The 2010 floods in Pakistan began as a result of unprecedented monsoon rains overwhelming the Indus basin. The ensuing floodwaters affected 78 out of 121 districts nationwide engulfing an area of 100,000 km2. The floods claimed 1985 lives, affected 20.2 million people, damaged 2.4 million hectares of agricultural land and damaged or destroyed 2.1 million houses and 515 health facilities.1 Indiscrimate damage was caused to state infrastructure including: transport and communication networks, water and irrigation channels, power and energy plants and grids. Over 37 million medical consultations were reported by the Disease Early Warning System (DEWS) within one year following the floods with acute respiratory infection (23%), skin diseases (11%), acute diarrhoea (9%) and suspected malaria (6%) forming the most common presentations in flood affected districts.2
ReliefWeb, an online database administered by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), provided humanitarian information to organisations and interventionists during the floods. The database was continuously updated with situational reports and bulletins by various stakeholders (e.g. UN agencies, NGOs) and enabled the humanitarian community to assess need and mobilise response to the disaster accordingly. However, much of the information published on the ReliefWeb database was fragmented and the number of summary reports documenting the floods in a holistic manner was limited. Furthermore many of these reports exhibited an inconsistency in format and content that did not follow a standardised method for reporting. Therefore their expediency to humanitarian organisation and interventions – although advantageous – can be probed.
Kulling et al. (2010) have proposed guidelines promoting a common structure and method for reporting health crises and critical health events. These guidelines require reports to include assessments of the status before the event, a description of the disaster and the subsequent damage, the relief and recovery responses to the events and identification of lessons that can inform preparations and interventions in future crises. Therefore a concise report on the Pakistan floods of 2010 based on key principles described by these guidelines can serve as a useful resource in analysing summary findings that may help to improve preparedness, planning and response for future crises whilst advancing international collaboration and learning.3
This summary report is based on the key principles of health crisis reporting described by Kulling et al.3 The main focus of this paper is to provide a summary focus on the pre-flood status of Pakistan, the impact of the floods and the subsequent response efforts by the humanitarian community. All the data included in this report are available in the public domain. As academic literature on recent floods in Pakistan have proved to be scarce and fragmented, a literature search was conducted using multiple search engines and databases to enable a wider inclusion, and therefore consideration, of primary data for this report. Search terms synonymous with “Pakistan floods”, “Pakistan floods 2010”, and “Pakistan floodwaters” were employed. An initial literature search was conducted on the PubMed/Medline databases and all resulting and related papers and references were extracted and analysed. Reliefweb, a database of humanitarian information maintained by the United Nations Office for the Coordination of Humanitarian Affairs, was used to collect all information related to Pakistan floods of 2010. Bibliographies of reports and articles were followed and extracted. Information and literature available on stakeholder websites including UN agencies, governmental departments, non-governmental organisations and academic institutions were studied. A wider search of grey literature was carried out on the internet.
Inclusion and Exclusion criteria: All information from frontline sources involved in the Pakistan floods including UN organisation, governmental departments, non-governmental organisation and academic institutions were considered. However, newspaper and journalistic report articles were excluded.
This report forms part of a research project that I undertook as part my medical studies at Barts and The London School, University of London. I received supervision from Dr Paul Wilkinson of London School of Hygiene and Tropical Medicine and Professor Virginia Murray of Extreme Events and Health Protection at Health Protection Agency UK. This report was not funded or allied with any governmental or non-governmental organisation.
3.1. Country Profile
Pakistan covers an area of 796,096 km2 and stretches from the Himalayan Mountains in the north to the Arabian Sea to the south. The country shares borders with Afghanistan and Iran in the west, China in the north-east and India in the east; and is made up of four large provinces: Balochistan, Khyber Pakhtunkhwa, Punjab and Sindh; and also a small federal capital territory and a group of federally administered tribal areas. Pakistan has a total population of over 178 million people.4 The Gross Domestic Product (GDP) of Pakistan is US$ 841 per capita with government expenditure on health of US$ 7 per capita forming a total expenditure on health of 2.9% of GDP.5
Pakistan’s climate is predominantly semi-arid to arid and is typically characterised by hot summers and cool or cold winters. The northern mountainous and hilly regions of the country are cooler than the warmer and topographically flat regions of the south. Pakistan, depending on geographical location, weathers four seasons: a cool and dry winter period (December to February), hot and dry spring (March to May), rainy summer or monsoon period (June to September) and a retreating monsoon period (October and November).6 The annual rainfall in the northern parts of Pakistan receives less than 250 mm per year as compared to 125mm in the south. Rainfall during the monsoon rains, which accounts for 59% of annual fall, can increase to 750mm in the plains and 625mm in the highlands.7,8
3.3. The Indus River
The Indus River originates in Tibet and travels westwards through India and Kashmir before entering Pakistan through the northern mountains. It then runs southwards through the centre of the country before emptying into the Arabian Sea. The basin stretches approximately 3,000 km in Pakistan and covers an area of 977,000 km2 (approximately 25% of total land mass). The river sources its water from annual rainfall, glacier melt from the northern mountains and a number of large tributaries including Shigar, Shyok, Gilgitm and Kabul rivers from the northern province and the larger Beas, Chenab, Ravi, Jhelum and Sutlej rivers from the Punjab province (Figure. 1).9
3.4.1. Hyogo Framework for Action (2005-2015)
The Hyogo Framework for Action (HFA) is a 10-year disaster risk reduction plan that has been adopted by 168 member states of the UN. It was established in 2005 and describes strategies aimed to reduce losses caused by disasters (e.g. lives, social, economic and environmental) by 2015. The guidelines list key activities to build national resilience and outline five priorities for action (PFA):
Pakistan became a signatory of the framework after the 2005 earthquake exposed vulnerabilities of the existing disaster risk management strategies adopted by the country. In 2006, the National Disaster Management Ordinance (NDMO) 2006 was introduced by the Government of Pakistan to provide a legal framework for disaster risk reduction at a federal, provincial and district level and included nine priority areas from the HFA. In 2010 the framework was enacted under the National Disaster Management Act 2010.12,13 Although institutional commitments to the PFAs have been attained at a Federal and Provincial level, the degree of achievement have varied for each strategy and action.12
3.4.2. National Disaster Management Authority (NDMA)
The NDMA, under the National Disaster Management Commission (NDMC), is responsible for devising guidelines and implementing programmes on disaster risk reduction, preparedness, capacity building, response and recovery. During disasters the NDMA acts a central hub for implementing, coordinating and monitoring disaster management. They communicate with all stakeholders to facilitate a collaborative response to the disaster (including Pakistan Disaster Management Authorities, Army, Governmental Ministries and Departments, NGOs).14
Some of the key functions of the NDMA include:
3.4.3. Provincial disaster management authroity (PDMA)
Each province has a disaster management authority in the form of PDMA that operates under a Provincial Disaster Management Commission (PDMC).
Some of the key functions of the PDMA include:
3.4.4. District Disaster Management Authority (DDMA)
The DDMA, under the District Disaster Management Commission, is involved in executing disaster risk reduction programmes at a district and tehsil level (second-lowest tier of local government).
