By: Alanna Shaikh

In case you missed the news, Pakistan is facing a natural disaster that keeps getting worse. The country is seeing flooding pretty much everywhere. The disaster began in the country’s North West Frontier Province, where 1500 people were killed in the floodwater.

Next struck was the Pakistani province of Punjab; thousands of villages are now underwater. The army and the United Nations are doing their best to evacuate victims, and emergency response groups are mobilizing to bring aid to the survivors. The water has been unaffected by these efforts. Rivers all over the country continue to surge. Pakistani authorities are now issuing flood warnings for the densely-populated Southern province of Sindh.

You can’t exactly go around ranking the horror of different kinds of natural disasters, but if you did, flooding would score major points for immediate destructive impact and long-term damage. In the short term, people die in the flood water or from the immediate damage to infrastructure. In the long run, they go hungry as a result of damaged crops, suffer and die from water-borne diseases, and then suffer and die some more because the floods destroyed sources of clean water.  (If you want to donate to help people affected by the flooding – and you should – InterActions’s list of NGOs responding to the Pakistan floods is here. I can personally recommend IMC because I used to work for them and their Pakistan team is great.)

Since this is a global health blog, I’ll look at the health impact of the flooding in a little more detail. It breaks down into three categories: immediate injuries as a result of the force of flood waters and their aftermath, waterborne and other diseases, and the health impact of the severe infrastructure damage that floods do.

Immediate injuries are pretty obvious. Drowning and near-drowning in the flood water. Crush injuries, strains, abrasions, and lacerations from the force of the water and the debris it carries. More injuries happen as people try to return to their homes, and then there are electrocutions from downed power lines. Fire is also a risk, as people light fires for warmth or light.

Waterborne diseases come from the contamination of clean water supplies by flood water, and people’s close living proximity to dirty water. The major disease risks seem to be cholera, cryptosporidiosis, poliomyelitis, rotavirus, and typhoid and paratyphoid. (if you’re wondering, the major waterborne NTDs are Guinea Worm disease (dracunculiasis) and schistosomiasis, neither of which are present in India. However, stagnant floodwater makes a great place for mosquitoes to breed and spread dengue and tallow fever.)

You don’t see outbreaks of waterborne disease immediately. They take a while to set in and spread. That means that good emergency response – rapid provision of housing, clean water, and latrines – can keep major outbreaks from happening at all. Let’s hope that we see that happen in Pakistan’s case.

Research on past floods also shows that they cause an increase in rodent-borne disease. Ugh. Leptospirosis in particular increases after floods in Pakistan. It seems to me that we’ll see the same thing in Pakistan.

Finally, infrastructure damage is the gift that keeps on giving, making the health impact of the floods last long into the future. Developing countries may not have the financial or human resources to build back right away. This leaves large populations without essentials like school buildings, clinics, electricity, clean water, or even traversable roads. The makes every health problem a regional faced before the floods get worse. Maternal mortality goes up because women can’t get to hospitals to give birth or get prenatal care. Child mortality goes up because clinics have been washed away.

Another long-term impact is on mental health. Especially when floods cause displacement of people, the mental health impacts of flooding are severe. Pakistan will probably see marked increases in depression and anxiety among people in the flood regions.

I know you’re depressed now. Or at least you should be. I am. Here is my tiny gram of optimism to help make up for that: rapid response can really reduce the impact of flooding. We can prevent waterborne, and rodent borne (still ugh) from happening at all. We can support rebuilding to happen fast enough to keep long-term infrastructure effects to a minimum. And in a safe environment, most of the mental health effects will pass on their own, without treatment. We actually understand good flood response. Let’s just try to make sure Pakistan gets the resources to support it.

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’

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