No reconstruction

By Thomas Rudhof-Seibert

Pakistan has always experienced heavy monsoon rains. Naturally. Most recently in 2010 and 2011, when the rains already came in the wake of exceptionally warm summers. The first people started talking of climate change. One million people were affected. It took a while for the news to be heard in the rest of the world. But then people responded, donations were collected that ran into millions. During those years, medico also received donations, so many in fact, that we travelled to Pakistan for the first time in 2010. Partners of the People’s Health Movement referred us to the aid organisation Health and Nutrition Development Society (HANDS) in Karachi. Our new colleagues were providing acute emergency aid: distributing food packages, drinking water and medicines, and setting up tents and toilets. They spoke with the people in the camps and with us about their plans for “integrated reconstruction” as soon as people returned to the villages.

First and foremost, houses needed to be built. Houses that would not just collapse in the face of new floods like the ones people had just lost. Along with the better houses, better dams and also finally schools and health centres were to be built, which many places had not actually had in the past. The Marvi Programme was part of this integrated reconstruction.

A marvi is a kind of community nurse, versed in treating common diseases, but also in diagnosing diseases that can only be treated in the closest larger town. The marvi is chosen in the village itself. Trained by HANDS and equipped with a supply of medicines, she becomes an important and respected person in her community.

Integrated reconstruction finally also included the establishment of committees and associations to bolster reciprocal care and in turn social cohesion - capable of acting especially in the event of another heat wave or renewed flooding. This also entailed equipping them with aid supplies and tools: HANDS created “disaster relief centres” in several district capitals, with warehouses for tents, blankets, water filters and other aid items. When a stronger monsoon came again in 2014, it became clear how good, how indispensable these precautions were, helping people to help themselves, to carry on.

Flood resistant?

In 2022, Pakistan experienced renewed flooding, the floods were stronger than ever before, it rained for almost four months, from July into November. The houses built by HANDS withstood the flooding longer than the old, traditionally built houses would have. In many places, people knew what to do, knew when to leave and where they could go. But ultimately, it didn’t help. Or at least not really. At some point, the houses did collapse, even if here and there some are still standing. The fact that they were “flood-resistant” did not and nor could it mean that they would withstand months of rain and metres of standing water. Such houses simply do not exist.

When it’s no longer one million people (like in 2010) and no longer five million people (like in 2011), but 30 million people (like in 2022) who are homeless at least temporarily, then disaster relief centres cannot help any longer, even if there were more of them than HANDS could ever build, equip and maintain. When the disaster is so huge that millions are left suffering from diarrhoea, skin diseases and fever, not even three times the number of marvis can help the sick. And even the largest, best-equipped and best-motivated aid organisation is helpless if the current year’s harvest has been lost along with next year’s harvest. If 800,000 cattle, goats and sheep have been swallowed up by the floods or died from drinking the putrid water.

So what will HANDS do now? What will medico’s second partner in Pakistan, the EdhiFoundation, which is also active nationwide, do? Both immediately provided acute emergency aid again this time. medico is supporting HANDS in providing drinking water treatment systems developed and produced in the country itself: as we had planned to do anyway. HANDS will build houses again: Those who have lost their house need a new one, HANDS will help, Edhi will help.

Climate dystopia

Nonetheless, things cannot carry on like this. If the floods in 2010, 2011 and 2014 were already “somehow linked to climate change”, by 2022 there was no longer any doubt: climate change is here to stay. Pakistan therefore has a Minister of Climate Change, called Sherry Rehman. She talks of a “climate dystopia”. She has not asked the world for help; she has demanded reparations. Because it is not Pakistan but Europe, the US and China who are responsible for the floods which Pakistan is sinking in. She has received no response. She and the country were promised help. But help will no longer help. Sherry Rehman is at a loss. HANDS and Edhi are at a loss. medico’s third partner in Pakistan, the NTUF trade union, is also at a loss. It has been fighting for the democratisation of Pakistan for decades, as are HANDS and Edhi in their own way. But how do you democratise a country which, from now on - everyone agrees - will be sinking again and again in floods that are getting ever heavier? A country, whose call for reparations no one answers?

This is what prompted medico and HANDS to opt for something new. We pay out cash to the people affected that we reach. It is up to the people themselves what they do with it. The amount will not be enough to build new houses. Nor will it be enough to move to Karachi, a metropolis of 30 million people, which has been suffering for years under increasingly severe heat, sometimes reaching 50 degrees. Nor is it enough to make it to Iran and from there to Turkey, the country that Europe pays to push back refugees. It is only enough for the first steps, wherever they may lead. Nobody knows where to go, nobody knows what to do. HANDS will build houses once again. In Germany, climate activists who poured black paint over Dani Karavan’s monument for our fundamental rights were brandished “Taliban” by members of the Bundestag. The monument was clean again a few hours later.

Translation: Rajosvah Mamisoa