DESTRUCTION. Devastation. Death. That the floods in Pakistan have left people quite literally clutching at straws is no secret. Although the floods have receded for now, those that have been affected by it are only just resuming their lives amid a survival crisis.

There is a dire need for not only medical intervention as disease grows, but also an even greater one for the bare minimum required for survival: food and water. In the wake of these floods, we need to demand immediate action in the face of one of Pakistan’s long-standing problems: undernutrition.

According to Save the Children, the floods of 2022 have increased the number of people facing food insecurity by 45 per cent; the number of people in Pakistan who were already facing a severe food crisis before the floods has gone up from 5.96 million to 8.62m after the deluge. Now, more than ever before, it is time to talk about how these circumstances did not come about overnight. In fact, Pakistan has been grappling with undernutrition for more than half a century.

Undernutrition, which is the body’s inability to meet its requirement of energy and nutrients, can cause impaired brain development, low birthweight, weakened immune systems and premature deaths. It also increases the risk of diabetes, cancer, stroke, hypertension, and other non-communicable diseases.

Unfortunately, this expanding burden of disease is shouldered by the most vulnerable in our community — our children. Globally, Unicef attributes nearly half of the deaths in children under five to undernutrition because the latter increases their risk of infection and delays recovery.

Whatever the implementation challenges may be, adequate nutrition for all is a cause worth fighting for.

According to the National Nutrition Survey of Pakistan 2018-19, four out of 10 children under the age of five show stunted growth, a total of 12m across the country. Stunting causes irreversible damage to the cognitive development of children, their education, income, and productivity later in life. Due to undernutrition, there is a huge burden of micronutrient deficiencies in children and 57.3pc of Pakistani children are anaemic. A survey for 2022 would no doubt paint a far drearier picture.

Despite that, undernutrition continues to receive little to no attention; it has not managed to become a political issue for the legislature and has not been prioritised by the bureaucracy. Most importantly, it lacks a unified national policy that works.

Commenting on the floods, Dr Nazeer Ahmed, the focal point in Pakistan for Scaling Up Nutrition — a global movement aimed at improving nutrition, “A country with a huge number of the population having limited physical and economic access to diversified food is now expected to experience severe shortage of foods which will result in a triple burden of malnutrition. Hence, an effective multi-sectoral well-coordinated response is a must.” Interestingly, such a strategy does exist somewhere in the shadows, but has so far failed to achieve what it set out to do.

The Pakistan Multi-Sectoral Nutrition Strategy was envisioned for 2018-2025 and aimed to enable emergency health services to respond to urgent clinical needs, improve access to nutritious foods, clean water, and sanitation, deliver services to high-risk populations, and build a gender-responsive approach to fighting the various causes of malnutrition.

Unfortunately, a seemingly comprehensive policy failed to translate into action, given the severe lack of budgetary allocation for development funds and resistance by the provinces to join forces. As a result, collaboration is low, outreach activities are few, and community networks are weak.

Additionally, there is a lack of technical capacity, a weak understanding of nutrition, and a shortage of front-line staff. To top it off, there are next to no systems for monitoring and evaluating progress. All these factors combine to ensure that the policy stays only on paper.

Whatever the implementation challenges may be, adequate nutrition for all is a cause worth fighting for. Food security is the right of every human being and protecting every human being’s right is our collective responsibility. It is the small price we pay to live in our city, our country, our world.

Efficient food systems are social indicators of health and well-being, and a lack thereof is a public health emergency. Optimal nutrition not only protects against disease but is necessary for physical and cognitive development, good academic performance, improved productivity, and ultimately, enhanced socioeconomic national growth.

As far as the flood-affected areas go, an estimated 760,000 children are fighting for their life against diarrhoea, typhoid, respiratory infections, malaria and skin conditions, as well as experiencing a multitude of mental health problems.

According to Abdullah Fadil, Unicef representative in Pakistan, “We are facing a nutrition emergency that is threatening the lives of millions of children. Without urgent action, we are heading towards a catastrophic outcome that is threatening children’s very development and survival.” What Fadil correctly attributes to flood victims is in fact the grave reality of more than 3.4m children who face chronic hunger in Pakistan.

With every passing year, the economic burden of undernutrition and its health consequences totals $7.6 billion which accounts for nearly 3pc of Pakistan’s GDP, a cost that continues to inflate by the day. However, what is infinitely more important than money is the lives at stake. With every dying cry, the undernourished population of Pakistan is screaming for attention. Sadly, in this age of politically driven agendas and a hyper-sensationalised media, their desperate pleas fail to get clout.

That is why we need to step away from our current role of bystanders and demand change. We need to advocate for an effective policy that fights this gross violation of health and human rights. We need be aware of our power as a community to end undernutrition in Pakistan, once and for all.

The writer is studying for a Master’s degree in Public Health at the University of California at Berkeley.

mahnoor_fatima@berkeley.edu

Published in Dawn, December 5th, 2022