Some of the key functions of the DDMA include:
3.4.5. Federal Flood Commission (FFC)
The Federal Flood Commission (FFC) was created in 1977 in response to the severe floods of 1973 and 1976; which exposed vulnerabilities in existing disaster risk management and signified the importance for a national policy on the flood problem. In 1978, the FFC prepared the National Flood Protection Plan (NFPP) that set out to reduce flood losses, prioritise flood protection for areas of greatest economic risk, provide protection for areas outside the flood plains and improve existing flood protection facilities.15 Under the FFC, three 10-year plans have been implemented: NFPP-1 (1978-1988) mainly emphasised for the installation of structural flood protection measures (e.g. precipitation measuring systems, radars and improvements to telemetry networks); NFPP-2 (1978-88) mainly focused on the installation of more structural flood protection measures and the establishment of the National Flood Forecasting Bureau, now Flood Forecasting Division (FFD); and NFPP-3 (1998-2008) focused on strengthening of NFPP-2. NFPP-IV (2008- 2018) is currently under approval by the Planning Commission.14
3.4.6. Flood forecasting Division (FFD)
The Flood Forecasting Division (FFD) of the Metrological Department is the sole flood forecasting agency in Pakistan and is responsible for issuing forewarnings to relevant stakeholders (e.g. FFC, Provincial and National Disaster Management Authorities, Ministry of Water & Power, Combatant Generals’ Headquarters (GHQ), Ministry of Defence) to prevent and mitigate damage to lives, property and infrastructure caused by floods. The FFD receive and process hydro-meteorological data from various national sources to prepare flood forecasts and warnings. The Water and Power Development Authority (WAPDA) and the Irrigation Department provide the FFD with rainfall and river flow data in the catchment areas of the river Indus and Jhelum and hydrometric flood data from the Tarbela, Chashma and Mangla dams.14 The data is processed every six hours and analysed to produce flood forecasts and reports.16
3.4.7. Pakistan Army
The Pakistan Army’s Corps of Engineers have the responsibility of providing assistance to civil authorities by operating rescue and relief operations during national disasters. The Pakistan Army is involved in all phases of flood mitigation from pre-, during- and post-floods. During the pre-flood preparatory phase, the Commander Corps of Engineers make regular inspections of flood protection structures. During floods the Corps Engineers are stationed at the FFD to monitor the flood situation and provide regular situational updates, forecasts and warnings to the designated Director General (DG) and all other CC Corps of Engineers. Units of the Army are deployed to target areas to carry out rescue and relief operations. It is the responsibility of the PDMAs to provide the army equipment during disasters (e.g. boats, life-jackets, tents, vehicles). Further meetings are held post-floods to assess performance and identify lessons for the future.14
3.4.8. UN Clusters Approach
In 2005, the UN’s Inter-Agency Standing Committee (IASC) established a ‘Cluster Approach’ to humanitarian assistance with the aim of improving predictability, timeliness and effectiveness of response and recovery. The initial nine clusters (Camp Coordination and Management, Early Recovery, Emergency Shelter, Emergency Telecommunications, Health, Hygiene, Logistics, Nutrition, Protection and Water Sanitation) with two added later (Education and Agriculture) consisted of groupings of UN agencies, non-governmental organisations (NGOs) and other international organisations and stakeholders around sectors and services that worked together to provide assistance during a humanitarian crisis.17
The cluster approach was first implemented, in its elementary form, in the aftermath of the 2005 earthquake in Kashmir. Each cluster was designated a lead agency and made responsible for coordinating deliverance of humanitarian assistance within that sector. These clusters held intra-agency forums to share information; formulate joint strategic plans and partnerships; define roles , responsibilities and delicate activities in order to avoid gaps in coverage, duplication of aid and delay in assistance.18 As a result of implementing the cluster system much experience had been gained and capacity formed in the northern regions of Pakistan.
3.4.9. Disease Early Warning System (DEWS)
The Disease Early Warning System (DEWS) was setup in Pakistan by the World Health Organisation (WHO) in collaboration with the Ministry of Health after the Kashmir earthquake in 2005. Its goals include reducing mortality and morbidity through early detection and response to alerts and diseases outbreaks (e.g. acute watery diarrhoea, cholera, malaria). DEWS receives surveillance data from 490 fixed and 554 mobile outreach centres and has been instrumental in predicting and controlling epidemics in Pakistan through weekly reporting of disease trends and responding to health alerts within 24 hours.19
3.5. Hazard: Floods
Pakistan is prone to natural disasters including floods, earthquakes, landslides and tropical cyclones. Riverine floods are a common phenomenon in Pakistan and are predominantly caused by concentrated rainfall in river catchments areas during the monsoon season; that are sometimes compounded by increased glacier melt. Monsoon currents from the Bay of Bengal in India and the subsequent depressions can result in heavy rainfall in the Himalayan regions of northern Pakistan. Furthermore the weather systems originating from the Arabian and Mediterranean seas can compound the heavy downpours in the north and inundate the Indus River and its tributaries.20
The Indus River has been responsible for 11 of the major floods in Pakistan including the floods of 1950, 1955, 1956, 1973, 1976, 1978, 1988, 1992, 1995, 1997 and 2005 (Figure 2).15,21 The floods of 1973 claimed 474 lives and destroyed over 3 million houses. The floods of 1976 caused 425 deaths and destroyed 10 million houses with a total cost to the economy of 6 billion rupees.21 The floods of 2005 that were caused by the warm weather and snowmelt in the northern regions killed more than 30 people and affected over 460,000 people nationwide.22
The poor quality of housing stock in the rural areas of Pakistan makes them vulnerable to natural disasters. Houses in the northern mountainous regions are typically of kutcha (non-permanent) stock and constructed from mud or stone rubble making them feeble and unable to withstand extreme natural events. Even the pucca (permanent) are not exempt from these dangers due to poor structural design comprising heavy concrete slabs supported by thin walls constructed of sand and cement mortar.23 Furthermore, the majority of houses lining the Indus River in Punjab and Sindh along the heart of the country are made of basic adobe materials and inhabited by poor agrarian people. Only 24% of rural areas have access to piped water and the major sources for drinking water are tube wells, hand pumps and boreholes. Furthermore, 43% of rural households do not have any toilet facilities.24
Extensive deforestation, particularly in the northern mountainous regions around the Indus River, has resulted in soil erosion. The resulting reduction in vegetation has led to an increase in surface water run-off during monsoon seasons. Augmented by increased glacial melt, deforestation has resulted in the Indus River receiving a greater amount of water upstream. 25
3.6.3. Flash Floodings
Flash floods, as opposed to slow rising riverine floods, can cause considerable damage to lives, communities and property as they can present suddenly and without warnings. Flash floods in Pakistan have predominantly occurred in the mountainous ranges of the Himalayans, Kashmir and Gilgit-Baltistan due to steeply uneven topography and unpredictable climate; and in D.I. Khan, D.G. Khan and Kirther Ranges of Balochistan and Sindh Provinces as result of hill torrents and around the coastal areas of Sindh and Balochistan due to tropical cyclones.20
3.6.4. Communicable Disease
The most prevalent communicable diseases in Pakistan include acute respiratory infection, diarrhoea, polio, tuberculosis, hepatitis B and C, measles and vector-borne disease including malaria, Leishmaniasis and haemorrhagic fever (CCHF). The prevalence of malaria is greater in the rural areas and risk reduction behaviour is low with only 6% of households owning mosquito nets. Pakistan has an endemic problem with tuberculosis (297,000 cases reported in 2008) and polio.24
3.6.5. Maternal and Child Health
Pakistan has a high maternal mortality rate of 276 deaths per 100,000 women. Major causes of maternal death include haemorrhages and sepsis. Approximately 62% of all deliveries take place within the home and only 39% of deliveries have a skilled practitioner present. Child mortality rate (under 5 years old) is 94 per 1000 live births; infant mortality rate (under 1 year old) is 78 per 1000 live births; and neonatal mortality rate (under 28 days old) is 54 per 1000 live births. The main causes of infant death include pneumonia, sepsis, diarrhoea and meningitis.24 Immunisation rate in Pakistan is remarkably low with coverage of only 46%.26
4. During floods
On 20th July 2010, the FFD issued the first of a series of flood warnings to low lying areas and districts of Punjab as result of widespread thunderstorms and heavy downpours generated by the annual monsoon season. The FFD advised all concerned authorities to take precautionary measures to protect human lives, infrastructure and property. Similar warnings were issued on almost a daily basis; however, the amount of time given between the issuance of the warning and the expected time for flooding varied and ranged from zero to several hours in the northern regions (KPK and Punjab) and a maximum of around 2 days for the southern regions (Appendix 1).
On 22nd July, the first of the heavy monsoon rains hit the north-eastern regions of Balochistan causing flash floods and affecting 50,000 people. A second spell of heavy rains, which lasted for two months, followed on 27th July and resulted in the FFD issuing high flood level warnings along the River Chenab in Punjab and River Kabul in Khyber Pakhtonkhwa. On 28th July the FFD issued further warnings of heavy flooding in the Kalat, Sibi, Naseerabad and Zhob districts of Balochistan and DG Khan and Rajanpur districts and river Tarbella in Punjab and northern Khyber Pakhtonkhwa provinces.
On 29th July, the Swat and Kabul rivers burst their banks resulting in the flooding of Nowshera and Charsadda districts and parts of Peshawar in Khyber Pakhtonkhwa. Furthermore, on-going rains in the northern regions caused landslides and further flash flooding in Khyber Pakhtonkhwa, Gilgit Baltistan and Pakistan-administered Kashmir causing loss of life and significant damage to property and infrastructure. By the morning of 31st July the upper regions of River Indus around the Chashma district of Punjab had been flooded. As the floodwaters headed southwards, floods continued to devastate low-lying district surrounding the Indus basin (i.e. Bhakkar, Layyah, Muzaffargarh, DG Khan and Rajanpur). The total rainfall within the month of July was exceptionally high for the annual monsoon season with recordings of: up to 257mm in districts of Punjab; up to 280mm in Khyber Pakhtonkhwa; up to 58mm in Balochistan and up to 189mm in Gilgit Baltistan & Azad Kashmir.27
By 5th August, as red alerted by the FFD two days earlier, the floodwaters reached the Sindh Province and drowned the district of Guddu. The FFD issued further red alerts of exceptionally high flooding in Sindh to the districts of Khairpur, Jacobabad, Sadiqabad, Shikarpur, Ghotki of Dadu Sukkur, Larkana, Nawabshah, Hyderabad and Naushehroferoze. By 7th August, the floods had affected 15 million people nationwide.
