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The wind-whipped open expanses of Gharo, halfway between Karachi and Thatta, are cramped with refugee camps. A crew of curious children follows me through the Aitemaad camp practicing their rudimentary English — Hello, Hello! — and giggling at my broken Urdu. Some of the younger children look fragile and bird-like; their collarbones protrude through their flimsy garments and their eyes are lackluster. Yet, many of them manage to return my smile and share their stories. "I was scared when the water came to swallow us," whispers one little girl whose hair is discolored from malnutrition, "I thought it was because I had done something bad." Most of them seem relieved to have a tent to call home and rice to fill their bellies. "I am happy here, not afraid!" exclaimed a barefoot girl who is expertly balancing a baby on her hip.
Ahmed Mazari, a tall man with a round face and clipped mustache, explains that Aitemaad Pakistan Trust was formed in response to both the devastating floods that hit Pakistan and an absence of trust and credibility in the government to provide judicious relief. To ensure transparency, Aitemaad displays all facts, funds and activities on its website. Mazari says Aitemaad runs on a participatory concept of relief that includes establishing a partnership with refugees and actively involving them in the relief process. With the funds raised by the justices, each of the refugees receives a weekly ration of flour, salt, sugar, milk, oil, tea, lentils, and rice. A few of the luckier refugees have catch fish from the nearby rivers and grill them on their makeshift stoves, an iron hook horizontally impaled in a dirt hole surrounded by kindled wood chips. A health worker visits the camp routinely and distributes free medicines such as anti-malaria pills, anti-fungal creams, and anti-diarrhea medicine which are collected through donations.
Mazari helps run the camp of 1,196 internally displaced people of which 614 are children. While walking though the off-white tent city, he introduces me to several refugees: a fisherman, barber, wood-carver, sugar-cane cutter, and new mother. "The water came slowly, then faster and faster," a refugee named Nean Sijawal recollects in the steady voice of a news anchor. "The army told us to vacate the house immediately." The lean subsistent farmer from the Northern region of Pakistan said he grabbed his children and ran toward high ground. "We didn't have time to bring anything, not even our clothes." He continued, "All of our animals were lost: six goats and one cow." Sijawal says he's uncertain if he wants to return home since "the roads are broken and there is water everywhere." He continued, "I hope the government will build us a home because we have lost everything . . . I hope people outside, if they are blessed, will support us too." Sijewal says he and half his extended family of 14 live at the camp. Although he is very grateful to Aitmaad for its help, he says the punishing summer sun makes the camps extremely hot. Sijewal says the majority of his family members have suffered from water-born skin diseases and heat strokes in the weeks following the flood.
Unlike the rich, the poor have no safety net during an unexpected calamity. Previously destitute Pakistanis hit by the floods lost their ability to feed and clothe their families. Many subsistent farmers like Sijewal have no crops to harvest this year and will not be able to repay their feudal landlords if they return to their homes. Others say they were squatting on land owned by overseers before the waters came, and they worry they will no longer have a place to call home even after the water resides. Several laborers claim that wealthy patrons diverted the flow of the raging Indus River, occasionally breaking dams and barrages in order to save landowners' estates at the expense of entire villages comprised of the poor.
Laborers and farmers, including Sijewal, say they would prefer to squat on the outskirts of Karachi or in the relief camps of Thatta and Makli than return to an uncertain future in their former villages. An estimated 200,000 Sindhis have already taken refuge in the sprawling slum cities of Karachi and may consequently disrupt the fragile equilibrium of the city's composition. According to Shehla Baqi, a pediatrician who provides free healthcare at a S.I.U.T. clinic, the social upheaval caused by the floods may provide a ray of hope for the devastated rural poor if they're able to reclaim their rights and dignity in the flood's wake. "I've heard reports of bondage laborers leaving their land and overseers right after the flood," said Baqi. She would like to see her country emerge from the floods not simply by re-envisioning the future rather than rebuilding the past. Baqi says the upheaval could be a positive development if it washes away the "corrupt and feudal ways" of Pakistan's ruling class.
