Will we fight a water war inside Pakistan?

Earlier in the month, the news of Narendra Modi threatening to cut off the flow of water from India into Pakistan made headlines across country. But as justified as this outcry was, it does beg the question as to why we seldom raise a voice against the manner in which water is stolen and wasted in Pakistan. The cries for more dams and reservoirs have thus far failed to result in tangible projects, while elsewhere in the country corruption watchdogs have uncovered that certain influential landlords play a big part in the theft of water. There have been many media trials in the past, leading to convictions, but non of this has led to a major political or judicial breakthrough on this important matter. One primary cause for concern is the tanker mafia which in many cities controls and dictates the flow of water. No criminals can thrive in a system without the support of those in power and the backing of their financial empires. Supplying impure and substandard water for the people of Pakistan will only further worsen the situation for the country’s already beleaguered masses. Additionally, the Indus Delta has also been on the verge of death for the last few years.

According to the 1991 Water Accord, it was decided that downstream water supply to regions in Sindh would be mandatory until a survey was conducted to determine the exact amount of supply required for the benefit of the people of the province. Let us break this down. A minimum of 10 million acre feet (MAF) of water is the required quantity, and the failure to reach this mark has led to a major shortage of water within the Indus Delta basin. For Karachi, the crisis is much more serious since the theft of water is a thriving business and politicians are yet to openly identify this growing problem and have yet to use legislation to crack down on it. Almost 35% of the water supply is stolen through different forms of organised crime such as the use of illegal hydrants, home suction devices or the mafia controlling the supply in highly populated areas, where water is sold for a higher price.

In some areas of Karachi, like Orangi, people walk all the way to main water tanks and fill their cans manually to ensure that households get a daily supply of water. Many of the pipelines that have been laid out are of substandard quality, thus leading to leakages and wastage of a lot of water along the transmission route. People still pay their water bills on time and the Karachi Water and Sewerage Board (KWSB) has yet to make sincere efforts to ensure that their internal problems are attended to. Sewage has started to penetrate water lines, contaminating the water supply and resulting in hazardous chemicals and diseases permeating the water. Furthermore, we must also keep in mind that bottled water is only affordable for a certain class, and ground water is brackish and not fit for consumption. People living in apartments are paying approximately Rs3,000 per month for water supply maintenance, while still using bottled water for drinking, where the average cost of drinking water on a monthly basis is around Rs4,000 a month for an average family of four to five people. So the combined cost of water per household today would be around 7,000 for starters.

Yet, the government has not announced any strategy on equitable water distribution for the nation nor have they announced the names of the biggest water thieves depriving the nation of the basic commodity which should actually be free for consumption in a true welfare state – after all what is point of us paying our taxes if we are not even getting basic amenities like water? We must also agree that the commitment made under the Water Accord of 1991 was subject to the construction of more dams. However, would one province agree to a drastic reduction in its own share in order to increase the share of water to another province? Is there a water policy officially in place? Will we fight a water war inside Pakistan? A policy must now be implemented to revisit the clauses of the agreement. Water is a booming business, a commercial enterprise that is reeking of profits right now. Civic sense must prevail and the people of Pakistan must be given a clear right to safe and clean drinking water. Progress reports on dams currently under construction or already functioning must also become public information. The people are suffering as a result of the economic downturn and we as a country are still not out of the woods yet. Sooner or later, the issue of dams will surface and we do not want a water emergency, especially in a country with a primarily agrarian economy, to remain unresolved and unattended.

Why is the government refusing to address the smog crisis?

A few weeks back in New Delhi, a climate emergency was invoked across the capital. Schools were closed and warning signs issued as the government activated a climate emergency. It was reported that many commuters in Delhi could not see beyond three to five feet ahead of them. Patients were brought into hospitals with acute respiratory infections and children wards were on high-alert. While the some equipped themselves with air purifiers and masks, a large segment of the general public on the streets continued to breathe in the toxic smog. Construction was temporarily banned in city limits as people with burning eye infections were admitted into hospitals. Life in the capital came to a standstill.

When tonnes of smoke or industrial emissions from farms, fields factories, turbines, cars and buses, go up in the skies and are mixed with atmospheric gases and sunlight, it creates light and dark brown fumes that form above the surface of the earth, resulting in smog. When the smoke from all the stubble burning is mixed with vehicle emissions and construction dust, it creates a massive toxic haze that remains in the air for days and weeks at times.

Similarly, in Pakistan, the city of Lahore registered the worst air quality in the country as this winter marked a dangerous smog-attack on the city. Crop burning, coal combustion, two stroke vehicles and industrial combustions took the Air Quality Index (AQI) levels to over 303. South Asia, in the last decade, has been facing the epidemic of air pollution as energy consumption levels rise across China, India and Russia. Adding fuel to the fire, rising population growth, higher urbanisation and heavy motorisation has resulted in more toxic air-generation across the skies. Trends indicate that air pollution is one of the rising causes of death in Asia and elsewhere globally. In a 2017 report by the World Health Organisation (WHO), it was reported that over 865,000 premature deaths occurred worldwide due to toxic air pollutants in the air. It appears there is a direct connection between rising air pollutants in the air and the percentage rise in respiratory ailments in urban centers.