On 9th August, the Indus River overflowed its banks in Sindh causing wide scale destruction. By 26th August, more river breeches had occurred in the district of Thatta and further flood warnings were issued for the district of Kotri. By 30th August, more villages were submerged under water and approximately 1 million people fled from the floods in Sindh. On 13th September, the large Manchar Lake breached its bank and overflowed causing serious flooding of the Jamshoro district (Figure 3).
4.2. Receding floodwaters
The impact of the floods varied amongst the provinces depending on the nature of the floods (i.e. flash flood versus slow-rising riverine floods), the topography of each affected area and the different levels of preparedness measures. Where Khyber Pakhtunkhwa was only affected by flash floods, the provinces of Punjab and Balochistan were exposed to both flash and riverine floods and the Sindh province to mainly slow-rising riverine floods. Furthermore, the receding of floodwaters also varied depending on the topography of the region. In the topographically hilly Khyber Pakhtunkhwa and Balochistan floodwaters started to recede within days of their onset, however it took several weeks until mid-September in Punjab and several months in some areas of the flat plains of Sindh for the waters to completely clear.29
The Pakistan floods of 2010 have caused unprecedented damage to livelihoods, property, infrastructure and economy in the history of the country. The floods claimed 1985 lives, injured 2946 people and affected over 20.2 million people nationwide. Around 11 million people were displaced nationwide; with 7 million people from Sindh alone.30 Both flash and slow-rising riverine floodwaters affected 78 of the total 121 districts and at one point one-fifth of the country was submerged under water (Figure 4).1 Unparalleled damage was caused to housing stock, educational and health facilities, communication networks, power plants and grids, irrigation channels, agricultural land and livestock. The World Health Organisation (WHO) identified 23 of the most severely affected districts (Table 1).
4.4. Impact on Human Health
4.4.1. Deaths and Injuries
The floods caused 1985 deaths and injured 2946 people. Majority of deaths occurred in Khyber Pakhtunkhwa Province (1156; 58%), followed by Sindh (411; 20%), Punjab (110; 5.5%), Balochistan (183; 0.02%). The remainder of deaths occurred in the smaller tribal and administrated areas. Furthermore, the majority of deaths had occurred within the first 14 days with official data reporting 1271 deaths and 1334 injuries by 10th August 2010.31 Sindh (1235; 41%) and Khyber Pakhtunkhwa (1198; 40%) had the most number of injured people (Figure 5).29
From 29th July 2010 to 21st July 2011 DEWS reported 37,391,802 medical consultations in flood affected districts. The most common illnesses included: acute respiratory infection (23%), skin diseases (11%), acute diarrhoea (9%) and suspected malaria (6%) (Figure 6).2 Other diseases reported by DEWS have included Tetanus, Meningitis, Leishmaniasis, Diphtheria, Acute Flaccid Paralysis, and Viral Hemorrhagic Fever.32
The incidence of acute respiratory infection increased within two weeks after the onset of the floods and reached a peak in early February 2011. The incidence of acute diarrhoea (AD) increased immediately after the floods and peaked towards the end of August 2010. After a falling trend from September 2010 to late February 2011 the incidence of AD began to climb again around mid-March 2011. The incidence of bloody diarrhoea (BD) remained generally low but constant with a slight increase between late August to mid-October. The number of suspected malaria cases increased between late-August 2010 till early January 2011 peaking in October 2010 (Figure 7).
4.4.3. Health Facilities
The damage inflicted on the country’s public health infrastructure was considered to be mild to moderate with basic health units and medical dispensaries mostly affected. From a total of 9721 health facilities in Pakistan, 2957 were situated in flood-affected districts of which 515 were either damaged or destroyed by the floods.34,26 Khyber Pakhtunkhwa and Sindh suffered most proportional damage with 10.9% and 11.7% of total health facilities damaged or destroyed; respectively. About 8.9% of total provincial health facilities in Fata, 6.3% in Azad & Jammu Kashmir, 2.1% in Balochistan and 2% in Punjab were affected by the floods (Figure 8). Most of these healthcare facilities were located in rural areas and provided basic health services to the local population. Although most of the secondary healthcare facilities were unaffected by the floods, however the disruption caused to primary healthcare providers led to secondary healthcare facilities becoming inundated with greater demand for services. Furthermore it is estimated that around 35,000 female health workers had been displaced during the floods causing further disruption to the health service.28 The total cost of damage to health facilities has been estimated around $50 million.1
4.4.4. Food and Nutrition
The World Food Programme Flood Impact Assessment reported that at least 10.1 million people required emergency assistance with food of which about 3.6 million people would require long-term assistance. Risks of diarrhoeal outbreaks caused by water borne diseases, poor feeding and loss of livelihoods predisposed the displaced and affected population to acute and chronic malnutrition.
The pre-existing levels of malnutrition in the population (13.2% of Global Acute Malnutrition (GAM) and 3% of Severe Acute Malnutrition (SAM)) had been exacerbated by the floods. Provincial surveys showed that the level of GAM in northern Sindh had increased to 22.9% and 26% in southern Sindh. A total of 13.2 million people required nutritional attention following the floods. Furthermore, about 2.8 million (14%) children under the age of 5 years old and 1.6 million (8%) pregnant and lactating women formed part of the total affected population 35
4.5. Impact on other Sectors
The floods affected 78 out the 121 districts of Pakistan inundating over 160,000 km2 of land mass causing unprecedented damage to housing, educational and health facilities, communication networks, power and energy plants and grids, irrigation channels, agricultural land and livestock (Figure 9). The total cost of damage was estimated to be around US$ 10 billion. Sindh suffered the most damage estimated to be around US$ 4.3 billion, followed by Punjab at US$ 2.5 billion, KPK at US$ 1.7 billion and Balochistan at US$ 620 million (Figure 10).26
Over 1.6 million houses were either damaged or destroyed by the floods. Approximately 1.45 million of the affected houses were of kutcha stock and around 850,000 had been completely destroyed. Around 156,000 units of pucca houses were affected by the floods of which around 65,000 were completely destroyed. Sindh suffered the most losses to housing with over 800 thousand houses (24% of pre-flood stock) becoming damaged or completely destroyed. About 375,000 houses (9% of pre-flood stock) in Punjab, 250,000 houses (9% of pre-flood stock) in Khyber Pakhtunkhwa, 80,000 houses (14% of pre-flood stock) in Balochistan were either damaged or complete destroyed by the floods.28 The total cost of damage to housing has been estimated at around $1.158 billion (Figure 11).26
4.5.2. Water Supply and Sanitation
The severity of damage caused to water supply and sanitation infrastructure varied across the provinces. Flash floods in Khyber Pakhtunkhwa caused most structural damage to water supply networks and infrastructure including pump houses, store tanks and water pipes. Whereas the slow-rising riverine floods in Sindh caused more damage to electrical and mechanical components, pump houses and machinery. Sanitation infrastructure was most affected in the south with extensive damage inflicted on sewerage and drainage systems.26 As water and sanitation is a major determinant of communicable diseases, the impact of the damage on this sector had wide-reaching health implications. The total cost of damages in this sector is estimated to be around $109 million.1
Severe damage was caused to the country’s 50 years old irrigation system that included irrigation channels, canals, drains and public tube wells. The Sindh province suffered most damage costing around $136.9 million followed by Khyber Pakhtunkhwa at around $68 million.1 The overall damage to the irrigation is estimated to be around $278 million.26 The direct damage to the irrigation infrastructure compounded with water siltation and water-logging of agricultural lands have also caused great destruction to crops.26
The floods caused indiscriminate damage to educational facilities that account for 6.2% of total institutions in Pakistan. A total of 10,407 educational institutions were severely affected by the floods of which 6,666 fully destroyed and 3,741 partially damaged. A total of 18.5% of total educational institutions were either damaged or destroyed in the Sindh province and a further 8.8% in Punjab, 12.9% in Balochistan and 5.6% Khyber Pakhtunkhwa.26 The total cost of damage to education sector has been estimated at around $311 million.26
4.5.5. Transport and Communications
The damage incurred to the transport and communication networks (including roads, bridges, railways, airports and telecommunication infrastructure) have had multiple implications ranging from mobility of the affected population to access to basic services (e.g. health, education, public services and markets). Approximately 25,000 km (10%) of road networks and 1,225 km (16%) of railways have been damaged by landslides and floods, incurring losses of $1.2 billion and $60 million, respectively. Damage to the telecommunications infrastructure, which includes cables, transmission towers and optic fibre networks is estimated around $35 million. The total damage incurred by this sector has been estimated to be $1.3 billion.26
4.5.6. Agriculture, Livestock and Fisheries
Agriculture, livestock and fisheries have been the most severely affected sector accounting for 44% of total damage inflicted by the floods. The damage caused to agriculture and livestock varied in each province according the nature of the flood. The unexpected flash floods in the mountainous areas of Balochistan, Khyber Pakhtunkhwa, Pakistan-administrated Kashmir and Gilgit-Baltistan overwhelmed the local population and resulted in the sweeping away of people, houses, livestock, feed stores and food. The slow-riverine floods in the topographically flat plains of Sindh and Punjab together with longer advance warnings by the FFD enabled the population to relocate and save most of their livestock. In total about 1.5 million animals and 10 million poultry birds were lost to the floods.26
