It is one of the most stunning geographies in the world, home to the Royal Bengal Tiger. It is also home to over 4 million people who have been at the forefront of the climate change battle.
As water levels rise and frequent cyclones destroy lives and livelihoods, people in this riverine delta are facing a battery of health problems – skin ailments, water borne diseases, gynaecological problems.
As the sea level rises, every few years they are forced to abandon their homes and move to high ground. But in recent years, frequent cyclones have wreaked havoc, forcing many to move to other states, leading the lives of unacknowledged climate refugees as they take up work in construction sites in places like Delhi and Kerala.
Since 2007, devastating floods have also become a way of life in faraway Khyber Pakhtunkhwa (KP), once known as the North West Frontier province of Pakistan. As recently as the first week of March this year saw 30 casualties but the aftershocks are felt till much after the water recedes – in the form of malaria, water borne disease, skin diseases and atypical pneumonia and influenza cases. Diseases that were not known earlier have arrived here. KP recently reported its first ever case of monkeypox.
There were 1,30,000 cases reported of influenza in this area bordering Afghanistan and crisscrossed by rivers. The province, like the rest of the country, is also facing the brunt of respiratory illnesses linked to the rising air pollution levels. World Health Organization (WHO ) estimates that air pollution is responsible for over 130,000 deaths annually in Pakistan.
In 2023, right after the floods, a diarrhoea outbreak swept through the three KP districts of Dir Upper, Dir Lower and Karak. More than 300,000 cases were reported. Cholera is endemic in Pakistan with WHO considering even a single laboratory confirmed case as an epidemic threshold. Peshawar – the capital of KP is one of the epicentres of the post flood cholera outbreaks that the country has seen over the years.
Fighting tigers, crocodiles and climate change
Sixty-five year old Jayanta Mondol has been a farmer in the Kultali block of the Sunderbans all his life but never has he been forced to rebuild his life from scratch as often as he has had to since 2019 when the area saw four successive cyclones – creatively named Bulbul, Fani, Amphan and Yas. The last one that the area saw before that was when Aila hit in 2009. But that is not the only thing that he is concerned about. Kultali is one of the 19 blocks in the Sunderbans designated as belonging to a fragile biosphere.
“Earlier, even in summers we could work in our fields till 12 noon. But now it has become so hot that beyond 9 am it is impossible to work. People are getting sun strokes, we had never heard of those earlier. The rainfall pattern has changed and the yield has reduced because the fertile season is now shorter. It is past mid-March and there is still such thick fog. All the buds on the mango tree have been destroyed so we already know our hopes of a good mango crop are over,” he says.
The changes in cropping patterns, say experts who are working in this area, have aggravated the malnutrition problem. Interestingly the conversation about climate change in the Sundarbans tends to gravitate towards its impact on the health of the mangrove vegetation and the future of the tiger population rather than the impact on the health of this massive population which is living its life at the frontiers of climate change. The rising sea level and the rising salinity of the water is pushing human habitation further inland but those who continue to stay back face the brunt not just of the obvious suspects like malaria and dengue but of commonplace ailments that have suddenly become more frequent and more virulent.
“On the one hand in these areas we see rising incidence of water borne diseases, diarrhoea, gastroenteritis etc. On the other hand with crop failures becoming more common there is rising malnutrition. Kultali has a high number of tiger widows – women whose husbands have been killed by tigers. The women become victims of crocodiles because of the practice of catching crabs in the water inside the tiger reserve. This practice also makes them vulnerable to skin infections, menstrual irregularities and even miscarriages. The children of these parents and those of migrants who almost never take their children with them struggle with mental health problems. The health system fails to reach these people and more importantly there is lack of credible data that can help us quantify the problem,” says Dr Sugato Hazra former director of the School of Oceanography in Jadavpur University whose team is currently working on a project to look at the impact of climate change on the health of people in the Sunderbans.
Dr Amitabha Chowdhury who has worked in the Sunderbans for the last 25 years says contrary to perceptions, malaria is not on the rise in the area. “Dengue is rising but often that is because of migrants returning home and carrying the disease from their places of work. The easier communication has come with advantages but it has also meant both people and diseases are travelling more freely,” says Dr Chowdhury. The devastation of the cyclones leaves scars among adults and children alike.
There is considerable medical literature analysing the suicidal tendencies of inhabitants of the Sunderbans. According to a 2013 article in the journal ISRN Psychiatry that dealt with participatory approach to prevent suicides by pesticide consumption: “The ecological character of this region is largely responsible for its remoteness, backwardness (human development index—0.55 in contrast to 0.62 of the district), and varieties of psychosocial community stresses (climatic insults and natural calamities like storm, cyclone, inundation of saline water into the agricultural field, crop failure, poverty, domestic violence related with dowry demand, alcoholism and gender discrimination, etc.)”
The absence of the public health system – for Kultali the nearest qualified medical doctor is about an hour away in Jamtala – is being filled in, albeit inadequately by the non government sector. Baikunthapur Tarun Sangha is one such organisation that used to run a maternity hospital in the area. As the funds dried up, the hospital was forced to shut shop but BTS continues to do village health camps.
