“Garmi bohot hai” — if you’ve lived in Karachi, you’ve probably said and heard this phrase one too many times. Rising mercury levels impact our lives everyday. Like many other issues, however, heat does not affect us all the same way, with those on the lowest rungs of the socioeconomic ladder bearing the brunt of the impact.

“There is neither water nor electricity at our house, where does one go?” asked Dilshad, a domestic help working in Karachi. “We are the labour class, we have to go out. It’s so hot, there are no trees or even a place where one can sit [outside].”

Dilshad takes a Qingqi rickshaw daily to reach her places of work and “it’s so cramped inside”, making it even more difficult to cope with the heat.

In 2015, Karachi experienced a severe heatwave that resulted in over 1,200 deaths, leaving another 50,000 sick. In 2018, a heatwave killed 65 people in just three days in the city. Last year, Pakistan, along with India, faced a deadly heatwave that broke records with Pakistan experiencing the world’s highest March temperature.

A 2022 report on health and climate change by the Lancet Countdown — a collaboration of 120 experts from different fields, stated that extreme heat was related to “acute kidney injury, heatstroke, adverse pregnancy outcomes, worsened sleep patterns, impacts on mental health, worsening of underlying cardiovascular and respiratory disease and increases in non-accidental and injury-related deaths”.

Of heatwaves and cyclones

What makes this heat even more dangerous is the “wet-bulb” phenomenon. The wet-bulb temperature (WBT) is simply the combination of dry air temperature with humidity, measuring heat-stress conditions on the human body.

“It’s different in different places, but according to the general definition provided by the WMO (World Meteorological Organisation), a [heat wave] is considered when the temperature rises higher than the area’s average temperature by 5°C and continues to stay that way for five consecutive days. That’s when we can declare it a heat wave,” said Sardar Sarfraz, chief meteorologist at the Pakistan Meteorological Department (PMD).

“For example, in June [the average temperature] is 36°C. If it rises to 40-41°C and stays like that for five days in a row, we can say it is a heat wave condition. “

“If you look at the temperature trend for the last few years, we can see extreme temperatures in different instances,” he said, adding that last year, Pakistan witnessed at least six to eight episodes of extraordinary heatwaves. It began in March and then continued till June, so for around three months, the wave stayed in almost all flat areas of Pakistan.

During this time, however, Karachi and other areas on the coastline fared much better compared to rural Punjab, Balochistan and KP’s maidaani [plain] areas.

“Every year is becoming progressively hotter than the previous one, as global warming is increasing. […] Especially in the last 25 to 30 years, it’s consistently a rising trend,” he said.

Globally, temperatures have risen by almost 1.1°C on average, compared to the pre-industrial revolution mercury levels pre-industrial revolution. In some places, this increase has been recorded up to 1.2°C, which is quite significant according to most scientists.

“In the Paris Agreement, all countries agreed that we cannot let this rise over 1.5°C, setting it as a threshold. It will be immensely damaging to all sectors if it crosses that. But the speed with which the temperature is rising, the concern is that in the next five to 10 years, the threshold might be crossed.”

The solution is moving towards alternative energies such as solar, tidal and wind, etc, he said. “Every year, the world sits together at the COP (UN climate change conference) and says ‘we must curtail’ this but then don’t do it,” he lamented. “This is exactly what they should do.”

The adverse effects are not only witnessed in the form of heatwaves on land but can also wreak havoc in the oceans. According to Sarfraz, because of the rising heat, the cyclones emerging in the ocean are of more intensity now. “In the last 20 years, the frequency of cyclones has almost remained constant but their intensity is rising — intensity in terms of torrential rains and high-intensity rain. These pose great dangers to the coastal areas in Pakistan.”

“Sea levels are also rising due to the heat which is a threat to the coastal areas. All the low-lying areas can be under water in the next 10 to 20 years.”