Waterlogging and siltation of agricultural lands caused great destruction to crops. According to the Preliminary Damage and Needs Assessment report, damage to crops accounted for 89% (i.e. 2.1 million hectares of mostly cotton, rice, sugarcane and vegetables) and live stock 11% of the overall losses.1 The Sindh province suffered 46% of the total damage to the agriculture, livestock and fisheries sectors, followed by Punjab (36%), Khyber Pakhtunkhwa (8%) and Balochistan (8%). The total damage to this sector is estimated at $5 billion.26
Forests, wetlands and other natural systems have suffered damages of around $12 million.26 Furthermore, the floods had serious implications on environmental health though contamination of drinking water, accumulation of solid waste and proliferation of disease vectors around stagnant waters.29
Pakistan’s electricity sector suffered major damages to hydroelectric power generation stations, distribution grid and networks. About 3.5 million people, predominately from Sindh and Khyber Pakhtunkhwa, were left without power. The total damage to the electricity sector was estimated to be around $155 million. Pakistan’s petroleum sector, although representing only 1% of the annual oil imports, also suffered damages totalling around $155 million. Over 240,000 people were cut off from gas supplies, and a number of power generation facilities were temporarily suspended following shortages of oil. Total damage to the energy sector is estimated around $309 million.26
4.5.9. Private Sector and Industries
Whilst the major industrial centres of the country were spared, the floods severely affected small and medium business enterprises. Shops, industrial factories and workhouses received the largest share of the damage estimated at around $282 million. Sindh and Punjab suffered most damage to commercial, agricultural and farming sectors (i.e. cotton, sugar, rice and flourmills). Losses of around 2 million bales of cotton had knock-on effects on the textile industry; which forms one third of the country’s manufacturing sector. Khyber Pakhtunkhwa suffered most damage to its marble, mining, silk, furniture manufacturing and tourism sectors.29 Furthermore damage to the private sector has had serious implications on the labour forces incomes and livelihoods and overall resilience. The total cost to this sector is estimated at around $282 million.26
The initial response to the floods was coordinated by the NDMA and carried out by PDMAs, DDMAs, local population, philanthropist and the army. Much experience and capacity had already been formed following the Pakistan earthquake of 2005 that allowed for early mobilisation of response; particularly in KPK where the recovery phase was still in progress following the earthquake. However, as the floods continued to overwhelm and exhaust the country’s resources and capacity, the Government of Pakistan sought help from the international community. By early August 2010 the UN appealed for $459 million through the Pakistan Initial Floods Emergency Response Plan (PIFERP) to cover the immediate relief period and at the heed of the Pakistan government prioritised four clusters (Food, Health, Shelter and Water, Sanitation and Hygiene (WASH)).10 Within weeks, the humanitarian response to the Pakistan floods became the largest relief operation launched by the international community in recent history comprising various United Nation agencies, international non-governmental organisations, foreign government and donors. However, due to initial poor flow of donations the initial response to the floods was heavily hampered, especially in the southern provinces. A revised PIFERP requested over $1.9 billion to cover the early recovery period lasting approximately one year.36 Eventually the UN increased the number of clusters to assist flood-affected people. The NDMA also arranged for visas-on-arrival for relief workers and exempted tax and duty for imported relief items.1
5.1. Rescue and Relief phase
The Rescue and Relief Phase started immediately after the onset of the floods in July 2010 and aimed to reduce mortality, morbidities, disease and malnutrition in the affected population.14 The NDMA, together with the assistance of the army, initiated a rescue operation that included moving stranded people to safety, transporting people that required medical attention and distributing emergency relief supplies (including tents, food, water, sleeping mats, hygiene kits and medical services) (Table 2). The army deployed 60,000 troops, utilised their entire fleet of C-130 planes in the initial operation. Marine support was provided through 1000 boats including 50 life-saving naval boats. The army was also involved in repairing transport infrastructure (e.g. roads, bridges) and setting up mobile medical camps.37 As a result 800,000 people were rescued within one month following the initiation of the Rescue and Relief Phase.38 By 17th September 2010 a total of 1.4 million people were either rescued or evacuated from the floods.1
A total of 88 helicopters (including 48 from friendly countries), 4 hovercrafts and 1238 boats were deployed during the initial rescue operation. A total of 5928 relief camps were established nationwide that sheltered over 3 million people at the peak of the disaster. These had decreased to 103 relief camps and 91,773 people by 31st December 2010 (Table 3).1
The relief efforts were further augmented with the formation of clusters that initially prioritised food, health, shelter and WASH but were later rolled out to include other sectors (Appendix 2). This paper will summarise the response of clusters directly related to human health: Health, Food, Nutritional, WASH and Shelter.
5.1.1. Health Cluster
The health cluster led by WHO and the Ministry of Health had the objective of providing emergency health assistance in the flood-affected areas of KPK, Balochistan, Punjab, Sindh, the small tribal areas and the state of AJK. During the initial Rescue and Relief phase a total of over 11.8 million medical consultations were reported from 29th July to 30th December 2010.39
Within one year from the onset of the floods over 37 million medical consultations were reported by DEWS, between July 29th July 2010 to 21st July 2011, from 73 out of 78 flood affected districts.2 The cluster provided essential medicine to over 14 million people and responded quickly to disease alerts, controlling over 480 outbreaks as identified by DEWS.40 The most common disease presentations included: acute respiratory infection, skin diseases, acute diarrhoea and suspected malaria. Over 10.3 million water disinfection chemical kits have been distributed.
5.1.2. Shelter Cluster
The movement of people from flood-affected districts led to the establishment of 5928 relief camps to shelter displaced communities. By 31st December this number had reduced to 103 as about 97% of people returned homes with 91,773 people remaining in the camps.1 Up until March 2011 the Shelter Cluster have reportedly distributed 1.36 million plastic tarpaulins and 381,000 tents to over 1 million households (approximately 66% of the total estimated number of houses damaged or destroyed by the floods) and 14,520 one room shelters and 24,111 transitional shelters (i.e. lightweight structures that can be relocated) were set up. However, only 67% of the emergency shelter needs had been met. Punjab has received the most coverage with (93%) while the shelter cluster in the Sindh province has only reached 51% of the target amount.41
5.1.3. Food Cluster
About 10.1 million people were in need of food following the floods. By December 2011, the food cluster, headed by the World Food Programme (WFP), distributed over 350,000 metric tonnes (mt) of food.42 By February 2011, over 480,000 metric tonnes of food had been distributed in 65 districts in the form of monthly rations (in accordance with SPHERE standards for food security, nutrition and food aid).35 About 8.8 million people (including 4.3 million women and girls and 1.2 million children under the age of 5 years) had been assisted at least once and an average of 6 million people were reached on a regular basis.35 Food and cash for initiatives were also implemented to help rebuild agricultural infrastructure and rehabilitate communities.43
5.1.4. Nutrition Cluster
The Nutrition Cluster established 625 therapeutic centres that comprised of 597 outpatients therapeutic clinics and 28 stabilisation centres. By March 2011, the Nutrition Cluster had screened over 1.29 million children under the age of 5 years and over 492,000 pregnant and lactating women for malnutrition.35 By August 2011, the screening programme identified 95397 severely malnourished children, 256,226 moderately malnourished children and 159,750 pregnant or lactating women who were put onto the feeding programs.40
5.1.5. WASH Cluster
Approximately 13.1 million flood-affected individuals required the provisions or services of the WASH cluster. Key priorities included installing permanent WASH facilities (e.g. safe disposal of excreta), restoring and exceeding pre-flood WASH coverage in the affected districts and hygiene education to promote sustainability.29 The WASH cluster have provided drinking water to 2.5 million people, over 400,000 hygiene kits, 3 million bars of soap and have provided education, health and hygiene promotion to over 750,000 people.29
5.2. Early Recovery Phase
The Early Recovery Phase started in parallel to the initial relief phase and was included in the Pakistan Flood Relief and Early Recovery Plan in November.28 The NDMA, United Nations Development Programme (UNDP) and UN Humanitarian Coordinator formed the Early Recovery Working Group (ERWG) to aid recovery in 29 of the most affected districts. The ERWG, setup at federal, provincial and district level, consists of 8 Sectorial Working Groups (SWG) focused on 8 prioritised sectors (Agriculture & Food and Security, Health & Nutrition, Education, Water & Sanitation, Housing, Governance, Non-Farm Livelihood and Community Infrastructure) and 4 Thematic Groups based on 4 cross-cutting themes (Disaster Risk Reduction, Gender, Environment and Protection. The SWGs and TGs devised strategies for each sector and thematic group after conducting a Map and Gap Analysis to identify early recovery needs, challenges, response, funding and funding gaps.44 On 15th April 2011, the Early Recovery Phase was formally initiated through the Strategic Early Recovery Plan that described sectorial and thematic strategies to address the gap between relief and long-term recovery and rehabilitation.
