SOME estimates say that 40 per cent of the people live in poverty, and 24pc below the poverty line in our country. It is no surprise that survival is their primary focus. Children growing up in these environments learn resilience in order to survive. But when a natural disaster takes away whatever little they have, going back to ‘normal’ is difficult.

After the 2005 earthquake, I went as part of my hospital’s team to Muzaffarabad to administer mass vaccinations in camps. Surprisingly, most children were eagerly or calmly standing in line, waiting for their turn. There was no screaming, crying or refusal. They were unafraid of needles. This was in contrast to what we see in our clinic and vaccination rooms. Was the pain from a needle irrelevant compared to the enormous tragedy they had experienced? Or did the helplessness surrounding them convince them to accept whatever help they could get?

The present floods have taken some 1,700 lives, approximately 600 of them children. People have seen their homes, cattle, crops and everything else they had, washed away. The trauma for children experiencing this and the loss of their parents and loved ones is immeasurable.

In disaster management, the initial focus is on rescue; next, providing food and shelter and treating injuries and illnesses; and finally, the long process of rehabilitation.

Most children in the flooded areas already suffer from malnutrition.

The physiological, developmental and emotional requirements of infants, children and adolescents require management different from that administered to adults. After the floods, children are at risk of contracting diarrhoeal, skin and infectious diseases, plus exposed to animal bites. A majority of those at risk already suffer from malnutrition. A limited ability to grasp the complexity of a natural disaster and the resulting trauma also lead to mental health problems like anxiety, fear, depression, even developmental regression. Children deprived of parents and caregivers can become the target of abuse, particularly sexual abuse. Focusing on children’s mental health needs is essential, along with providing them safety and medical help. Psychological first-aid and long-term provision of psychological help are of utmost importance.

Pakistan’s educational crisis with millions of children out of school has been compounded. According to Unicef, the floods destroyed around 16,000 schools in Sindh alone; the remaining school buildings are serving as camps in the flood-affected areas. As soon as the safety and health needs of survivors are taken care of, the primary focus should be to immediately start rebuilding our educational infrastructure. The provision of educational sessions and activities for children in camps would not only lower their stress levels but also give structure to their routine. The social welfare department and child protection authorities should open shelters for children who have lost their caretakers and provide bodily autonomy and safeguarding lessons to children in camps.

Unicef has placed Pakistan in the extremely high-risk category for the Children Climate Risk Index. This means that Pakistani children are exposed to not only the risk of extreme climatic and environmental hazards but also the lack of fundamental rights, making them very vulnerable. In the wake of climate change, it has become essential that the government focus on strategic planning for floods in the future. They should not only fully equip themselves for rescue operations but also implement changes that prevent the loss of life and property such as by developing infrastructure like dams and drains.

Disaster preparedness should be included in the curriculum of all schools. In areas in imminent danger of floods, special sessions should be conducted to educate parents and children of the consequences. Each family should have a disaster plan, which includes an evacuation route, emergency communication and safety instructions. They should be told that floodwater is unsafe for drinking, bathing, playing, driving or walking in.

The floods have caused devastation in our country. With the help of the Pakistani and international community, flood relief money should be used to rebuild houses that can withstand floods. Also, opportunities to start small-scale businesses should be provided for those whose agricultural lands have been affected.

This is also our chance to reach out to families and children in remote areas, with no access to health facilities. It is a window of opportunity to take care of their chronic medical problems along with acute illnesses. It is also a good time to shift our attention to malnutrition that plagues children in these areas. Further, children who have missed vaccinations should be immunised immediately. Post-floods, the only silver lining is the urgent awareness to search for permanent solutions for Pakistani children’s basic rights. For what is a state if it cannot take care of its future?

The writer is a paediatrician at AKUH.

Twitter: @kishwarenam

Published in Dawn, October 6th, 2022