The Pakistan Clear Air Programme report has further identified four key high risk factors that include solid waste burning in open spaces, industrial emissions in urban city centres, carbon-monoxide in vehicle smoke emissions and natural dust particles in the air we breathe every day. Yet no substantial measures to meet ambient air quality measures have been established by the federal or provincial health ministries, and this is perhaps the most alarming thing. The Minister of State for Climate Change, Zartaj Gul, dismissed the smog crisis by stating that it was a result of the wind carrying smog into Pakistan from India and thus those across the border were to blame. This viewpoint was endorsed by Fawad Chaudhry, and it seems that the government is more interested in downplaying this health hazard and blaming others for it rather than trying to remedy this problem.

The callous attitude of other nations too in this regard is highly disturbing. For instance, the United States announced its departure from the Paris Agreement and refused to meet pollution-reduction standards. As the world populations continues to rise, the right to life around the world is in jeopardy due to the in-action of governments and policy makers. We need stronger legislation to help cut down smoke emissions and industrial pollution. Unless there is a state led imitative with regards to this matter, Lahore will continue to be held hostage by smog every year in what seems to be becoming a routine. A highly recommended path to effective policy measures is to engage in higher taxation on polluting sources so as to curb harmful emissions. We need to redefine public safety standards, get stricter laws in place, create an emission control strategy and educate our people though a robust social media campaign. But none of these much needed changes can become a reality until the policymakers in Pakistan begin to treat this as a real problem which requires immediate

Private healthcare in Pakistan – costly, unregulated and predatory

The former chief justice of Pakistan Saqib Nisar was not wrong when he said, “Only the rich have access to healthcare facilities in Pakistan.” Of the innumerable crises Pakistan is facing today, healthcare is probably one of the most serious ones. The right to healthcare is a basic human right of every citizen, enshrined in United Nations 1948 Universal Declaration of Human Rights and Article 12 of 1966 International Covenant on Economic, Social and Cultural Rights. Pakistan is a signatory to both. Yet, it has all but abdicated its responsibility in providing basic, let alone quality, healthcare to its citizens.

There are several healthcare providers (HCP) in Pakistan: the formal sector, including government-run facilities, private facilities, charitable trusts and NGOs. The informal sector includes homeopaths, hakims, faith healers and ‘quacks’ (unqualified healthcare personnel). Pakistan’s large population and high prevalence of all illnesses, both communicable and non-communicable, coupled with illiteracy, ignorance, mis-perceptions and stigma of many conditions, ensures that all these different HCPs get enough ‘business.’

In Pakistan, out-of-pocket healthcare expenditure (people paying themselves) is as high as 80%- 90%. Government healthcare facilities, ostensibly free but chronically underfunded, are accessed only by the poorest. Hence, in the absence of a public funded healthcare system, private medicine has flourished and has become a multi-billion dollar industry in Pakistan. Private hospitals, doctors, laboratories, X-ray centres, medical device manufacturers and pharmaceutical companies are all cashing in. Unfortunately, all this is at the expense of the hapless Pakistani population, many of whom sink into poverty and debt to pay their medical costs.

A cataract operation in Pakistan can cost anything from Rs. 50,000 to 150,000, a normal delivery ‘package’ in a private hospital up to Rs 200,000-300,000 and average cost of a private room between Rs 8000-15,000/day (not including charges for doctor’s visit, medicines, tests or other service). An intensive care unit (ICU) bed can be as high as Rs 100,000/day or more. Consultation charges with a specialist can cost between Rs 2,000 to Rs 6,000 per visit. If the hospital stay is prolonged due to complications, the costs go up exponentially.

With so much money to be made, innumerable private healthcare facilities have sprung up all over the country. These facilities can charge whatever they like and there are no standards to meet. All are totally unregulated. Except in a few, there are no mechanisms to address grievances of patients. The acts of violence towards healthcare staff one reads about are in many cases the result of medical negligence and poor quality of healthcare along with the high costs of hospitalisation.

In Pakistan, medicine is predatory, as hospitals vie with each other to get a piece of the pie, and many hospitals have started marketing their services to attract more patients. Some hospitals give discounts on tests and consultations on special occasions such as Ramazan or Eid. It is not uncommon to see physicians and dentists, in white coats and stethoscope round their neck, endorsing services or products, ignoring the ethical and moral foundations on which the medical profession stands.

Everyday, thousands of Pakistanis undergo lab, X-rays, CT and MRI tests, in many instances unnecessarily, which enrich labs and doctors but do little for the patients. Many labs give kickbacks to the referring physicians.