5.2.1. Health and Nutrition
The Health and Nutrition SWG focused on screening and providing nutritional support for moderate to severely malnourished children and pregnant and lactating women in 29 priority districts. The Health and Nutrition SWG identified 8 million people, including 1.4 million children under 5 years old and 1.4 million women who needing access to health care. Capacity was also developed through the restoration and rehabilitation of healthcare facilities. Temporary structures, medical supplies, and human resource support (e.g. female staff) was provided to manage with the increased number of patients.45 Further partnerships had been formed with UNICEF and World Food Programme to make up for the short fall in capacity.29
Up and until October 2011, 685 Outpatient Therapeutic Program (OTP) and Stabilization Centers (SC) had been established. Over 5.28 million children under the age of 5 years had been screened of which 127435,589 were included in OTP/SC and 4.3 million admitted in the Supplementary Feeding Program (SFP). Over 1.6 million pregnant lactating women had been screened for malnutrition of which 2.52 million were admitted in the Supplementary Feeding Program (Table 4).
5.2.2. Water and Sanitation
With the passing of the initial relief and recue phase, the emphasis shifted onto recovery and strengthening of institutional capacity to achieve long term health and development goals and supporting the return of displaced people.29 Sanitation has been the main focus of the Water and Sanitation SWG work. Their work has included repairing damaged water supply networks, installing or repairing hand-pumps and constructing latrines for the affected population. Much emphasis has also been placed on hygiene awareness through educational and training programmes. Until August 2011, 1.6 million homes were reached with hand pump installation or repair, 30,000 households have been provided with latrines and 1.2 million households have received educational sessions on hygiene.40
5.3. Early recovery in Other sectors
5.3.1. Agriculture and Food Security
The Agriculture and Food Security Sectorial Working Group led by the World Food Programme has been involved in ensuring food security for the affected population and building agricultural assets of local communities. From February 2011 to July 2011 food and cash for work initiatives were introduced to enable affected communities to rebuild agricultural infrastructure. About 100,300 households have benefitted from the cash for work initiative. About 768,680 households were provided with crop/vegetable packages and 327,340 households with livestock.44
On 31st March 2011 the Shelter Cluster was handed over to the Housing Early Recovery Group (HERG) after being led by the International Organisation for Migration (IOM) during the Rescue and Relief Phase. The main strategy has been to focus exclusively on houses that were completely destroyed by building cost-effective and durable one-room shelters made from mud and brick per destroyed house. Up and until August 2011 453,293 one room shelter units have been constructed and around 63,700 transitional shelters have been completed.40 Emphasis has also been given on training programmes and centres that provide technical assistance to families building their own homes.41
5.3.3. The Watan Card Scheme
The Government of Pakistan established the Watan Card Scheme to enable the delivery of cash directly to the flood affected families. ATM cash cards were registered and distributed to affected families who were then able to obtain cash from ATM machines. Around 1.5 million households benefited from the scheme receiving sums of approximately £150 each. This scheme also allowed for money to be injected directly into the local economy.
5.4. Pakistan floods 2011
At the time of completing this report, the new onset of floods in the southern regions of Pakistan in 2011 had undoubtedly compromised the recovery and rehabilitation phase following the floods of 2010.47 The floods, triggered by heavy monsoon rains, have caused 486 deaths, injured 753 people and affected a total population of 5.15 million people in Sindh alone. Extensive damage has been caused to nearly 800 thousand houses, 200 health facilities and 2.28 million acres of agricultural lands.48 A comprehensive review of the impacts and effects of the floods 2011 in Pakistan and the post-flood relief and recovery efforts are beyond the scope of this paper.
The floods of 2010 in Pakistan have caused unprecedented damage and affected over 20 million people, however the impact on health (i.e. mortality and morbidity rates) has been relatively low when compared to other natural disasters in recent history (e.g. Asian Tsunami in 2004 Hurricane Katrina in 2005). This could be attributed to three factors: the early warning system by FFD; the type of floods (flash floods versus slow-rising riverine floods); and the timing and dispatch of early response and recovery efforts to the disaster.
Flash floods that devastated the northern mountainous regions of KPK were responsible for more deaths (1,156) than the slow-rising riverine floods in the south. Furthermore, the number of deaths in Punjab (110) and Sindh Province (411) were remarkably low despite having a larger affected population. This discrepancy in mortality rates could be attributed to range of advance warning given by the FFD. The southern provinces benefitted from longer advance warnings compared to the northern regions. This supports the importance of an effective and timely advance flood warning system to allow people adequate time to prepare and relocate. The NDMA concedes that the current early warning system in Pakistan is of limited nature and can provide a forecast range of 3-4 days; however, coverage is almost non-existent in the north-western region and around the coastal belt of Balochistan.42 Further investment is needed in enhancing early warning systems through the application of modern technology for developing a more comprehensive system for monitoring and archiving data. More, infrastructural investment is needed in developing more efficient channels for disseminating warnings to vulnerable communities. The current system relies upon police wireless networks in police stations, the Forestry Department, mosque committees and other grass root organisations and the growing use of mobile (GSM) networks.12
The sudden and violent nature of flash floods, as seen in the northern mountainous region of KPK and Balochistan, have been responsible for more deaths – to both humans and livestock – than the slow-rising riverine floods that devastated Sindh and most of Punjab. The exact cause of death has been difficult to verify during the course of this report – as the information is not readily available – however review papers show that the leading cause of death by flash floods is drowning.49 Although the timing of flash floods is difficult to predict it is undeniable that they can be a major determinant of human health. Therefore a comprehensive risk analysis and hazard map should be drawn up so vulnerable communities can be identified and appropriate disaster risk reduction intervention can be implemented (e.g. informing, motivating and involving communities’ people in all aspects of disaster risk reduction)
The swift and immediate responses by the NDMA and the military, especially in KPK, may have saved lives that may have been otherwise been lost. The capacity to respond to natural disasters had already been developed by the PDMAs of the northern regions following the 2005 earthquake in Kashmir. This gained knowledge and experience was reflected in the relief efforts during the July 2010 floods. It was felt by stakeholders (e.g. NGOs) that the deployment of relief response was quicker in the northern regions than in the southern provinces where sufficient warning time had been issued in advance of the floods. This shows that much more capacity building is required at a national and provincial level to ensure response is equal, measured and effective.
The United Nations led health cluster approach to coordinating humanitarian assistance to disaster victims has had mixed reactions from stakeholder groups. Although it is generally accepted that the approach had improved since the earthquake in 2005, it was commented that some clusters – which comprised over 600 agencies – lacked experienced leadership. This impacted on cluster meetings, which, rather than being utilised as a forum to coordinate assistance served as platform to share information. As a result of communication failure there were gaps in coverage, duplication of aid in certain areas and delays in assistance.29,37
An overwhelming case has been made for further investment in disaster preparedness and risk reduction. Pakistan needs to continue implementing strategies of the Hyogo Framework for Action (HFA). Although much progress has been achieved through institutional commitments, the Government of Pakistan needs to invest in emergency preparedness, response and recovery programmes.
7. Lessons Identified
The NDMA have been central to coordinating response to the floods of 2010. The NDMA initial rescue operation pays testament to the value of local capacity and leadership. However, where response coordinated by NDMA was swift in the northern regions of Pakistan, the response in Sindh was much slower despite adequate early warnings issued by the FFD. The NDMA need to invest in building capacity in Sindh and Punjab and disaster risk reduction measures in all provinces.
The Watan scheme was an innovative idea that helped to put cash directly in the hands of those in need. However, the scheme was fraught with bureaucracies and red tape that delayed the money reaching its intended beneficiaries. The registration system relied on presenting a national identity card on application. As majority of the people affected were poor and did not own an identity card they were excluded from being enrolled on to the scheme. The scheme could be enhanced by removing some of these barriers to make it more equitable. The government should carry out a registration process of all the people in the area as a preparedness measure for future floods.
The Clusters have achieved varying levels of success. There seems to have been a lack of clear leadership amongst the clusters, especially when some clusters have more than 600 humanitarian agencies grouped together. Initiatives that can rank agencies according to their leadership strengths and experiences should be explored and also structure the size of the meetings to allow for efficient communication and information sharing.
