Nowadays if you visit a clinic, barring the ones in posh areas, you will find it crowded with patients suffering from jaundice -- also called Hepatitis E.

These patients are easily identifiable because of their yellowed eyes and skin caused by an increased level of bilirubin, a yellowish substance released by liver, in their blood. This malfunction occurs because of the inflammation of liver caused by the said disease.

Jaundice has adverse effects on one’s health and leads to fatigue, nausea, loss of appetite, body ache, major harm to liver, if not treated properly, and so on. Currently, it is widespread, to the extent that it is being seen as an epidemic too hard to control. Being a contagious disease, jaundice has the tendency to multiply in the areas where its incidence is high. There is no prescribed treatment or vaccine for the ailment, and one recovers only after a particular period of time provided one takes certain precautions and controls one’s diet.

The given situation calls for an immediate analysis especially of what is leading to the spread of the disease, and why the concerned government departments have failed to address this.

Dr Ashraf Nizami, President, Pakistan Medical Association (PMA), points out that Hepatitis E is primarily caused by the human consumption of drinking water mixed with sewage water which is unfortunately too common in Lahore.

"The underground water pipes are age-old and these have not been replaced or repaired at points where these are damaged," he says, adding that the disease is contagious and can be passed on from one person orally. That is why, people suffering from jaundice are advised to use separate utensils.

Similarly, Dr Nizami says, it is quite common that the hepatitis E virus is carried from an affected person who handles food to the consumers. "Unfortunately, no one cares to use gloves, and no one is concerned about hygiene at food joints, or even the health of the chefs. Therefore, it is advised to avoid dining out, especially at a place where the prescribed food preparation methods are not being taken care of."

Nizami suggests that the "government should spend money on installing a proper sewage system in the city, making the repairs wherever required, and ensuring that the pipelines for drinking water supply are at safe distances from those meant to dispose waste."

He laments the fact that traces of polio virus have been discovered in sewages of Lahore. "The government has neglected this sector. It is disturbing to note that the provincial government has failed to properly utilise the budget earmarked for providing proper water and sanitation facilities for the people."

As per details, an amount of Rs20.5 billion was allocated in the Annual Development Plan (ADP) 2018-19 for water and sanitation, of which Rs8.4 billion was meant for the ongoing schemes while Rs12.091 billion was for new projects. But during the year, only Rs6.2 billion was released for the ongoing schemes and not a penny for the new ones. The rest of the budget lapsed due to the failure of the Punjab government to deliver in this sector.

This was despite the fact that the MPAs from both the treasury and the opposition benches had passed a resolution in the Punjab Assembly that bound the sitting government to judiciously spend the whole amount in the sector. Water Aid UK, a global organisation working for water and sanitation rights of the citizens, was also a part of the lobbying exercise and helped to mobilise the legislators during the process.

Coming back to the pollution of drinking water, it is revealed that samples of water collected from congested areas like Sant Nagar, Krishan Nagar, Shadbagh, Mughalpura, Baghbanpura, and Shahdara have traces of e-coli bacteria (which is found in sewage water).

Dr Abdul Basit, a medical practitioner based in Lahore, says that "the phenomenal growth in the number of residents in the already congested areas has increased pressure on the existing sewage and drainage pipes. It is likely that at certain points this causes cracks or leakages, which is how the drinking water gets mixed with sewage water. But since the pipes are underground, it is not easy to prove this."

Imtiaz Ghauri, Spokesman, Water and Sanitation Authority (WASA), claims that "our laboratory regularly analyses the samples collected from different parts of the city, and takes corrective measures without delay."

He also speaks of receiving complaints about leakage of WASA sewage pipes, but says that "we inspect the sites and even change the pipes if we feel the need to do so."

He is of the view that on many occasions "the problem is with the pipes laid by private individuals in their houses. It is possible that clean water coming through the WASA pipes mixes with sewage water leaking from underground sewage pipes inside a house. He adds the water and sewage pipes in some areas of the city were replaced recently when development funds were released for the purpose."

Ghauri also says that water suction by consumers through motors, especially where tubewells are not working, pulls bacteria and other harmful particles along with water, causing serious health issues for the people.

Another reason for the spread of Hepatitis E is the use of sewage water for vegetable production in the outskirts of the city. If these vegetables are consumed in raw form, traces of sewage may enter the human body and damage the liver. For the farmers, it may be an easy way to go about it because they do not have to extract water from tubewells, nor do they need to use fertilisers.

Naseem ur Rehman, Director, Environment Protection Department (EPD), agrees that the quality of drinking water in the province is not good, and cites the shortage of funds as the main reason behind this.

According to him, a couple of years back the department collected 20 samples each from the 36 districts of Punjab, of which on average 15 were found to be contaminated. The situation, he says, might not have changed much since then.

He explains that the pipes laid ages ago were made of iron ore and have rusted. The new pipes are rust-free and made of material that lasts much longer "but the problem is that the expenses required for this replacement are too huge for any government to bear."

The problem is very real, and calls for action on a war footing. The Supreme Court of Pakistan (SCP) has also taken notice of the issue. In a hearing, Justice Umar Ata Bandial mentioned that he had heard about the epidemic of Hepatitis E in Lahore, and that one of his friends were affected by it.

Former senior minister Aleem Khan had also once admitted that the hepatitis virus was found in the drinking water resources all across the province. He shared the PTI government’s plans to set up an authority that would ensure provision of safe drinking water. One can only hope for a breakthrough and that the issue of clean drinking water is addressed on urgent basis by the government.