It’s a silent killer that does not make waves like floods and earthquakes. Globally, heatwaves kill thousands but the media and governments often ignore their humongous death toll.

The tragic loss of life in Karachi has finally alerted the news media and, to some extent, the governments in Pakistan to the harmful impacts of heatwaves. With the death toll reaching 830, the State’s impotence lays bare.

The lack of emergency shelters, water supply, and inadequate medical treatment of those suffering heatstroke yet again shows the inability of Pakistan’s civil administration to cope with the frequently occurring natural and man-made disasters.

Also read: Political inertia in heat crisis

The belated response to the crisis by Prime Minister Nawaz Sharif leaves much to be desired. Mr. Sharif directed the National Disaster Management Agency (NDMA) to offer relief. The NDMA responded by asking the Core Commander Karachi for assistance. That the civilian authorities cannot cope with the aftermath of heatwaves and need the army’s assistance shows how little progress Pakistan has made in developing civilian institutions for disaster management.

The lessons learnt from similar disasters in France, the United States, and Russia reveal that the deaths from heatwaves do not occur until the second, third, or the fourth day of the heatwave. This delay in excess mortality allows the authorities to respond in time and prevent a larger death toll. This may be true elsewhere, but not in Pakistan.

Syed Qaim Ali Shah, the chief minister of the province, had been missing in action since the crisis unfolded. Even when he graced the provincial legislature days later, the chief minister pleaded ignorance. Karachiites are doomed with such leadership.

Heatwaves in Europe and North America

The worst recent incidence of heatwave related mortality occurred in France in 2003. Almost 15,000 people, mostly seniors living in urban centres, died in a matter of two weeks in August 2003 (Poumad`ere and others, 2005).

The United Nations Environmental Programme declared the 2003 European heatwave the costliest weather-related disaster of the year.

Excess mortality in August 2003 in France. —Source: Poumad`ere and others, 2005.

But France is not alone to experience the catastrophic impact of heatwaves.

As recently as July-August 2010, the heatwave and air pollution killed 11,000 individuals in Moscow (Shaposhnikov and others, 2014). The wildfires worsened air pollution and a 44-day sustained heatwave left a disastrous impact on Moscow’s elderly.

Even large cities in the United States suffered huge death tolls from heatwaves. Chicago, Illinois, reported 700 excess deaths in July 1995 where the heatwave lasted for four days. A sophisticated city like Chicago experienced a massive loss of life (Semenza and others, 1996). Earlier in July 1966, the City of New York reported 1,181 excess deaths because of heatwaves. At the same time in St. Louis, a much smaller city than New York, the heatwave killed an additional 618 individuals (Schuman, 1972).

The heatwave not only increased the mortality rates for frail and elderly cohorts, it also caused an increase in other social problems. The crime rate increased during the two-week heatwave with a sudden and significant increase in the homicide rate.

What Pakistan can learn from others’ experience

The experiences in Western Europe suggest that even developed economies in relatively colder climates are not exempt from the adverse and disastrous impacts of extreme weather episodes. Pakistan, being a less developed economy with severe income disparities, is increasingly ill-prepared to cope with such disasters, notwithstanding the extreme hot weather conditions during the summer months.

The experience with heatwaves in Western European countries offers valuable insights to developing economies with hot climates. First, it shows the need to have an adequate definition of heatwaves so that such events are catalogued appropriately.

Second, the epidemiologists have to develop an adequate definition for excess mortality so that the deaths are correctly categorised. This will also require proper registering of all deaths in urban and rural areas.

Third, before (if possible) and after studies of heatwaves should be conducted to determine the at-risk cohorts, the need for emergency response logistics, and long-term care of those who survive the heatwave.

Also read: Is Karachi experiencing climate change?

Ad hoc definitions of heatwave or excess mortality restrict the ability of the State and society to act in time to prevent disastrous outcomes. In worst-case scenarios, the public and the State may fail even to register the disastrous impact of a heatwave because of it being a silent killer. In France, for instance, the heatwave caused 6,000 excess deaths in 1976. However, the epidemiologists noticed the excess deaths 27 years later.

In Moscow, the heatwave was defined as the temperature rising above the 98-percentile of the daily mean temperature for the same time period in the past and lasting for at least three straight days. The heatwave there lasted for 44 days.

The European experience with heatwaves reveals that the elderly, i.e., those over 65 years of age, are the most likely victims. Also, older women are more susceptible than older men. This does not mean that younger cohorts are not at risk. The French heatwave recorded a 23 per cent increase in the mortality rate of men between the ages of 35 and 44.

Urban living, poverty, poor health (especially cardiovascular ailments and diabetes), isolation, and homebound individuals are more likely to succumb to heatwaves than the rest. These characteristics of at-risk populations were common in the European heatwave episodes.

In the absence of verified statistics, one has to rely on media reports about the heatwave victims in Karachi who are overwhelming low-income individuals living in crowded environments and are already infirmed.

Younger children and the elderly constitute a large proportion of the currently hospitalised population in Karachi.

Also read: After bombs and bullets, heat preys on Karachi

It is unfortunate to see that not much published research is available about the disastrous impact of heatwaves in Pakistan. Even after suffering the worst possible natural disasters, i.e., the earthquake in 2005 and the floods in 2010, only a handful of quality research reports are available about natural disasters in Pakistan.

The epidemiological studies of natural disasters are urgently needed in Pakistan. The lax rules about registering deaths and the refusal by the deceased’s kin to perform autopsies are partially responsible for the failure to determine excess deaths in Pakistan.

The influenza epidemic in the 1920’s motivated epidemiologists to develop methods to determine excess mortality. Pakistan must not stay a hundred years behind the rest of the world, it needs to catch up fast.

One can only hope that the exceptional academics and researchers at the Aga Khan University in Karachi act fast to collect the epidemiological data from the field to produce research that may help the State and society to better cope with similar disasters in the future. Colleagues at the Aga Khan University can consult researchers in France and the United States to get the ball rolling.

On my visits to Paris in the past, I learnt a great deal from Marc Poumad`ere and Claire Mays, the coauthors of the French study, about the French experience with the disastrous heatwave in 2003. Marc and Claire are exceptional researchers and dedicated humanists whose experience and knowledge can help Pakistan respond to natural disasters.

References:

• Poumadère, M., Mays, C., Le Mer, S., & Blong, R. (2005). The 2003 heat wave in France: dangerous climate change here and now. Risk Analysis: An Official Publication of the Society for Risk Analysis, 25(6), 1483–1494.

• Schuman, S. H. (1972). Patterns of urban heat-wave deaths and implications for prevention: Data from New York and St. Louis during July, 1966. Environmental Research, 5(1), 59–75.

• Shaposhnikov, D., Revich, B., Bellander, T., Bedada, G. B., Bottai, M., Kharkova, T., … Pershagen, G. (2014). Mortality related to air pollution with the Moscow heat wave and wildfire of 2010. Epidemiology , 25(3), 359–364.

• Semenza, J. C., Rubin, C. H., Falter, K. H., Selanikio, J. D., Flanders, W. D., Howe, H. L., & Wilhelm, J. L. (1996). Heat-related deaths during the July 1995 heat wave in Chicago. The New England Journal of Medicine, 335(2), 84–90.