Population & Family Health

Columbia Public Health and Nursing Professor Richard Garfield coordinates a U.N. assessment of needs project

The worst flooding in Pakistan’s history has left over 2,000 people dead and an estimated 15 to 20 million displaced, according to the United Nations – a total that exceeds the combined number of people displaced by the 2004 Indian Ocean tsunami, the 2005 Kashmir earthquake and the 2010 earthquake in Haiti. Millions of Pakistanis are without food and safe water to drink.

During the last two weeks in August, Richard Garfield, the Henrik H. Bendixen Professor of Clinical International Nursing and Clinical Population and Family Health, led field surveys in four of the most severely affected provinces in Pakistan to determine short and long term needs for health, water and sanitation, nutrition, agriculture, livelihoods, shelter, and issues affecting women.  

This ‘combined needs assessment’ is an effort by the international community to jointly set priorities. The data will be used by the U.N. and other organizations. Dr. Garfield previously took part in a similar effort in Myanmar and is evaluating a similar survey process done earlier this year in Haiti for the U.S. Centers for Disease Control.  

The project involved teams of researchers who fanned out across the country to interview flood victims in 380 locations in the provinces of Gilgit Baltistan, Punjab, Sindh, and Khyber Pakhtunkhwa. Researchers spoke to refugees living in camps, damaged homes, and spontaneous settlements.

To be useful in an emergency, this type of assessment must be accomplished swiftly.  From start to finish, the entire process in Pakistan took 20 days.  Preliminary results were presented a week ago and a draft of the report was then given in Pakistan to U.N. Under-Secretary-General for Humanitarian Affairs, Valerie Amos, on her second day on the job.

Richard Garfield, RN, DrPH

Not surprisingly, the survey showed that families rated food and shelter as their most critical needs. Families also identified cash and construction materials as priorities for rebuilding their lives.   

The survey was conducted almost entirely among rural farmers who constitute nearly all of the flooding victims.  Among those who lost assets in the deluge, most lost between 75% and 100% of their income, including an average of 3 months worth of stored food stocks.  The largest loss of standing crops was cotton--one of the few crops for which women are paid directly for their labor.  Women will thus have an additional deficit in income at this crucial time.

Also of note:

• Overall water storage facilities are poor and sanitation is even poorer.  Most people do, however, report washing their hands before eating 
• Approximately 60% of households surveyed reported that they have no food on hand.
• Twenty percent or fewer households reported access to toilets that they perceived to be clean and functioning.
• Only 40% of women feel they have adequate privacy for personal hygiene, even fewer report having sufficient privacy for bathing.  Only 20%  feel they have privacy to breastfeed their children.  Some local NGOs have distributed infant formula and bottles, and many women report having since stopped breastfeeding altogether.
• The majority of Pakistanis have access to some kind of health care within one hour of where they reside. Further analysis of the data is required for comparisons pre-flood.
• More than half of people interviewed said they had received some food aid in the previous two weeks

A more comprehensive account of the assessment will be forthcoming. “The potential to minimize the long term damage is a real humanitarian challenge,” says Dr. Garfield, who teaches in the Mailman School’s Program on Forced Migration and Health. But he believes that the possibility of rebuilding may offer opportunities to make life better than before the floods, as some of these areas had very little pre-existing infrastructure. “Perhaps as part of the recovery, children in these areas may be able to attend school for the first time.”

See main report and other information on the Pakistan floods.

September 9, 2010