More than 120 children have reportedly died in Thar Desert of Sindh province because of malnutrition and disease over a period of three months. This is an unfortunate calamity that so many children have died due to preventable causes which could have been addressed with effective public policy interventions.

Tharparkar is geographically spread over 22,000 square kilometres with an estimated population of around one million. The World Food Programme ranks the district as the most food insecure of Pakistan’s 120 districts. The livelihood of people in the area revolves around rain-dependent agriculture and livestock.

In the last year, however, between March 2013 and February 2014, the area has been hit by a rainfall deficit of roughly 30 per cent, according to government data. The worst-hit towns are Diplo, Chacro and Islamkot that got barely a drop of water for months. It is reported that low rainfall in district Tharparkar has caused crop failure which, coupled with disease outbreak in the livestock, has led to a substantial deterioration in the district household food security.

The crisis in Tharparkar has also succeeded in drawing political attention as both provincial and federal governments have started providing assistance to the affected population. Relief Department of Sindh has notified the entire district as calamity affected area.

The steps taken by the government are good but these lives could have easily been saved. Under-nutrition levels in Sindh are not a new phenomenon. Many government and independent researches and surveys have indicated that malnourishment in Sindh has crossed the emergency threshold of 15 per cent of the population -- a level that requires public policy action.

It is a pity that the PPP’s government in Sindh, which promised provision of food to everybody, has failed to avert the disaster in Tharparkar. The zero hunger programme initiated by former Prime Minister Yousuf Raza Gilani did not work due to lack of government attention. A major task of the project was to provide food to 45 extremely food insecure districts of the country, including Tharparkar.

Lola Castro, World Food Programme Representative and Country Director Pakistan, tells TNS that the provincial and federal government have begun to recognise the critical nature of the situation, and the prime minister has announced a grant of one billion rupees to respond to the urgent food needs of the population in Tharparkar. "This shows the government’s seriousness in tackling this complex issue. However, considering the weak healthcare infrastructure in the district there is a critical need for increasing the international organisations’ support in nutrition and other interventions," she says.

Castro also says that a recent Joint UN Mission to Tharparkar conducted on March 10, 2014 calls for WFP, UNICEF and WHO to increase their ongoing interventions in the district by increasing number of IUC and expanding the treatment of acute malnutrition to more children and pregnant and lactating women. "Realising the criticality of the situation, the relevant department of Sindh has issued red alert to the district administration of Badin, Thatta, Dadu, Ghotki, Khairpur, Umerkot and Sanghar district."

Lola Castro says Pakistan is also signatory to the "Scaling Up Nutrition (SUN)" initiative which is looking at an integrated approach to tackle the underlying and multi-sectoral causes of chronic malnutrition which is also a very serious concern in Sindh and Tharparkar. "WFP would need approximately 2.4 million dollars to scale up its nutrition and livelihood activities in district Tharparkar. We are working closely with FAO in the livelihoods interventions to ensure sustainable food security," she says. According to Castro, WFP has assisted 1,561 moderately malnourished children and over 2,000 women under its "Community Management of Acute Malnutrition (CMAM) Programme" in partnership with UNICEF and WHO in Tharparkar.

In Sindh, under-nutrition remains a recognised health problem and plays a substantial role in the region’s elevated maternal and child morbidity and mortality rates. Around 40 per cent of children in Sindh are underweight. Nearly two thirds of mothers and children in Sindh are anaemic, and nearly half the mothers and children have vitamin A deficiency. In the province 57 per cent children under age 5 are stunted and 35 per cent are severely stunted respectively, whereby the situation is more severe in rural areas.

The National Nutrition Survey (NNS)-2011 also determined Sindh as the poorest most food deprived province of the country. Interestingly, Sindh has the second most agriculturally productive land in country after Punjab. But it still has the highest level of food insecurity amongst all four provinces and has several underdeveloped districts with higher prevalence of under-nutrition.

According to the NNS-2011, about 58 per cent of the households were food insecure at the national level while in Sindh 72 per cent of household were found to be food insecure. The survey also found that 50 per cent of children under the age of 5 in Sindh were stunted, 17.5 per cent were wasted (already above emergency levels), and 41 per cent were under-weight.

Against the national level rate of anaemic children 62.1 per cent, Sindh had 73.3 per cent of sample children anaemic (severe to moderate deficiency of haemoglobin level).

Civil society organisations working in Tharparkar say that poverty and under-nutrition ail the area. "Food and other goods are available in the area but purchasing power of the people is very low," says Zafar Iqbal Junejo, CEO of Thardeep Rural Development Program, an NGO working in Thar. "Livestock raising is the mainstay of the economy in the area. It is needed to be developed on scientific standards. Premature births are normal as no health facilities are available. This issue is linked with socio-economic development," he says, adding that the situation can deteriorate as spring gives way to the hot summer. "Hot weather would increase frequency of diseases among cattle. They need to be vaccinated," he says.

The social indicators of Tharparkar district are quite appalling. The literacy ratio of the district is about 18.32 per cent (28.33 for men and 6.91 for women). Infant mortality rate is 112 per 1,000 live births and population growth rate is 3.1 per cent much higher than national growth rate. The population in the district also lacks access to safe drinking water and proper sanitation -- two key contributors to under-nourishment.

According to a survey done in the district by Sukaar Foundation, a local NGO, and Unicef in 2012, around 88 per cent surveyed households and above 90 per cent schools lacked access to toilets. Similarly, above 90 per cent of people did not have access to safe drinking water. Thus, limited access to wells provides mostly contaminated water, either chemically or bacteriologically. This adds to health hazards provoked by open defecation in the area.

Experts believe that Sindh needs a long term strategy to avert similar situation in other districts and should actively engage with other stakeholders so that malnourishment and hunger could be addressed from multi-dimensional perspective with effective multi-prong programmes.

"While providing rapid emergency assistance to the affected people, we should not forget to address root causes of the crisis", said Arif Jabbar Khan, Country Director of Oxfam in Pakistan, who leads Pakistan Emergency Food Security Alliance -- an alliance of six international organisations working in Pakistan. "There is no dearth of food, but persistent economic inequalities, lack of public policy action, unaccountable governance, unfair distribution of resources and control on decision-making by few are the major causes, which, if not addressed, would further aggravate the situation in future," he says.