Pakistan: Summary of MSF's Flood Response

Update on MSF's response to the flooding in Pakistan as of October 1, 2010.

Overview of MSF’s Emergency Flood Response, by location:


At present, the most severely flood affected areas are in central Sindh Province, where the overflowing Manchar Lake has submerged vast areas with a second wave of flooding in recent weeks.

Along the banks of the Indus River, MSF teams still observe large areas of stagnant water, mostly in Sindh’s agricultural heartland. Where water levels are slowly receding some displaced people have started moving closer to their places of origin. They have adopted a cautious “wait-and-see” approach. They are still faced with great uncertainty over their future—especially those who are considered “the poorest of the poor,” tenant farmers with no way to repay debts to their landlords. An MSF psychologist engaged in an assessment in Jamshoro district noted high levels of anxiety and depression among people living in the camps.

An MSF medical team has been working from Dadu, near Lake Manchar, while also preparing to set up a new base in Johi, a town isolated by floodwaters and reachable only by boat.

Basic needs for medical care, clean water, and shelter remain high, and the number of malnourished children under five treated by MSF is increasing.

In Sukkur, rising numbers of malnourished children are being treated in the Intensive Therapeutic Feeding Center (ITFC) at the Railway Hospital. There have been 100 new admissions since it opened in late August. There are plans to expand the reach of nutritional programs through an Ambulatory Therapeutic Feeding Center (ATFC). Water and sanitation activities have also increased, with the amount of water chlorinated and distributed daily now reaching 75,000 liters per day. There has been a general decrease in the number of patients treated for Acute Watery Diarrhea at the Sukkur Diarrhea Treatment Center, which is in line with a decrease in the number of patients treated for Diarrhea in other projects.

In Larkana, MSF teams are providing ITFC and DTC services. Relief item distributions in both Sukkur and Larkana have increased; 1,709 kits and 668 tents have been distributed so far.

Further south, in Jamshoro, MSF medics have conducted just over 4,000 consultations through mobile clinics in recent weeks, and 6,683 relief item kits have been distributed. Teams are also now running two 20-bed capacity DTCs in Shahbaz camp, in Jamshoro, and at the Sehwan Hospital, about 100 kilometers (60 miles) to the north. MSF water and sanitation teams are distributing an average of 300,000 liters of safe drinking water per day at 11 sites across Jamshoro.


“There are still houses that are totally isolated by the water. Weeks after the initial floods people still have no access to healthcare. Two weeks ago, the Manchar Lake was in danger of bursting, threatening nearby towns. So it was drained, severely affecting some villages which have now become islands.

In some villages there are hand pumps and water is available, but we need to check if it’s sufficient and clean. The main access road has been washed away and the only way to bring relief supplies in is by boat. Working with boats is difficult but MSF have done it before.”

MSF Emergency Coordinator Rosa Crestani recently joined an MSF’s exploratory assessment to the Dadu district that viewed conditions up close and, in a helicopter, from above.


The impact of the floods is still being felt strongly in Dera Murad Jamali (DMJ), where people are beginning to move back towards their homes in Jacobabad and Jafarabad after transiting in Dera Allah Yar. Consequently, MSF is stepping up its water and sanitation services and its relief item distributions while shifting its efforts towards the Dera Allah Yar area.

MSF teams on the ground are also observing that the number of malnourished children in MSF programs has increased significantly since the flooding began. There have been 130 new admissions to MSF’s mobile therapeutic feeding programs during this past week, as compared to the 95 admissions in the previous week.

A total of 432 patients still remain under treatment, but MSF medics are expecting the number of treatment defaulters to increase because more people are moving closer to their villages. This makes follow-up visits difficult. More than one-third of the 38 young patients currently in the ITFC and suffering from severe acute malnutrition were admitted because they were also suffering from medical complications, making their cases difficult to manage.


“As news spreads of the water receding we have seen a substantial influx of people to the camp in Dera Allah Yar. Over a period of three days we saw a nearly 30 percent rise in the camp population, and there are now nearly 1,000 families living there. This is a mix of people who have been resident there since the floods and those transiting on their way back to what is left of their lands and homes.

There are about 800 families living beside the road or close to their submerged land waiting for the water to recede. In Sohbatpur we have distributed 400 relief item kits to families living along a 25-kilometer (15 mile) stretch of road. MSF teams are assessing the situation in the camps daily to adjust the provision of clean water to people’s growing needs.”

– Mike Seawright, project coordinator for MSF’s emergency response in Dera Murad Jamali


MSF is winding up its flood response operations in Kot Addu and many displaced people have started to make their way back home to rebuild their shattered lives. A total of 3,385 patients have received consultations from MSF medics since August 21.

During the height of the emergency, MSF operated a 70-bed capacity DTC at the Muzaffargarh district hospital, where nearly half of all the triaged cases were treated for AWD. During the past 14 days, the number of patients presenting with AWD has decreased measurably. Currently, only 10 percent of the cases represent people with AWD. MSF teams have also distributed 3,050 relief item kits and 1,824 tents in Kot Addu.


“We observe that the majority of displaced people have started returning home. In the villages where the water stood at about one meter deep, the water level has gone down and some families have been able to start rebuilding their homes. Meanwhile, our screening activities for malnutrition among children younger than five years have indicated that less than two percent of children here are in fact severely and acutely malnourished. We have decided to return in about six weeks to do another round of MUAC screenings to determine if there is a need to further treat malnutrition.’’

– Jean Hereu, MSF emergency coordinator for Khyber Pakhtunkhwa and Punjab


MSF operations in northwestern Pakistan report that the water has receded in Khyber Pakhtunkhwa province, that life is slowly returning to normal, and that people are returning to their homes.

MSF’s emergency interventions have been concluded in Charsadda, and MSF teams in Nowshera have handed over water and sanitation activities to other implementers. Since the onset of the floods, MSF medical teams conducted 4,599 consultations in Peshawar, 8,998 consultations in Nowshera, and 12,384 in Charsadda. MSF teams conducted aid distributions in Charsadda (604 tents and 16,523 relief item kits) Peshawar (6,324 tents and 8,575 relief item kits) and Nowshera (11,147 tents and 3,210 relief item kits).


“We have had the electricity supply restored for more than three weeks now, and with that the regular supply of clean water. MSF has started health promotion activities, which is vitally backed up by the distribution of relief kits containing hygiene items. The remaining evidence of the floods here is sediments of higher than one meter that are still being removed from peoples’ homes.”

– Josep Prior Tio, MSF project coordinator in Swat