by Saman Nizami

I joined a local Pakistan-based NGO in 2010, where I started off as part of a team implementing UNICEF’s Nutritional Support Program. This is where I saw firsthand the aftermath of the disastrous floods of July that year. The victims endured the traumas that have been talked about, and can be expected — massive destruction, homelessness, displacement and the subsequent rapid spread of disease. However, another adverse impact of the floods was severe malnutrition. Based on UNICEF’s reports, the levels of malnutrition and hunger observed in flood-affected areas were comparable to critical levels seen in some of the most disadvantaged parts of sub-Saharan Africa. Even before the flood crisis, Pakistan was plagued with alarmingly high rates of malnutrition as a third of Pakistan’s children were born with low birth weight. The province of Sindh is in particular need of nutritional support as its stunting rates among children surpassed the national average (see my picture below).

I met Mahira at an IDP camp in Hawksbay, Karachi. She is eight years old, but her growth was stunted.

According to UNICEF, it is difficult to determine the level of increase in malnutrition attributed to the floods because many mothers and children were being screened for the first time. Ironic as it may seem, these ruinous floods spurned action to address existent critical problems such as poor nutrition levels, which had existed for years but were simply neglected.
The high malnutrition rates were a culmination of many factors. The floods destroyed 5.4 million acres of arable land, drastically reducing food availability in rural areas. Even when the crop yields recovered, these families could not afford to buy food at soaring prices, prolonging their suffering. The flood victims, most of whom were seeking refuge in overcrowded areas, lacked access to safe drinking water, sanitation facilities, and hygienic food supply, triggering an increase in communicable diseases such as diarrhea and worm infestation. Even more heartbreaking was that we typically found these diseases in young children since they tend to be the most susceptible. These diseases led to severe dehydration and malabsorption of nutrients from the meager food they had, making them even more vulnerable to disease and malnutrition.
Limited access to milk worsened the nutrition levels of their children. The starving lactating mothers could neither produce milk to feed their newborns nor could they buy it for their families. Even if these families bought milk, they couldn’t store it without a basic supply of electricity. Powdered milk is not a viable option either as these villages and Internally Displaced Person (IDP) camps do not have safe water for preparation. Given the health complications stemming from unsanitary living conditions, lack of safe drinking water, and limited food supply, malnutrition poses a grave threat for the flood victims and a difficult challenge for Pakistan to tackle.
Below: A snapshot from the Super Highway IDP camp in Karachi.

To address the issue, our project’s objectives included screening flood-affected pregnant and lactating women and children less than five years of age for moderate to acute malnutrition, and providing essential micronutrients to improve their overall health. The screening process entailed measuring their weight, height, and mid-upper arm circumference (MUAC) to determine whether the victim met the moderate to severe malnourishment criteria. Based on these indicators, we gave the affected the appropriate nutritional supplements (i.e. Unimix and Plumpy’nut). Our project encompassed mobile therapeutic feeding units that targeted various IDP camps in Karachi and a stabilization center in Dadu where severe cases were treated. The team would then follow up on the beneficiaries and measure progress until they were no longer in need of nutritional support.

While mothers brought their babies for treatment, it was common for siblings to take the responsibility of their younger ones and bring them to us as well. We saw young children take on parental roles of protecting and looking after their younger brothers and sisters despite the difficulty of their own condition. I was impressed with the level of maturity and consideration these children exhibited. They would explain the health problems their younger siblings were suffering from, closely listen to the instructions that we gave them, and respond with thoughtful questions and suggestions.

The process for screening was systematic. The victims, in the form of a line, had to consult various team members in a sequence starting with the issuance of a registration card, measurement of weight, height, and MUAC, recording of the measurements, screening of the level of malnourishment, provision of supplements, recording of the supplements given, and end with the assignment of a follow up date. The system appeared long and laborious to these starving children who were usually in need of immediate attention, especially if their younger brothers and sisters were ill. Nonetheless, they waited patiently, demonstrating their maturity and discipline during a challenging time.

Children would come to us prepared to explain other pressing problems their families were experiencing. They would discuss the lack of safe drinking water, insufficient food, their inability to go to school, or inadequate living space on their families’ behalves. At times, they would walk us through the relief camp pointing out their friends who are not in school, the camp’s unusable sanitation facilities, empty water tankers, or their tents to show us their poor living conditions. Considering they had just faced one of the most horrific floods the world has seen, I was moved by their patience, endurance, and keen sensitivity to the needs of their families. These children grew up fast…but they had no choice.
Here are some of my favorite pictures from various flood relief camps in Karachi of the grown up little ones taking charge.

Saman is currently working for a Pakistan-based NGO, HOPE (Health Oriented Preventive Education), where she is primarily involved with disaster response projects aimed to help the victims of the catastrophic flood that struck Pakistan in 2010.

This post was published by on May 13, 2011.

One Response to The grown up little ones

  1. Aqeel Aamir says:

    Ms. Naveen! Its pretty pleasing to see your efforts bringing fruit.
    I am impressed to see many lives touched.
    God Bless You.

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