“We see a lot of women with menstrual irregularities come to these camps, many complain of white discharge. Skin ailments are pervasive as are digestive and gastrointestinal problems. The salinity level of even pond water in some areas is high. But the four back of back cyclones have broken the economic backbone of the area, causing much more migration than earlier. Children get left behind and when we go to the field these are the children that we will see not mingling, sitting in a corner. Adolescents become vulnerable to trafficking because there is nobody at home to take care of them,” says Sushanta Giri, director of BTS.
For people the changing weather conditions and the rising incidence of some diseases are disparate conversations that they will enthusiastically participate in. But the linkage between skin and eye allergies, the common medical advice (dispensed by quacks) of avoiding pond water (because of its high salinity) in many diseases, the menstrual irregularities, miscarriages and white discharge to the unseasonal fog and intense heat is not yet established. There is a dearth even in academic journals of works that cohesively and conclusively link climate change and health.
In Kishori Mohanpur village, Tumpa Sau’s fisherman husband just left for a construction job in Thrissur in Kerala, leaving her and her young child at home. She says: “We are constantly battling digestive issues and skin and eye allergies. Eye allergies sometimes take years to heal. For skin infections the doctors usually say do not bathe in the pond. We also have a serious problem of white discharge which is very common. For that too, doctors ask us to avoid pond water.” The “doctor” in question is almost always a quack. In fact quacks here do not even hide their lack of medical degree. There are two classes of doctors -MBBS – who rarely ever come to these parts and when they do they demand a hefty fee and the “quack doctors” that do home visits, daily dressings etc.
Quack doctor Bageswar Das’s “clinic” is well stocked in medicines which he also sells while dispensing medical advice. He happily comes on camera to talk about his job of “helping people”. “Most of my patients come with scabies, skin infections, diarrhoea and pneumonia. Women have a lot of UTIs that they catch because of the practice of catching fish and crabs while standing in the water. Many people report menstrual irregularities but it is difficult to link any of these to climate change,” he says.
The dearth of fresh water has been aggravated in the last few years by the rise of the water mafia that have illegally started selling whatever freshwater is available to farmers who are in dire need.
Battling old scourges and new
35-year old Engineer Khali Ahmad suffering from a severe chest infection was waiting for his checkup at the Lady Reading Hospital Peshawar
“Due to the climate change many people around me are facing chest infection and other complications. Peshawar has become the most polluted city of Pakistan and we are paying the price”, he said. Sana Ahmed who was also seated in the waiting area said that she had been sick for the last one week and had been diagnosed with influenza. Initially she had a seasonal ailment but had now caught an influenza like virus, according to her doctors.
Dr. Anila Basit Associate professor at Lady Reading Hospital Peshawar and pulmonology specialist said: “Because of climate change diseases like influenza, flu and chronic obstructive pulmonary disease (COPD) were increasing every day. Asthma has started to affect rural women because they mostly use Biomass coal or they use wood fires to cook their meal. The frequent floods in Khyber Pakhtunkhwa are also increasing the incidence of many viral diseases,” she said.
A recent United Nations report claims that 44% of children suffer from stunted growth primarily because of malnutrition. This is a consequence of Pakistan’s food insecurity and poverty which are linked to climate change. Unseasonal rains and smog are contributing to viral, waterborne, and vector-borne illnesses like Zika virus, Dengue, Typhoid, and Malaria. According to a World Health Organization report amongst vector-borne illnesses, Malaria could pose a threat to around 46 million people annually by the year 2070, Outdoor air pollution is a huge contributor to respiratory illnesses and WHO data collected in major cities of Pakistan showed a considerably higher value than the mean PM 2.5 levels recommended by WHO for a clean environment.
Dr Irshad Ali Roghani, director of public health at the Directorate General Health Services KP said: “When we analyzed our data for 2023 when flood hit many area of Khyber Pakhtunkhwa we found that the effect was not just of damaging the economy of the province. Diseases like malaria , skin diseases and other vector borne diseases were reported in large numbers. KP recorded 1,30,000 patients of Influenza as well.Climate change has also led to a spurt in throat infection and upper respiratory infections. The KP government .has organised special training sessions for district health officers in water borne and vector borne diseases. The first case of Monkey pox was also recently reported. The health department has plans to make a resilience centre to tackle the disease emerged from climate change.”
Pakistan formulated a National Climate change Policy in 2012 and a framework was laid for its implementation in 2014. “Pakistan Vision 2025” is a comprehensive plan which includes positive inputs on the future of sustainable development and economic growth in the country.
Dr. Shumaila Javaid consultant pulmonologist said: “Climate change is a pressing discussion. Rising temperatures, fluctuating humidity, disturbed air quality, plenty of aeroallergens and mighty dust storms are a significant threat to health, leading to illnesses and even fatalities. Children, elderly individuals, and those with pre-existing respiratory conditions are especially susceptible to the health effects of climate change. At one end of the spectrum are heat waves exacerbating existing cardiovascular diseases and respiratory disorders while on the other the concern is of increase in vector-borne diseases like dengue fever and malaria. The increasing temperatures because of climate change are conducive to the breeding of disease-carrying vectors.”
The increasing pollution levels and crop failures because of climate change that triggers nutrition insecurity add additional dimensions to that problem, she said. “Burning of fossil fuels and the release of greenhouse gases contribute to poor air quality, which has lead to respiratory problems from worsening allergies to infections and exacerbations of existing disorders like COPD and parenchymal diseases, all because of the climate change driven air pollution. This is particularly concerning in densely populated areas like Peshawar city,” she added.