source