Without a system to screen people in the community, people access specialists directly, even for minor problems. In 72 years, neither the government nor any institution in Pakistan has developed comprehensive ‘health systems,’ where minor problems are dealt with by family physicians at primary health care (PHC) units, cases of moderate complexity by secondary care, and only the more complex cases by specialists. The reason of course is commercial. As long as people are ready to pay, neither the specialist will be too bothered to treat minor ailments such as cough and diarrhea nor will the family physician be hesitant to distribute third generation anti-depressants to patients with complex psychiatric illnesses.

As the World Health Organisation (WHO) advocates for Universal Health Coverage (UHC), i.e. free healthcare at the point of service, it is imperative that developing countries like Pakistan invest in a public-funded quality PHC system, using a disease prevention and health promotion approach, focusing on the socio-economic and political determinants of ill health. A health promotion model includes provision of playing grounds for children or walking tracks for adults to prevent obesity and heart disease. A disease prevention model includes provision of clean drinking water and food hygiene, vaccination programmes, enforcement of laws for helmets for motorcyclists, seat belts for motorists and smoke and noise emitting vehicles. Up to 80% of healthcare problems can be managed effectively at the PHC level, with only about a quarter to a third requiring specialist care.

Stop-gap measures and programs such as ‘Sehat cards’ are not the long term answers to Pakistan’s ever growing healthcare needs. If the cards are to be used at the same unregulated, expensive, poor quality facilities, what good are they?

There is also an urgent need to regulate Pakistan’s private medicine sector, which should include, amongst other things, registration of hospitals, tax accountability, fees structures, quality standards, credentialing of healthcare staff and systems for patients’ complaints. The regulation should also cover charitable and NGO health facilities, many of which operate under the principle of ‘something is better than nothing’ by providing ‘free’ healthcare which strips people of all dignity and respect.

American senator and presidential candidate Kamala Harris argued,

“I believe that health care should be a right, but the reality is that it is still a privilege in this country. We need that to change. When someone gets sick, there is already so much else to deal with: the physical pain for the patient, the emotional pain for the family. There is often a sense of desperation — of helplessness — as we grapple with the fear of the unknown. Medical procedures already have risks. Prescription drugs already have side effects. Financial anxiety should not be one of them.” 

Harris was talking about one of the most advanced and richest countries in the world. In light of this, one can only imagine what patients and their families go through as they negotiate Pakistan’s costly, unregulated and predatory private healthcare system.

Global Warming

The term global warming mean increase in greenhouse effect. Global warming occurs when carbon dioxide and other air pollutants and greenhouse gases collect in the atmosphere and absorb sunlight and solar radiation that have bounced off the earth’s surface.  this radiation would escape into space but these pollutants which can last for years to centuries in the atmosphere, trap the heat and cause the planet to get hotter.

Global warming has emerged as one of the major threat to our planet in this century. It has been proved that due to the increase of the greenhouse gases in our outer atmosphere. The earth’s temperature has warmed by 0.74°C over the last 100 years, leading to floods, famines, droughts and cyclones among other natural disasters.

Global warming is the center of attention for every country. Global warming is a phenomenon in which the temperature of the earth rises with time. The rise in temperature occurs due to greenhouse gasses that are emitted on regular bases, the burning of fossil fuels, smoke discharge from the factories etc.

The human activities like burning of fossil fuels, excessive smoke discharges from factories and the depletion of forests have led to an increase in the concentration of the greenhouse gases, mainly carbon dioxide, methane and nitrous oxide, in the earth’s outer atmosphere which are responsible for trapping excessive heat inside the environment and thus increasing the overall temperature of the earth, leading to the phenomenon of global warming

Moreover the major part of the Pakistani land is dry and barren because of the great variability in the climate. The major water resource of Pakistan is the melting snow from the Himalayan glaciers, as well as the heavy monsoon rainfalls.

Although Pakistan itself contributes very little to the overall emissions of the greenhouse gases, yet it remains one of the most severely hit countries of the world by the process of global warming. Pakistan’s economy has been crippled heavily by devastating and repetitive floods during the last decade.

The nation is facing ever-rising temperatures, drought and flooding that threaten health, agriculture, water supplies and hopes for development of a society that ranks in the bottom quarter of nations, based on income per person.

How to control Global Warming?

Firstly replace one regular light bulb with a compact fluorescent light bulb will save 150 pounds of carbon dioxide a year.

 Secondly walk or do cycling  more you'll save one pound of carbon dioxide for every mile you don't drive.

Thirdly plant trees a single tree will absorb one ton of carbon dioxide over its lifetime.

Lastly avoid plastic bags a single tree will absorb one ton of carbon dioxide over its lifetime.

Global warming is an alarming situation for the nation. As Pakistan is already a source stressed country it is the duty of every citizen to feel their responsibility and act like a responsible citizen.

-Hamza Ghumman