"During the earthquake of 2005, the earth opened up," explains my fixer Toxy Cowasjee. "During the flood, the rivers opened up." After the earthquake, displaced people could return home and scavenge for lost possessions amidst the rubble. However, after the floods, people realize their former lives were swallowed whole and there is nothing left to salvage. The camp where Sijewal resides is a veritable Noah's Ark of last remnants saved from the floods: goats, wicker baskets, chickens, rolling pins, bedding, mats, wire mesh, straw mats, and colorful scarves. "People initially did not want to leave their homes despite the flood warnings because they did not want to part with their few belongings, especially their animals," explained Dr. Naqvi, a surgeon at S.I.U.T hospital. However, having finally vacated their flood-ravaged lands, some are not eager to return. "If the water has gone then we might go back, but only if there is hope for us," says Sijewal, a middle-aged father of six. The floods severely damaged Pakistan's agricultural sectors by washing away fields of rice, wheat, and cotton supplies. The government estimates that the monsoon rains inundated 8.9 million acres (3.6 million hectares) of agricultural land and 7.2 million farm animals.
Just southeast of Karachi in the flood-destroyed historic city of Thatta, I meet an overworked surgeon donning green scrubs who shows me around the S.I.U.T field hospital and mobile clinics. Dr. Rehan Mohsin says he treats 600 patients daily at the hospital and an additional 200 patients at his mobile clinics. "We set off with a van and ask if there are any ill people," he explains. "They come to the van and we distribute oral rehydration packages, medicines, and anything else needed." Mohsin says that many people donate medicine that is only suitable for adults, not children. Other medical staff have reported that pharmaceutical companies may be engaging in the practice of "dumping" by donating expired medicines to the third-world in wake of a major catastrophe. Sometimes the drugs come from well-intentioned individuals emptying their medicine cabinets, but more often they come from pharmaceutical companies looking for tax write-offs. As of now, it's too early to confirm whether companies are engaging in this dangerous practice in Pakistan.
When I ask Dr. Mohsin what inspires him to work under such difficult conditions, he shrugs. "These are our people and we must take care of them," he says. "We anticipate we will stay [in the field] for another 3-6 months, but we will stay longer if needed. We will stay until the last patient has been treated." He hopes the international community will get more involved in relief efforts not only by sending medications, but also by providing food since many medications are useless on an empty stomach. "Foreigners should visit the area so there is not any misconceptions," said Dr. Mohsin, "The main issue is that children are suffering and also there are not enough female doctors available for the female patients." The U.N. estimates that 3.5 million children are at risk of contracting water-borne illnesses in the wake of the epic floods. Pakistan's government estimates 500,000 pregnant women are also at risk of falling ill due to flood-related diseases.
Dr. Mohsin continues, "We've seen so many cases of watery diarrhea, chest infections, and reoccurring malaria." The doctor explains that malaria is on the upswing since stagnant pools of water attract mosquitoes. "Malaria often reappears in the same patient if he does not finish the complete course," explains the doctor who works with a staff of 25 doctors, paramedics, pharmacists, and lab technicians in the field hospital. "The government should be doing more," says Dr. Mohsin, "They should fumigate the area so there is not a malaria epidemic."
A soft-spoken man named Sarmad arrives at the clinic and tells Dr. Mohsin that his 3-year-old son has contracted malaria. The little boy with large, droopy eyes looks like he's on the verge of tears. Sarmad says he's a clerk from Sujawal, an partially inundated area in Sindh Province. "I lost all my furniture and possessions during the flood," explains Sarmad. "I just grabbed my family members and took the money in my pocket. I want to return, but my house is completely drowned." He continues, "I am happy the NGOs are helping, but I am not happy with my government." When asked about his son's malaria, Sarmad says with noticeable distress, "Even if my son gets cured, I sometimes wonder what's the point? He might get it again when we return home."