The Pakistan floods of 2010 affected over 20.2 million and claimed the lives of 1985 and injured 2946 people. The floods affected 78 out of 121 districts and at one stage submerged 20% of country total landmass underwater causing total damage of over $10 billion. KPK and Balochistan suffered predominantly from flash floods; whereas Punjab and Sindh suffered mainly from slow-rising riverine floods. The amount of fore warning disseminated to vulnerable communities was inconsistent throughout the country. The northern provinces of Pakistan were disadvantaged with shorter advance warnings than the southern provinces. However, response to the floods was much swifter in the northern regions as compared to the southern regions. The NDMA coordinated all response efforts and the UN Cluster approach was adopted to provide humanitarian assistance to affected communities. The initial Rescue and Relief Phase was discontinued on 31st January 2011; except in 27 most affected districts where eight Sectorial Working Groups (SWG) were established in April 2011 to start the Early Recovery Phase. Unfortunately, recovery and rehabilitation efforts have been hampered by the recent floods of 2011 that have affected 5.2 million people and destroyed over 1 million houses in Sindh. The floods of 2010, and indeed 2011, have exposed vulnerabilities in the country disaster risk reduction system where further investment is required in emergency preparedness, response and recovery programme.
AcknowledgementsA special thank you to Dr Paul Wilkinson and Professor Virginia Murray for kindly supervising me during the course of writing this report. I would also like to thank Ms. Carla Stanke for her invaluable support and contribution during the editing process.
Flood Forecasting and Warnings Time by the Pakistan Metrological Department. 
 Pakistan Metrological Depart. Government of Pakistan. Rainfall statement July 2010 Accessed on 21st June 2011 via: http://www.pakmet.com.pk/FFD/index_files/rainfalljuly10.htm [online].
Cluster Groups involved in the Pakistan Floods 2010
- NDMA. NDMA Annual Report 2010. The Natural Disaster Management Authority. Government of Pakistan; 2010. Available at: www.ndma.gov.pk.
- Government of Pakistan, World Health Organization. Weekly Epidemiological Bulletin: Flood Response in Pakistan: Volume 2, Issue 4, Monday 25 July, 2011. 2011.
- Kulling P, Birnbaum M, Murray V, Rockenschaub G. Guidelines for reports on health crises and critical health events. Prehosp Disaster Med. 2010;25(4):377–383.
- Government of Pakistan. Population Census Organisation. 2011. Available at: http://www.census.gov.pk/. Accessed December 23, 2011.
- World Health Organization. WHO EMRO: Country Profiles. World Health Organisation - Regional Office for the Eastern Mediterranean. Available at: http://www.emro.who.int/emrinfo/index.aspx?Ctry=pak. Accessed December 23, 2011.
- Blood PR. Pakistan: A Country Study. DIANE Publishing; 1996.
The floods in Pakistan began in late July 2010, resulting from heavy monsoon rains in the Khyber Pakhtunkhwa, Sindh, Punjab and, Balochistan regions of Pakistan, which affected the Indus Riverbasin. Approximately one-fifth of Pakistan's total land area was affected by floods. According to Pakistani government data, the floods directly affected about 20 million people, mostly by destruction of property, livelihood and infrastructure, with a death toll of close to 2,000.
UN Secretary-General Ban Ki-moon had initially asked for US$460 million (€420 million) for emergency relief, noting that the flood was the worst disaster he had ever seen. Only 20% of the relief funds requested had been received on 15 August 2010. The U.N. had been concerned that aid was not arriving fast enough, and the World Health Organization reported that ten million people were forced to drink unsafe water. The Pakistani economy was harmed by extensive damage to infrastructure and crops. Damage to structures was estimated to exceed US$4 billion (€2.5 billion), and wheat crop damages were estimated to be over US$500 million (€425 million). Total economic impact may have been as much as US$43 billion (€35 billion).
The floods were driven by rain. The rainfall anomaly map published by NASA showed unusually intense monsoon rains attributed to La Niña. On 21 June, the Pakistan Meteorological Department cautioned that urban and flash flooding could occur from July to September in the north parts of the country. The same department recorded above-average rainfall in the months of July and August 2010 and monitored the flood wave progression. Discharge levels were comparable to those of the floods of 1988, 1995, and 1997. The monsoon rainfall of 2010 over the whole country was the highest since 1994 and the second highest during last 50 years.
A research by Utah State University analyzed conditional instability, moisture flux, and circulation features and the results support a persistent increase in conditional instability during the July premonsoon phase, accompanied by increased frequency of heavy rainfall events. The increased convective activity during the premonsoon phase agrees with the projected increase in the intensity of heavy rainfall events over northern Pakistan. Large-scale circulation analysis reveals an upper-level cyclonic anomaly over and to the west of Pakistan–a feature empirically associated with weak monsoon. The analysis also suggests that the anomalous circulation in 2010 is not sporadic but rather is part of a long-term trend that defies the typical linkage of strong monsoons with an anomalous anticyclone in the upper troposphere. An article in the New Scientist attributed the cause of the exceptional rainfall to "freezing" of the jet stream, a phenomenon that reportedly also caused unprecedented heat waves and wildfires in Russia as well as the 2007 United Kingdom floods.
In response to previous Indus River floods in 1973 and 1976, Pakistan created the Federal Flood Commission (FFC) in 1977. The FFC operates under Pakistan's Ministry of Water and Power. It is charged with executing flood control projects and protecting lives and property of Pakistanis from the impact of floods. Since its inception the FFC has received Rs 87.8 billion (about 900 million USD). FFC documents show that numerous projects were initiated, funded and completed, but reports indicate that little work has actually been done due to ineffective leadership and corruption.
Flooding and impact
Monsoon rains were forecast to continue into early August and were described as the worst in this area in the last 80 years. The Pakistan Meteorological Department reported that over 200 millimetres (7.9 in) of rain fell over a 24-hour period in Khyber Pakhtunkhwa and Punjab. A record-breaking 274 millimetres (10.8 in) rain fell in Peshawar during 24 hours; the previous record was 187 millimetres (7.4 in) of rain in April 2009. On 30 July, 500,000 or more people had been displaced from their homes. On 30 July, Manuel Bessler, head of the UN Office for the Coordination of Humanitarian Affairs, stated that 36 districts were involved, and 950,000 people were affected, although within a day, reports increased that number to as high as a million, and by mid-August they increased the number to nearly 20 million affected.
By mid-August, according to the governmental Federal Flood Commission (FFC), the floods had caused the deaths of at least 1,540 people, while 2,088 people had received injuries, 557,226 houses had been destroyed, and over 6 million people had been displaced. One month later, the tally had risen to 1,781 deaths, 2,966 people with injuries, and more than 1.89 million homes destroyed.
The Khyber Pakhtunkhwa provincial minister of information, Mian Iftikhar Hussain, said "the infrastructure of this province was already destroyed by terrorism. Whatever was left was finished off by these floods." He also called the floods "the worst calamity in our history." Four million Pakistanis were left with food shortages.
The Karakoram Highway, which connects Pakistan with China, was closed after a bridge was destroyed. The ongoing devastating floods in Pakistan will have a severe impact on an already vulnerable population, according to the International Committee of the Red Cross (ICRC). In addition to all the other damage the floods caused, floodwater destroyed much of the health care infrastructure in the worst-affected areas, leaving inhabitants especially vulnerable to water-borne disease. In Sindh, the Indus River burst its banks near Sukkur on 8 August, submerging the village of Mor Khan Jatoi. Law and order disappeared, mainly in Sindh. Looters took advantage of the floods by ransacking abandoned homes using boats.
In early August, the heaviest flooding moved southward along the Indus River from severely affected northern regions toward western Punjab, where at least 1,400,000 acres (570,000 ha) of cropland were destroyed, and toward the southern province of Sindh. The affected crops included cotton, sugarcane, rice, pulses, tobacco and animal fodder. Floodwaters and rain destroyed 700,000 acres (3,000 km2) of cotton, 200,000 acres (800 km2) acres each of rice and cane, 500,000 tonnes of wheat and 300,000 acres (1,000 km2) of animal fodder. According to the Pakistan Cotton Ginners Association, the floods destroyed 2 million bales of cotton, which increased futures prices. 170,000 citizens (or 70% of the population) of the historic Sindh town of Thatta fled advancing flood waters on 27 August.
By mid-September the floods generally had begun to recede, although in some areas, such as Sindh, new floods were reported; the majority of the displaced persons had not been able to return home.
Heavy rainfalls recorded during the wet spell of July 2010
Heavy rainfalls of more than 200 millimetres (7.9 in) were recorded during the four-day wet spell from 27 to 30 July 2010 in the provinces of Khyber Pakhtunkhwa and Punjab based on data from the Pakistan Meteorological Department.
* Indicates new record.
The power infrastructure of Pakistan also took a severe blow from the floods, which damaged about 10,000 transmission lines and transformers, feeders and power houses in different flood-hit areas. Flood water inundated JinnahHydro power and 150 power houses in Gilgit. The damage caused a power shortfall of 3.135 gigawatts.