Heat threshold for humans

Normally, the human body sweats to cool down, but above a certain wet-bulb temperature, the body can no longer do that. This is the WBT threshold that identifies the limit of human adaptability to extreme heat. Once the body surpasses this limit, its organs begin to fail.

Earlier it was believed that this threshold value was 35°C (from a 2010 study), but a recent study, found that the real threshold is much lower. “Our data is actual human subject data and shows that the critical wet-bulb temperature is closer to 31.5°C ,” the authors concluded.

The number of times this threshold has been crossed — albeit only for a few hours — has also been increasing globally. “The times these events last will increase and the areas they affect will grow in direct correlation with global warming,” climate scientist at NASA’s Jet Propulsion Laboratory, Colin Raymond, told The Guardian. There were about 1,000 occurrences of a 31°C WBT, and about a dozen above 35°C, in Pakistan, India, Saudi Arabia, Mexico and Australia, according to his research.

Due to the exponential rise in temperatures, “vulnerable populations (adults older than 65 years, and children younger than one year of age) were exposed to … more heatwave days in 2021 than annually in 1986–2005, and heat-related deaths increased by 68 per cent between 2000–04 and 2017–21”, according to the report.

Not only does it cause a number of ailments, heat also impacts people’s ability to work and exercise. The role of the state and the institutions is also crucial in determining how any group is actually affected by extreme temperatures.

Among people over the age of 65, for instance, rising temperatures and heat waves are “projected to result in 38,000 additional deaths per year by 2030 and 100,000 by 2050”, according to the UN Office of the High Commissioner of Human Rights.

Gender is also another aspect that has a major impact on the process of heat mitigation. According to the Lancet Countdown report, “socially deprived” people are at the forefront.

In Pakistan, the climate crisis has “compounded vulnerabilities” for women, said the UNDP and the National Commission for the Status of Women (NCSW). For example, when people migrate due to heat or other climate-related crises, it is often the men who move out, leaving women to take care of their families and the household in extreme weather conditions. Research from Europe has also shown that women are more likely to die in extreme heat events.

Women also lack access to public cooling spaces and are often confined to indoor spaces, making them more vulnerable to heat during heatwaves and power cuts.

“When we work [in the heat], we get sick. There are no [work] leaves given to us,” said Dilshad. “If we miss work, we don’t get paid or get fired. If we don’t work, how will we eat?”

She also pointed out that she has to buy water to drink. “How can me and my children take frequent baths?” she asked rhetorically. “Bijli teen teen ghante hoti nahi hai. Ek ghanta dete hain, dou ghanta kaat te hain [Power goes out for hours. It’s there for an hour, then gone again for the next two],” she added.

Occupational hazards

People who work outside are at the highest risk. Farmers, construction workers, miners, and factory workers are prone to “heat stroke, heatexhaustion, heat cramps, or heat rashes. Heat can also increase the risk of injuries in workers as it may result in sweaty palms, fogged-up safety glasses, and dizziness”, according to the Centers for Disease Control and Prevention.

“It [heat] hurts us, takleef deta hai [gives us pain]. There is no water to drink or cool us down. Here, there is a water problem,” said Muhammad Ashraf, who hails from Quetta and sells toys at a flea market in Karachi. “People who used to come here, don’t anymore. There were trees here, now there are no trees so people tend to come less. It hurts my business.”

“In Karachi, if there is no hawa, then there is a lot of garmi. Jab hawa chalti hai tou guzara hojata hai [If there is wind, the heat is manageable].”

“It is very hot but majboori hai kya karen,” said Faisal Abbas, a daily-wage labourer working on a construction site at University Road. When I asked him how the heat is impacting his work, he said that he has to work regardless of how hot it gets.

“It is very difficult. After every five to ten minutes, we go in the shade. We drink water, what else can we do?”

The government often advises people to take regular baths and pour water on their bodies to keep cool. He laughed and said, “Idhar peene ka nahi milta, nahane ka kahan se lain? [We don’t get water to drink, where do we bring it to take a bath?]”

