This article was originally published on The Third Pole under a Creative Commons license.

Gulan Allah Baksh can share plenty of reasons for why life is tough in Rato Khan Rind, a village in Pakistan’s coastal belt, just 7 kilometres from the Arabian Sea. “We have no gas, no […] roads, no employment,” she told The Third Pole. But water problems top the list. “Either there is way too much water or there is a drought-like situation,” she said. In either case, crops suffer.

The village is in Sindh province’s Thatta district, about 80 km from the port city of Karachi. A huge canal, locally called the saim nala (a sub-drain that collects saline water, agricultural effluent and floodwater, draining it into the Arabian Sea) runs along the village. Using a network of thick black rubber pipes which snake to their homes, the villagers try to draw out the saline water with the help of diesel-run motors. “During the rainy season, the canal overflows and the water reaches up to our homes,” said Baksh’s 21-year-old daughter-in-law, Malda Barkat. There are days when the water reaches up to her waist.

The inconsistent supply of water has been a reality for over a decade now, forcing men from the village to leave farming and find alternative livelihoods in towns and cities. Barkat’s father, Mohammad Yunas, gave up growing tomatoes, pumpkins, rice and wheat. He now works in Karachi’s fisheries. Ilm Din, a local activist, recently found work at a multinational company. “I don’t want to put money into doing agriculture, there is too much uncertainty,” Yunas said.

Perween Akbar and one of her four daughters walk to a nearby pond to fetch water. They can carry 30 litres on their heads at a time, which means they must make four trips to meet the daily needs of their household. This water is precious and used frugally for “drinking, washing clothes and utensils, cooking and bathing” she said. Carrying it gives her “chronic pain”.

“My head, hair, neck and back hurt all the time,” Akbar told The Third Pole.

Barkat’s family of 14 owns a donkey cart, which means the women do not have to carry the water. She said they are rarely able to carry Akbar’s or any other woman’s canisters as there is little space left in the cart. “We are dying of thirst,” said Barkat.

Not fit for drinking

Not only is the water scarce, what is available is unfit for drinking or bathing.

The Third Pole collected three water samples from three locations in Rato Khan Rind village. These samples were tested at the Pakistan Council of Research in Water Resources (PCRWR) laboratory in Karachi. The results showed that the samples were unfit for drinking.

Although they do not boil the water before drinking it, the villagers insist they do not suffer from any illness due to consuming this water. “I am healthy,” Akbar said, but added that her husband often complains of stomach pain. Diarrhoea was common among children, the villagers said.

Commenting on the sample of water collected from a hand pump in Rato Khan Rind, infectious disease specialist Jamil Muqtadir said: “[There are] inadequate chlorides so capacity to disinfect the water to kill organisms is low. Consumption may cause gastrointestinal diseases, but [it is] not hazardous if used for washing utensils, clothes or bathing. It is not fit for drinking.”

On the results of the water sample from the pond, Muqtadir said: “High turbidity means the water will shield bacteria and disinfectants won’t work. It has faecal content and danger of severe diarrhoea; even typhoid increases manifold. [It is] quite hazardous to consume this water even if boiled.”

Most villagers knew the water from the saim nala is never to be used for drinking. Yet, Baksh admitted, when there is an acute shortage, they do end up using it to bathe or to wash their clothes.

She lifted one cuff of her shalwar (loose pants) and pointed to an ugly rash along her leg caused by incessant scratching. “I went to the nearby clinic to get medication and the doctor told me to boil the water. I have given up the treatment, as I realised it’s a waste of money since we cannot afford so much wood to boil water.” She is resigned to living with the problem.

Muqtadir saw the test results of the saim nala sample and said: “[It is] not fit for drinking or washing. It is high in chlorides and carbonate making the water hard so cleaning agents like detergents may not be as effective. It will have an unpleasant smell and a metallic taste. It has faecal content as well. The total dissolved solids [TDS] in the water can cause discolouration of teeth, skin and hair. [It] can damage pipes.”

Gul Mohammad is the doctor in charge of the nearest government-run basic health unit (BHU), which operates from 8:00 am to 2:00 pm and covers nearly 260 small villages. “Unless these villagers use and drink clean water, they will continue to flock to the clinic for treatment of diarrhoea, hepatitis C, abdominal pain and skin diseases,” Mohammad said. He treats them with oral rehydration salts which are given through an intravenous drip for “severely dehydrated patients”. Some are sent home with antibiotics to treat infections.

Mohammad said several women who came to the clinic were found to be “severely anaemic” and complained of urinary tract infections (UTIs). He said the continued use of contaminated water could be a factor behind these health issues.

The BHU is half a kilometre from Rato Khan Rind, but for Mohammad it means making a two-hour journey on a motorbike, from Makli, a nearby town. He never forgets to bring his own water, like other staff members working at the BHU.

“There is a storage tank here, but it would be expensive for the government to supply drinking water here as this healthcare unit is really remote,” said Rustom Khan Khaskheli, the clinic’s medical dispenser.

Unlike the BHU at Rato Khan Rind, the government clinic closest to the village of Ahmed Raju in the adjoining district of Badin gets bottled water. “We get 50 litres of water in the winter and 80 litres in the summer,” said Sharif Chandio, the head doctor.

On average, he said, they have 150 patients a day, of which “roughly 70% were women”. Among the water-borne diseases, he said many suffer from diarrhoea, hepatitis B and C and different kinds of skin diseases. Many come with kidney stones that he says are caused by drinking contaminated water. “The water is salty and not fit for consumption.”

Ali Nawaz, the medical dispenser, said children come in with stomach worms, hair lice and dandruff due to playing in the nearby canal.

Twelve-year-old Aizam Ali admitted that he longed to play with neighbourhood kids in the canal, especially in the scorching summer months, but his father has forbidden it. “My dad says I’ll drown,” he said. His aunt Abida Mustafa, listening to Ali, interjected: “The water is dirty.”

A widow with a seven-year old daughter, Mustafa lives with two brothers in their joint family. Her seven sisters, all married and living in the same village, go every morning to a hand pump a kilometre away which is “very crowded” with “100 or so women” – all of whom must wait their turn. “But the water is quite good, and we do not have any problems or sickness,” she said. However, the water tested and analysed from two different hand pumps in the village tells a different tale. Experts term it “unfit for drinking”.

Commenting on the sample of water taken from the canal in Ahmed Raju, Muqtadir said: “[There is] high turbidity and presence of coliforms. This water sample is the most hazardous of all the six. It must not be used for drinking, bathing, or washing clothes. It will cause discolouration of skin, hair and teeth.”

According to a joint monitoring report by the World Health Organization and United Nations Children’s Fund (Unicef) titled ‘Progress on household drinking water, sanitation and hygiene 2000-2020’, between 2016 and 2020, water, sanitation and hygiene (WASH) scores improved globally. Access to safe drinking water at home increased from 70% to 74%; safe sanitation services grew from 47% to 54%; and access to hand-washing facilities with soap and water increased from 67% to 71%. Yet these scores remain off track to meet the Sustainable Development Goals WASH targets of 6.1 and 6.2.

If current trends persist, by 2030 81% of the world’s population will have access to safe drinking water at home, and only 67% will have safe sanitation services. About 78% will have basic hand-washing facilities. The way things stand at the villages of Rato Khan Rind and Ahmed Raju, these residents will be among those who will miss the SDG targets.