Black death diseases (e.g. gastroenteritis, diarrhoea, and skin diseases) due to lack of clean drinking water and sanitation pose a serious new risk to flood victims. On 14 August, the first documented case of cholera emerged in the town of Mingora, striking fear into millions of stranded flood victims, who were already suffering from gastroenteritis and diarrhoea. Pakistan also faced a malaria outbreak.
The International Red Cross reported that unexploded ordnance, such as mines and artillery shells, had been flushed downstream by the floods from areas in Kashmir and Waziristan and scattered in low-lying areas, posing a future risk to returning inhabitants.
The United Nations estimated that 800,000 people were cut off by floods in Pakistan and were only reachable by air. It also stated that at least 40 more helicopters are needed to ferry lifesaving aid to increasingly desperate people. Many of those cut off are in the mountainous northwest, where roads and bridges have been swept away.
By order of President Asif Ali Zardari, there were no official celebrations of Pakistan's 63rd Independence Day on 14 August, due to the calamity.
Potential long-term effects
Floods submerged 17 million acres (69,000 km2) of Pakistan's most fertile crop land, killed 200,000 livestock and washed away massive amounts of grain. A major concern was that farmers would be unable to meet the fall deadline for planting new seeds in 2010, which implied a loss of food production in 2011, and potential long term food shortages. The agricultural damage reached more than 2.9 billion dollars, and included over 700,000 acres (2,800 km2) of lost cotton crops, 200,000 acres (810 km2) of sugar cane and 200,000 acres (810 km2) of rice, in addition to the loss of over 500,000 tonnes of stocked wheat, 300,000 acres (1,200 km2) of animal fodder and the stored grain losses.
Agricultural crops such as cotton, rice, and sugarcane and to some extent mangoes were badly affected in Punjab, according to a Harvest Tradings-Pakistan spokesman. He called for the international community to fully participate in the rehabilitation process, as well as for the revival of agricultural crops in order to get better GDP growth in the future.
In affected Multan Division in South Punjab, some people were seen to be engaging in price-gouging in this disaster, raising prices up to Rs 130/kg. Some called for Zarai Taraqiati Bank Limited to write off all agricultural loans in the affected areas in Punjab, Sindh and Khyber Pukhtunkhwa especially for small farmers.
On 24 September, the World Food Programme announced that about 70% of Pakistan's population, mostly in rural areas, did not have adequate access to proper nutrition.
Already resurgent in the Federally Administered Tribal Areas and Khyber-Pakhtunkhwa province, agricultural devastation brought on by the floods left Pakistan more susceptible to an increase in poppy cultivation, given the crop's resiliency and relatively few inputs.
Floods damaged an estimated 2,433 miles (3,916 km) of highway and 3,508 miles (5,646 km) of railway and repairs are expected to cost at least 158 million USD and 131 million USD, respectively. Public building damage is estimated at 1 billion USD. Aid donors estimate that 5,000 schools were destroyed.
Climate-resilient model villages
Following the 2010 floods, the Punjab government subsequently constructed 22 'disaster-resilient' model villages, comprising 1885 single-storey homes, together with schools and health centres. The Climate & Development Knowledge Network was engaged to advise on how to make the new infrastructure resilient to extreme weather events occurring in the future. The idea was that the villages should provide 'triple wins' of limiting greenhouse gas emissions, promoting development and building resilience to climatic events. Now inhabited, the model villages incorporate biogas plants, solar energy systems, livestock sheds, covered sewerage, brick-paved streets, parks, play areas, markets and community centres.
It was reported that the flood would divert Pakistani military forces from fighting the Pakistani Taliban insurgents (TTP) in the northwest to help in the relief effort, giving Taliban fighters a reprieve to regroup. Helping flood victims gave the US an opportunity to improve its image.
Pakistani Taliban also engaged in relief efforts, making inroads where the government was absent or seen as corrupt. As the flood dislodged many property markers, it was feared that governmental delay and corruption would give the Taliban the opportunity to settle these disputes swiftly. In August a Taliban spokesperson asked the Pakistani government to reject Western help from "Christians and Jews" and claimed that the Taliban could raise $20 million to replace that aid.
According to a US official, the TTP issued a threat saying that it would launch attacks against foreigners participating in flood relief operations. In response, the United Nations said it was reviewing security arrangements for its workers. The World Health Organization stated that work in the Khyber Pakhtunkhwa province was already suffering because of security concerns.
A self-proclaimed Taliban spokesperson based in Orakzai told The Express Tribune: "We have not issued any such threat; and we don't have any plans to attack relief workers." Nevertheless, three American Christians were reported killed by the Taliban on 25 August in the Swat Valley.
The floods' aftermath was thought likely contribute to public perception of inefficiency and to political unrest. These political effects of the floods were compared with that of the 1970 Bhola cyclone. The scepticism within the country extended to outside donors. Less than 20% of the pledged aid was scheduled to go through the government, according to Prime Minister Yousuf Raza Gilani, with the remainder flowing through non-governmental organisations. The government's response was complicated by insurgencies (in Balochistan and Waziristan), growing urban sectarian discord, increasing suicide bombings against core institutions and relations with India.
On 7 September 2010, the International Labour Organization reported that the floods had cost more than 5.3 million jobs, stating that "productive and labour intensive job creation programmes are urgently needed to lift millions of people out of poverty that has been aggravated by flood damage". Forecasts estimated that the GDP growth rate of 4% prior to the floods would turn to −2% to −5% followed by several additional years of below-trend growth. As a result, Pakistan was unlikely to meet the International Monetary Fund's target budget deficit cap of 5.1% of GDP, and the existing $55 billion of external debt was set to grow. Crop losses were expected to impact textile manufacturing, Pakistan's largest export sector. The loss of over 10 million head of livestock along with the loss of other crops would reduce agricultural production by more than 15%. Toyota and Unilever Pakistan said that the floods would sap growth, necessitating production cuts as people coped with the destruction. Parvez Ghias, the chief executive of Pakistan's largest automotor manufacturer Toyota, described the economy's state as "fragile". Nationwide car sales were predicted to fall as much as 25%, forcing automakers to reduce production in October–2010 from the prior level of 200 cars per day. Milk supplies fell by 15%, which caused the retail price of milk to increase by Pk Rs 4 (5 US cents) per litre.
By the end of July 2010, Pakistan had appealed to international donors for help in responding to the disaster, having provided twenty-one helicopters and 150 boats to assist affected people, according to its National Disaster Management Authority. At that time the US embassy in Pakistan had provided seven helicopters. The United Nations launched its relief efforts and appealed for US$460 million (€420 million) to provide immediate help, including food, shelter and clean water. On 14 August, UN Secretary-GeneralBan Ki-moon visited Pakistan to oversee and discuss the relief efforts. A Pakistani army spokesman said that troops had been deployed in all affected areas and had rescued thousands of people. Prime Minister Yousaf Raza Gillani visited the province and directed the Pakistan Navy to help evacuate the flood victims. By early August, more than 352,291 people have been rescued.
By the end of August, the Relief Web Financial Tracking service indicated that worldwide donations for humanitarian assistance had come to $687 million, with a further $324 million promised in uncommitted pledges. At that time, the Secretary-General Ekmeleddin Ihsanoglu of the Organisation of the Islamic Conference (OIC) stated that Muslim countries, organisations and individuals had pledged close to US$1 billion (€950 million) to assist in Pakistan's flood emergency, a statement placed in doubt by findings from the UN Financial Tracking Service, which indicated that only three of the OIC's 56 member states – Saudi Arabia, Turkey, and Kuwait – had pledged more than single digit millions. Pakistan's Prime Minister Yusuf Raza Gilani stated that by the end of August, Saudi Arabia's support exceeded that of the US, yet both UN data and data from Pakistan's Disaster Management Authority failed to support this claim.
Since the early stages of the emergency, the United Nations had warned of a potential "second wave of death" that would result from post-flood disease and food shortages, stating that 3.5 million children were at risk of death if they did not get assistance, including due to cholera. UN spokesperson Maurizio Giuliano stated that "an already colossal disaster [was] getting worse and requiring an even more colossal response", referring to the relief operations as "a marathon at sprint pace" and acknowledging shortcomings in the response insofar as the needs were outpacing available resources also due to endless rains. He indicated that the floods had a worse impact than several other recent natural disasters combined, and that they were the worst natural disaster in United Nations history.
According to UNOCHA, by 2011, a total of $2,653,281,105 had been raised in humanitarian support, the largest amount by the US (25.8%), followed by private individuals and organisations (13.4%) and Japan (11.3%).
With need for substantial support to repair infrastructure, US Secretary of State Hillary Clinton suggested that the Pakistani government enlarge its tax base by asking the wealthy citizens of Pakistan to contribute more for their country; by that time both the US and the EU each had contributed about US$450 million, €395 million for the relief effort.
Response by national governments
- Afghanistan finance minister Omar Zakhilwal handed a cheque worth US$1 million (45 million Afghanis) to Pakistani ambassador Mohammad Sadiq at the end of a press conference in Afghan capital Kabul.