Ashraf, the flea market vendor, agreed with Abbas. “Thele walon ko peene ka paani nahi milta yahan, kahan se layen paani? [Flea market vendors don’t get water to drink here. Where do we get water from?].”

According to Abbas, his body is now used to working under the scorching sun and he rarely falls ill because of it. “Aadhi hogaye hain [We are used to it],” he said with a wry smile.

Originally from Mianwali, he moved to Karachi to make a living. Compared to his home city, he found the heat in Karachi bearable. Not everyone is used to it, though.

“It is really hot in Karachi. We are suffering in these conditions. There is no shade, there is nothing,” Mohammad Wajid, a mechanic working opposite Abbas’ construction site, told me.

The heat is not only adversely impacting his body but also his work. “Kaam hai hi nai, aap ke samne hai [There is no work, it’s in front of you],” he said, waving towards his empty mechanic shop located on one of the busiest thoroughfares of Karachi.

“In winter, our work returns to normal. In summer, no one leaves their house,” he added.

Saddan, a rikshaw driver, also had a similar experience to share. “Since it’s so hot, people tend to go out less. They come out to work during the evenings and nights and during the day, they stay home.” Saddan also fell ill due to the heat some time ago. Even if it hurts his wages, he now prefers to drive during cool hours and avoids the hottest parts of the day.

“We do not have the facilities to mitigate the heat. If someone comes and parks their car under the sun, we have to stay there and work under the sun.” He also complained that his house has electricity for two to three hours only. “Baaki time bus khair khairyat hai [The rest of the time, we just make do].”

Ashraf too said that his house gets only six to ten hours of electricity. “After every one to two hours, there is load shedding,” he said. He also said that his body gets red and he feels sick in the heat.

Access to electricity — or the lack of it — intensifies the impact of heat on the human body. Not only do power cuts shut down fans and other cooling infrastructure run on electricity, they also indirectly cause diseases; for example, without a working fridge, food quickly goes bad and with the skyrocketing inflation, the majority of the population has no choice but to eat it. This results in a great number of gastric illnesses such as food poisoning.

Cool infrastructures

“Karachi, being a metropolis city, has failed to build a decent transport infrastructure to facilitate the movement. People spend hours during their commute in 40-degree temperatures, the majority of whom use personal bikes and public transport which exposes them to extreme heat,” said Atoofa Samo, a research associate at the Karachi Urban Lab, working on cooling infrastructures in the city.

“You would not find sufficient shade at bus stops where people can wait comfortably and wait for the transport to arrive,” she said, citing an example of the lack of planning.

During her research on heat, Samo learned that one of her respondents “has to walk for 15 minutes to reach the bus stop and there is no shade” on the way. These “day-to-day experiences of commute acerbate [people’s] vulnerability to heat.”

“She felt drained and dehydrated due to the excessive precipitation before reaching the workstation,” said Samo.

But all is not lost.

Over the last few years, since the scathing heat waves of 2015, Dr Sunita Lata Lohano, Additional MS (AMS) at the Dr Ruth Pfau Civil Hospital Karachi, noted that she has observed a marked decline in the number of heat-related cases.

She said that the mortality rate during the heat emergency in 2016, when she was working in the ER, was very high. “Now there are awareness programmes, availability of beds, availability of medicines and contingency plans are made too. This has brought many changes and significantly lowered the mortality rate.”

In 2022, the total number of people admitted for heat-related ailments at the government hospital was 35, of whom one person passed away. This year, 12 people have been admitted so far and all of them have recovered successfully.

“Elderly, children, poor and homeless are the most affected [by heat-related illnesses]. For children, it’s less than 14 years of age, and for the elderly, it’s more than 60 years of age.”

Preventive measures

According to Dr Lohano, the impact of heat can be divided into direct and indirect categories. The former includes heat-related illnesses such as dehydration, cramps, strokes, etc, while the latter pertains to the effects on health facilities, such as an increase in the number of ambulances required, the need for medicines, the burden on emergency services at hospitals and so on.

