Pakistan – a most vulnerable country

By Wajid Shamsul Hasan - World Healthcare Journal

By the end of May, the total number of coronavirus cases in Pakistan almost reached 70,000 with more than 1500 casualties. Unfortunately, the government is keeping to itself the reasons why the graph has risen so steeply over the last few weeks and is not sharing the conclusions with the public.

Most likely whoever takes a closer look into the matter would find two major reasons - most of it, if not all, pertaining to the pandemic. Firstly, lack of awareness about the seriousness of the virus. People do not respect nor observe social distancing protocols (SOPs), so it’s only natural that more catch the virus.

If only the public had behaved more responsibly when social interaction restarted, there’s no doubt things would not have been so bad that the Prime Minister would have to appear with such frequency to lecture his countrymen to take the threat seriously.

Secondly, it was a colossal blunder by the Federal government to delay lockdown, followed by further easing of lockdown despite the opposition from the medical community. Now, having introduced relaxation of the lockdown measures, the Prime Minister warns of the dire consequences of Covid-19 if SOPs are not followed strictly.

Six million people in more than 202 countries are afflicted, with over 373,000 dead. Pakistan, despite being close to China, was Covid-19-free until February 26 when a young man tested positive after returning from Iran. Covid-19 spiked soon afterwards as the Khan Government allowed more pilgrims who tested positive to enter from Iran.

Unlike Islamabad, Sindh province had a clear and effective policy of pursuing lockdown with social distancing, closure of schools, offices, businesses, shopping malls, bazaars, and suspension of prayers in mosques, whereas the Federal government persistently opposed these measures and its functionaries carried on a vicious campaign against lockdown.

It was noticeable that Sindh virtually gave a lead to the provinces in measures to curb Covid-19. Sindh’s effective handling of the pandemic led to instant appreciation from WHO-Director General Dr Tedros Adhanom Ghebreyesus and representatives who advised other countries to take a lesson from Sindh.

Heading towards an emergency

Currently, the pandemic is surging in an alarming manner and Pakistan is heading towards a Covid-19 emergency with the response from its Prime Minister and government falling too short of the challenge.

Medical experts believe that the country could face a crisis of enormous magnitude if it fails to act properly without loss of time.

It is very depressing to note that Pakistan’s people seem to be taking the pandemic lightly. Prime Minister Imran Khan’s last address to the nation was too complacent in asking people to learn to live with Covid-19, not to panic and to be prepared mentally to survive for a year. It is going to be a battle to save people from Covid-19 at one end without letting them die of hunger on the other. He has so far not come up with a concrete policy to blunt Covid-19’s march.

In comparison, Sindh Chief Minister Murad Ali Shah’s persistent measures to impose lockdown - self-distancing, banning of prayers in mosques, closure of schools, businesses etc—have proven to be most effective.

Pakistan urgently needs a collective approach to the pandemic by strictly imposing SOPs regarding social distancing and lockdown, and equipping doctors and paramedics with PPE to stop further casualties. Pakistan now manages to manufacture ventilators, face masks, gloves and gowns locally.

The issues surrounding lockdown

Lockdown did not have ready acceptability among the people and when it came to banning of religious congregations in mosques, the clerics came up with tough resistance. Dr Arif Alvi, the President, had to intervene with religious leaders to come up with an SOP that could prohibit congregations in mosques, especially in the month of Ramadan when prayers become more than routine, mandating the prayers to be held at home backed by religious edicts (fatwa) by the Ulema.

It was Pakistan’s good fortune that Saudi Arabia, as the leader among Muslims with the religious establishment of Holy Ka’aba in Mecca and Masjid-e-Nabvi (Prophet’s Mosque) in Medina, had taken the initiative of closing down both the holiest places in Islam, thus making it easier to impose lockdown elsewhere.

Hardest hit are daily wage earners living below the poverty line. Now the lockdown has been eased from June 1 but, as warned by the Pakistan Medical Association, relaxation has been responsible for multiplying number of deaths and infecting a larger number of people.

The most alarming aspect is the increasing number of casualties among doctors and nurses. It seems inevitable that the Federal government shall have to review its decision of relaxing lockdown urgently.

Facing infrastructure and social problems

In view of the gravity of the situation, the Army Chief General Javed Qamar Bajwa has personally intervened and involved the Pakistan army in the war against coronavirus. He has established a Covid-19 Command & Control Centre under a three-star general to keep monitoring the situation.

It must be mentioned here that Pakistan has a minimal healthcare system and it was almost facing collapse when struck by the virus. In this period of national emergency, several makeshift treatment and isolation centres with several thousand beds have been established, but they require lot of funding and assistance to successfully run them.

Besides, there are permanent hindrances in the fight against Covid-19, religious and social taboos, plus the disbelief of the masses who question the reality of Covid-19.

Pakistan is one of the most vulnerable countries in the crisis. It needs to be helped to increase the capacity of hospitals, the number of ICU beds, ventilators and immunity build up facilities and protective gear for doctors and paramedics, not ruling out another spike in cases in the future.

Notwithstanding the environmental considerations, Pakistan’s poverty level, lack of running water, toileting facilities, and dense occupancy in a house all combine to pose the most potent risk factors inviting all sort of diseases.

By Wajid Shamsul Hasan 

(Former High Commissioner of Pakistan to UK)

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