- Algeria donated €100,000 to Pakistan.
- Argentina sent drinkable water.
- Australia announced that it will double its aid program to Pakistan to $66.5 million in official development assistance in 2010–2011, as well as committing two C17 Globemaster aircraft to deliver emergency supplies and to assist relief efforts and deploying a medical task force consisting of up to 180 personnel and more than 33 tonnes of equipment.
- Austria donated €5.6 million to Pakistan.
- Azerbaijan gave US$2 million financial assistance to help the victims and eliminate the aftermath of the disaster. The Azerbaijani embassy in Pakistan said the Azerbaijani president, Ilham Aliyev ordered to send two Il-76 planes with a humanitarian assistance on board to Pakistan. One of the planes delivered 40 tonnes of humanitarian cargo to Pakistan. Also the staff of Azerbaijan embassy in Pakistan also transferred its two-days' salary worth around $2,000 to relief fund.
- Bahrain donated $6.9 million to Pakistan.
- Belarus donated blankets, tents, canned meat, water, and medicines, all worth around €200,000.
- Belgium donated €150,000 for the victims.
- Botswana donated US$103,040.
- Brazil donated US$0.7 million through World Food Programme or life-saving assistance to the affected.
- Canada announced that it would donate C$2 million worth of emergency aid. C$750,000 are expected to be donated to the ICRC for distribution of shelter-materials and water, sanitation and health-services, while the remainder goes to the WFP to provide much-needed food-assistance. On 14 August the Canadian government announced an additional C$32 million in aid. The Canadian government announced on 22 August that it will match, dollar-for-dollar, citizen donations made to registered charities between 2 August and 12 September, later extended to 3 October 2010. On 14 September, an additional $C7.5 million in relief aid was announced by the Canadian government.
- In September 2010, China had provided 320 million yuan (47.1 million USD) worth of humanitarian supplies to Pakistan in four batches with $200 million USD more aid promised by Premier Wen Jiabao. which will total 1.86 billion yuan (274 million USD). China initially announced that it would provide emergency aid worth 10 million yuan (approx. US$1.48 million) to help the flood-victims. The People's Liberation Army donated another 10 million yuan to Pakistan. The Chinese Red Cross also gave $50,000 USD in cash to Pakistan. The Chinese ambassador to Pakistan travelled to Khyber Pakhtunkhwa and expressed his condolences to those affected by the tragedy. On 13 August, China announced further emergency humanitarian aid worth 50 million yuan (US$7.35 million) bringing the total official Chinese relief aid then to more than 70 million yuan (approx. US$10.3 million). A Chinese search and rescue team arrived in the southern Pakistani city of Thatta, Sindh Province, where heavy floods swept away hundreds of villages. The Chinese rescue team, consisting of more than 60 members, set up tents and field hospitals to provide medical services to flood victims. The Red Cross Society of China and some of China's local governments had also offered cash and material assistance to Pakistan. China announced another aid package of 200 million RMB on 6 September. Chinese ambassador in Pakistan Lui Jian said that the Chinese total contribution had reached 50 million dollars with another batch of $200 million promised by China's premier Wen Jiabao on 23 September. On 20 September, China dispatched 4 of its military helicopters to aid in the search and rescue to Pakistan, which is the first time China had ever dispatched military helicopters overseas to perform such duties. The helicopters also provided flood relief aid.
- Cyprus donated €131,062 to Pakistan.
- The Czech military have sent 24 flights with humanitarian aid.
- Denmark donated 63 million DKK (11 million euro) in relief efforts and another 130 million DKK (22 million euro) in further development aid.
- Egypt donated medicine, medical supplies and foodstuffs.
- Estonia donated 64,000 €.
- The European Union released €10 million to help Pakistan's flood victims on 11 August, as part of emergency aid to flood-stricken country. By 18 August, the EU had committed to spending €70 million (90 million dollars) on aid for victims of the floods.
- Finland government donated €1.2 million for humanitarian assistance to the flood victims. €600,000 were channelled through the World Health Organization, €400,000 through the UNHCR and €200,000 through Finn Church Aid.
- France donated 1.05 million € and 35 tonnes of emergency supplies, tarpaulins, tanks, blankets, jerry cans, kitchen sets, water purification tablets, 200 shelters and anti-cholera medicines.
- Georgia donated €100,000 in aid to Pakistan.
- Germany initially committed €1 million for the victims, which was further increased to €2 million on 6 August. On 12 August, Germany announced a €13 million aid package. On 13 August Germany increased its aid commitment by €10 million to now €25 million in direct help plus €43 million via contributions through international organisations with which it is associated. In addition there have been private donations to charities in the scale of €24 million up to 18 August. The Muslim community in Germany also donated generously for the victims of Pakistan floods.
- Greece donated €100,000.
- Hong Kong donated HK$ 3 million to World Vision for a relief project for flood victims in Pakistan.
- Hungary donated €50,000.
- Iceland contributed ISK 23 million (€190,000) to emergency aid in areas impacted by the monsoon floods in Pakistan.
- Indonesia The Government of Indonesia dispatched a cargo flight carrying humanitarian assistance of US$1million for the flood victims. The relief assistance which arrived at the Chaklala Air base by a charted cargo flight consisted of 15 tons of emergency supplies included 4.5 tons of ready to eat meals' packets, 3 tons of medicines, 5 tons of powdered milk for children, 4000 blankets and 4000 Sarongs.On behalf of the Government of the Republic of Indonesia the donation of the relief goods was handed over by the Ambassador of the Republic of Indonesia H.E. Mr. Ishak Latuconsina to the State Minister for Information and Broadcasting Mr. Sumsam Ali Shah Bukhari at the Chaklala Air base on 7 August 2010.
- India, on 13 August, offered condolences and $5 million in financial aid. Pakistan accepted the offer on 20 August, a day after the meeting between Indian and Pakistani Prime Ministers. On 1 September 2010, India raised the aid amount to US$25 million. Nearly 400 Indian medical staff have been waiting for the Pakistan government's visa approval to help flood victims. India had also already supplied the first consignment of 25 truck-loads of potato to Pakistan.
- Iran had committed over 400 tonnes of relief goods; out of which 330 tonnes had already been delivered by the Iranian transport aircraft as of 24 August 2010. Iran also offered to set up field hospitals and community centres for flood victims in Pakistan. In response to the UN's appeal for help at New York, Iran committed US $10 million towards the flood relief. In addition to this fund, Imam Khomeini Relief Committee was directed to collect private donations from Iranians and donate it to Pakistani government. Iranian interior minister during a meeting with Pakistani interior minister informed the latter that Iran is the third largest donor nation in terms of delivered aid. Iran also assured Pakistan of its continued support and aid into the future. In order to better supply relief to flood victims, Iranian president Dr. Ahmadinejad would visit the flood hit areas of Pakistan. Iran also donated 50,000 tents and sent 500 doctors and nurses to help with ongoing international relief operation. Iran started to send an additional 1,100 tonnes of relief goods to Pakistan on 5 September 2010 as part of its ongoing relief operation. Iran is also setting up 15 relief and medical camps in every Pakistani province each capable of holding 1,000 families. On 12 September 2010, Iran allocated an additional US $100 million for Pakistan flood relief. 51% of all relief distributed by International red crescent in Pakistan had been donated by Iran. Iran announced on 8 November 2010 that in addition to 5,300 tonnes of aid cargo shipped by Iran to Pakistan, the Iranian hajj pilgrims will donate money and the 103,000 slaughtered sheep of Iranian pilgrims to Pakistan.
- An initial €200,000 was donated by the government of the Republic of Ireland. An additional €550,000 was added on 9 August 2010. Then the total was €960,000. The Irish media were critical of the country's government for providing less than half the aid it donated to Haiti after the earthquake there. €1.19 million was added on 19 August, bringing the total at that stage to €2 million, the total given to the Haiti disaster.Minister for Overseas DevelopmentPeter Power, TD, said at the time that more aid would be forthcoming from Ireland and that the country had provided a "proportionally greater" amount than "most other European countries". The Irish public had provided an additional sum of more than €2.5 million by 20 August. Ireland proved to be the most generous European country in donating aid to Pakistan.
- Israel offered aid to Pakistan, but the officials said they have not received an answer from Pakistan on whether or not the aid should be forwarded.
- Italy provided €1.33 million, including a humanitarian aid flight carrying emergency supplies such as medicines, generators, water purifiers and containers.
- Japan provided $230,000 USD for emergency relief goods, while additional assistance of up to $3 million USD was committed for the disaster aftermath.In a press release, Japan announced to extend the aid to 14.4 million USD (approx. 1.22 billion JPY) in total, in the form of the provision of emergency relief goods, as well as food, water, sanitation etc. Japan is also expected to send a unit of six helicopters and some 300 SDF Troops