“For this, we at the hospital, make a contingency plan to prepare us,” she said. Another impact on health services is an “increased risk of accidents” because excessive heat makes driving difficult, said Dr Lohano.

“People should be made aware of the ways to regulate body temperature. In the morning and afternoon, try to keep your surroundings at less than 32°C, and during night hours, keep it below 34°C,” she suggested. “People who take medication must ensure that the medicines are stored below 25°C.”

According to Dr Lohano, “the common signs and symptoms of a heat stroke are a higher body temperature, loss of consciousness, pulse rate initially decreasing and then increasing, feeling nauseous and dizzy, intense thirst, headache and most importantly, muscle strain and fatigue.”

At what point must you immediately go to the hospital though? “When you’re hot and red, your skin is dry, and the temperature is 40°Cor 104°F,” said the doctor. If someone around you is experiencing these symptoms, you must immediately bring them to the nearest hospital, she recommended.

The Civil Hospital now has a separate section for heat-related cases. More than 15 beds are available for heat stroke patients in case of an emergency, Dr Lohano told Dawn.com. Besides the beds, medicines, ORS and other resources are also available at the hospital.

“Drink lots of water, try to take breaks if you’re working outside, and stay under shady areas for some time … avoid going outside during the hottest time of the day,” the doctor advised. “Also, reduce the intake of alcohol,” she stressed, “in addition to sugar and caffeine.”

Simple as they may sound, many of these simple interventions are near impossible for many residents of Karachi.

There are a “variety of micro-climates” present in Karachi across its districts and “each one has unique physical features and built environment that contributes to thermal experiences in the city”, according to Samo.

“Fifty percent of Karachi’s population lives in informal settlements. Most of them are settled along Karachi’s major stormwater drainage channels — the Gujjar Orangi Nullah, and Lyari (Ilyas Goth).

These informal settlements are characterised by dense populations, cramped streets, and limited access to public utilities and services. Houses are built with metal sheets (roof) and bamboo, without adequate access to basic services such as water and electricity,“ she said.

“Communities living in these settlements are introduced to compounded vulnerabilities, heat risk, and urban flooding. Extreme heat impacts are pronounced in these populations due to a lack of awareness of acute/chronic heat (waves) occurrence and risk, inadequate access to routine energy services access to potable water, and lack of access to cooling centres.”

In essence, heat disproportionally impacts the poor, especially those not seen as ‘formal’ by the state.

“There is substantive literature that suggests heat waves and urban heat island effects reinforce each other’s effects. These heat islands are concentrations of buildings, paved areas, and other surfaces that absorb and retain heat. For instance, high-density, high-rise buildings interfere with the asphalt used for the roads and produce heat.

Meanwhile, lower-income neighbourhoods are highly dense settlements, leaving no room for natural ventilation with limited access to energy services, electricity and water. Hence, the lack of public parks, lack of access to cooling spaces, and limited green vegetation also intensify the heat crises,“ she explained.

Can better urban planning mitigate the effects of heat though? “Urban planning solely would not be able to lessen the heat crises; heat is also a governance issue in the case of Karachi,” said Samo.

“As we witness during the 2015 heat wave, an unexpected number of causalities happened, and the government was impotent in playing the role of first responders. It was local NGOs and welfare foundations such as Edhi who actively contributed to managing the heat crises.”

“Moreover, at the national level, heat is understood as a one-time event, rather than as something recurring that has long-term effects such as slow deaths,” she added.

The role of the government is important to consider here given how the national policy for climate crises in Pakistan mentions the term heat only nine times. There are no extensive measures that particularly focus on heat.

“Heat should be declared as a disaster, not only because of its devastating effects, but also to allocate a budget (and resources) to practically tackle the issue. For instance, developing a heat (wave) alert system that could reach a wider audience, creating cooling spaces, and installing portable water camps across the city during extreme summers.”