Water-borne and vector-borne diseases can be lethal in the wake of large scale flooding, particularly when a large number of people have been displaced and drinking water has been contaminated. These, according to the World Health Organisation, when taken together, are ingredients for long-term catastrophe and the current situation in Pakistan has them all.

Already volatile circumstances, with an estimated 20 million people adversely affected by unprecedented flooding, many of them already exhibiting signs of sickness, will be exacerbated if, or when, there is a major outbreak of disease as appears increasingly likely.

Water-borne diseases are usually the first to surface under such disastrous circumstances. These include cholera (which has already been confirmed by the United Nations in Mingora, Swat), typhoid fever, leptospirosis and hepatitis A — the latter already a known problem in the country. Major outbreaks of diarrhoea related diseases are being treated, particularly in children, at medical relief camps set up throughout most, although sadly not all, flood affected districts.

But, along with a dire shortage of medical staff and medicines, there is the problem of those who have either already returned to their salvaged homes or, like numerous settlements in Khyber Pakhtunkhwa, have not yet received any help for a variety of reasons, including landslides and bad weather.

Access to clean drinking water is a top priority in the wake of flood related disasters. Land/mud slides may result in contamination of usual sources of drinking water like springs, wells, tube wells, streams and rivers. In the absence of clean drinking water people are liable to resort to using whatever happens to be available which is when sickness quickly materialises. Questionable brands of bottled water, especially those ‘processed’ in flood affected areas, are another potential danger.

In post-flood circumstances there are also high possibilities of contracting a wide range of infections, such as infection of open sores and wounds, conjunctivitis, nose, ear and throat infections and skin infections, such as dermatitis which can all be distinctly problematic.

Leptospirosis, a bacterial disease transmitted through rodent urine, is another cause for concern as this infection can be present in water, mud, sugar cane, wet vegetation, anything with which rodents have been in contact. Like humans, rodents too have had to flee flood affected areas in search of dry or drier ground and, also being hungry, could, quite conceivably contaminate food stocks and cooking utensils.  Stringent hygiene is therefore necessary at all times and in all circumstances; unfortunately, few people are aware of such dangers and of how to avoid them.

Vector-bone diseases are another matter: Standing water is the perfect breeding ground for mosquitoes which carry malaria and, in some areas, dengue and dengue haemorrhagic fever. In the absence of blanket spraying to prevent mosquitoes from breeding and with thousands of people having no option but to live, basically, out in the open and in extremely crowded conditions, malarial outbreaks are nearly bound to occur.

Malaria epidemics can be controlled by prompt courses of medication if the required medicines are made easily and freely available. Prevention being better than cure, spraying of standing water to prevent mosquitoes from breeding is the ideal thing to do but, taking a realistic look at the magnitude of this on-going disaster, this is unlikely to happen outside of heavily populated locations.

All of the mentioned diseases and infections are quite liable to materialise in camps hastily set up to shelter flood affected people and, under such conditions, scabies, fleas and body lice could well be another problem.

Malnutrition, with young children being in the highest risk category, has already claimed lives in Kohistan where relief efforts have been badly hampered by adverse weather conditions.

People living in areas that were not directly affected by flooding, lower income groups in particular, are also entering a high risk period as prices of fresh fruit and vegetables soar beyond their reach. Without some type of immediate, cohesive action throughout the country, the entire nation is feared set to pay the price for this year’s monsoon deluge.