Outside the out-patients department at Civil Hospital Karachi, Sona adjusts one child on her lap and inquires about the other. Her husband, standing beside her, mumbles in response an glances at their second child.

Sona and her husband have travelled over 400 kms from Islamkot to Karachi after their second-born developed breathing problems.

Her relative, Mukesh Kumar, says they live an hour’s drive away from Mitthi. When the child initially fell sick, they took him to Civil Hospital Mitthi, but that was some time ago.

Not much improved and medics kept telling Sona her child will eventually feel better. When the baby’s condition worsened, Sona got on a bus with her husband and travelled to Karachi.

In the past 28 months, Sona has given birth to three children, but only two have survived. Her last child was born prematurely at six months, and complications made it clear the baby would not live. “There were no incubators in Mitthi at the time,” Kumar says in broken Urdu, speaking above the usual din of the paediatric ward.

Coping with chaos

A month ago, Civil Hospital Mitthi was under pressure as the rising death-toll of infants could “not be controlled”, according to one doctor at the hospital. The facility continues to function under duress, with families piled outside its premises waiting to see a doctor or a nurse.

Their stories are all the same.

On my third visit, the hospital staff appears far more defiant and is better-prepared to respond to questions about the rising death toll. Families of ailing children, meanwhile, seem less eager to answer my queries. They say they fear hostility from the hospital staff in case of saying something amiss, particularly while they are inside its premises. Looking around, one finds that other parents also feel the same. Some distance away, the paediatric ward opposite the emergency ward is closed, with a male nurse guarding its entrance.

Between experts blaming the negligence of authorities and the lack of healthcare facilities, and others alleging that the arid region only receives seasonal attention dictated by political tensions between the PPP and the Muttahida Qaumi Movement, there is a lot that needs to be explained, understood, and corrected about the situation in Thar.

Three years of untimely rainfall

The Association for Water Applied Education and Renewable Energy (Aware) has been working in arid and semi arid areas of the Tharparkar district and Umerkot since 2003. Its executive director, Ali Akbar Rahimoo, explains that Thar’s aridity results in a two-year-long drought every ten years.

Typically, a drought can be caused by a combination of four reasons: hydrological, meteorological, agricultural and socio-economic issues.

Thar’s current drought is an agricultural and a socio-economic drought that has been exacerbated by the lack of rainfall. Livestock farming, which is the major source of income for Tharis, has been particularly affected.

“With little rainfall, the crops grow slowly, resulting in lesser food for the livestock,” Rahimoo explains. Since Tharis depend on the food provided by their livestock, most of them end up sick by diseases contracted through unhealthy produce.

From May to August however, Tharis look on with hope. These are the peak months for rainfall; any delay beyond the end of summer can ruin their harvest. Even if it rains after the peak period, the crops cannot benefit since their growing period is over.

Just as continuous rain without eventual sunlight affects the crop’s growth, continuous rain around the time the crops are ready to be harvested is useless. In either case, the food chain is disturbed all the way up to the top, from the ruined crops to poorly fed livestock to the Tharis own health.

Although the district received some rainfall in 2014 and 2015, it wasn’t enough to quell the slow growth of beans and millet crops. But the longevity of the drought in part depends upon the steps taken to control its affects on the ground.

When superstitions dictate

Without sustainable policies to manage Thar’s socio-economic situation, the drought’s impact will only worsen with him. Dr Sono Khangharani, former head of Thardeep Rural Development Program (TRDP), says that policies are either stuck in limbo or never implemented.

In 2014, legislators drafted a draft mitigation policy to present to the provincial assembly. “The draft is still finding a footing in terms of approval by the house,” Khangharani says. “Policies made either await beauracratic approval or are not implemented properly.”

To add to the diseases spread by the drought, Tharis have their own set of superstitions and beliefs which Khangharani feels come in the way of improving matters.

For example, many families avoid giving breast milk to newborns during their first days after birth, due to a belief that the milk is impure.

Often, this period stretches on longer. Among women, child marriages and the lack of family planning also contribute to unhealthy practices and the spread of diseases which can range from diabetes, heart infections and thalassemia to pneumonia and diarrhea.

Where do patients go?

One of the biggest hurdles faced by Tharis during drought is the lack of medical facilities. Doctors at Civil Hospital Mithi, the area’s only secondary care hospital, admit that the lack of Basic Health Units (BHUs) is a problem that needs to be addressed immediately.

Civil Hospital Mithi itself is understaffed and operates on a budget for 74 beds, even though the hospital for build for 174. The hospital’s staff covers up for the remaining five talukas in Thar, receiving the bulk of its patients from Islamkot, Diplo, Umerkot and Nagarparkar.

If a newborn cannot be helped by the facility or the diagnosis is difficult, a patient that has traveled from either Nagarparkar or Chachhro is referred to the National Institute of Child Health (NICH) in Karachi.

According to Mohammad Latif, one patient’s relative, the BHUs in their talukas operate as dispensaries and referral centers, rather than providing the medical care they should be.

“Anywhere else, these deaths would have sparked a national debate,” Khangharani stresses, “but we deal with it seasonally.” He believes that Thar’s deaths are only being highlighted to settle political scores between PPP and the MQM in Karachi, while the media is acting as a conduit.

“This is the sad reality of our times,” he laments.

Dr Rahimoo meanwhile proposes implementation of policies which are based on the reality Tharis face. The budget needs to be maintained and assigned efficiently, and healthcare services need to be brought up to par. “A drought takes a town five years back,” he warns.

Dr Ashok Bhaktani, the senior program manager at the TRDP in Chachhro, says the three year long drought reminds him of the one in 1987. Called ‘Karo Dukkar’ (Black Drought) at the time, the situation was similar: livestock and children were dying, newborns were suffering from malnutrition, and all the while, policy makers were looking at Thar as an ‘isolated challenge.’

The bizarre response of government officials

Total infant deaths in 2015: 326

Source: Local administrator, Mithi.