The dengue fever situation has become alarming as the number of patients nationwide has crossed 21,000. Out of these cases, 41 percent have been reported from Islamabad and Rawalpindi causing major public relations damage to the dengue control efforts of the federal and provincial governments.

12-year-old Sajid Ali, a resident of Rawalpindi died after three days of treatment in intensive care unit (ICU) at Benazir Bhutto Hospital (BBH) while a 70-year-old resident of Mansehra lost his life in the Holy Family Hospital, Rawalpindi.

According to media reports, the death toll from dengue fever has mounted to 35 in Rawalpindi this year. However, the Rawalpindi administration maintains that only 12 people have lost their lives due to the dengue fever this year.

Shah Saood, a 16-year-old resident of Wazir Town, Rawalpindi is also suffering from dengue fever. He says, when he was taken to Benazir Bhutto Hospital (BBH) by his family members, a large number of the patients were waiting for dengue tests. He added that the hospital staff informed him that he would have to wait for at least an hour for his turn.

"My brother is a nurse. He took my blood sample himself and ran the lab tests. The results showed that I had dengue fever", he adds.

He says when his family showed his report to the doctors at BBH, they prescribed some medicines and advised his family to take him home, due to a shortage of beds in the hospital.

The doctors told them that better care and treatment was possible at home as compared to hospitals in the current situation.

The three public hospitals of Rawalpindi have 800 beds. Out of these 650 are currently occupied by dengue fever patients. The Pakistan Red Crescent Society has provided 107 beds for dengue patients at their Rawalpindi centre.

The provincial government has issued directives to the private medical laboratories to carry out blood CP test for Rs90 only and to give 35 percent discount on other medical tests required for the dengue virus diagnosis.

The Rawalpindi administration has also started mobile health units that travel across the district -- mostly to the areas where dengue fever cases have been reported and conduct dengue tests. The dengue patients are sent to the hospitals for treatment.

To overcome the burden of general patients, the administration has established 10 filter clinics in Rawalpindi. The filter clinics conduct dengue tests and if a patient is diagnosed with dengue fever he is sent to the hospital.

"They have 100 beds for the dengue patients at their Rawalpindi centre. 50 of those are occupied. 4 medical team from the Holy Family Hospital is looking after this centre and providing treatment to the dengue patients," says Nadeem Iqbal, the director of Pakistan Red Crescent Society.

Iqbal says that the people should cooperate with the Health Department officials during fumigation and surveillance visits.

According to the Ministry of National Health Service, Regulations and Coordination, more than 21,000 dengue cases have been reported across the country. 4,800 dengue patients were reported in Islamabad followed by 4700 in the Punjab. The number of dengue patients reported in Khyber Pakhtunkhwa is 4,300; whereas, 3,600 patients have been reported in Sindh, and 2,700 in Balochistan. 800 dengue fever patients have been reported in Azad Jammu and Kashmir. The dengue cases reported in Rawalpindi and Islamabad make up more than 40 percent of the cases reported from across the country.

"More than 120 patients are diagnosed daily in various hospitals in Rawalpindi. The administration is doing its best to control dengue fever but it cannot be eliminated without the support and efforts of the entire community," says Dr Sohail Ahmed, CEO of District Health Authority Rawalpindi.

He says people should keep their surroundings clean. Standing water and used tires provide breeding grounds for mosquitoes.

He says he expects the ‘dengue season’ to continue till the mid of December.

Dr Amir Sheikh, a health professional, says that several factors have aggravated the dengue situation this year in Rawalpindi. These include the weather, dense population and development projects.

"Green belts and graveyards of the twin cities are breeding places for the dengue mosquito. A dilapidated tomb can host billions of mosquitoes. Underground water tanks at under construction buildings are also providing breeding ground for mosquitoes," he says.

Dr Amir says that 90,000 dengue cases were expected in Rawalpindi alone had the administration not taken the matter seriously.

"The efforts of the district administration, especially the Health Department, have helped," he says.

"The disease can be controlled through awareness among the masses. Dengue fever cases have been reported mostly from underdeveloped areas of the city. The people do not take care of the graveyards and open spaces which turn into breeding place for the dengue mosquitoes," he adds.

"20,000 cases of dengue fever have been reported across the country. More than seven thousand patients have been discharged from hospitals in twin cities after treatment," says Dr Rana Safdar, the focal person for dengue fever at the National Institute of Health.

A senior government official in Rawalpindi speaking on the condition of anonymity says that two union councils of Rawalpindi, Gulzar-e-Quaid and Dhok Munshi were affected by dengue epidemic.

"These two union councils are located in Potohar Town. The deputy commissioner is responsible for these. The Health Department did not work properly to prevent the dengue situation from worsening. After dengue fever cases were reported from these areas, the district administration deputed all their manpower there. Dengue fever spread to other areas of the city due to the lack of proper surveillance", he says.

"The ministry has established a centralised data-base to collect authentic information about dengue patients reported across the country. This data will be helpful for research and pro-active measures to control the dengue in future," says Sajid Hussain Shah, the spokesperson of the Ministry of National Health Service, Regulations and Coordination.

"As soon as a dengue case is reported in any hospital of the country, the database is updated and a surveillance team immediately visits the area to fumigate it to prevent other residents from getting dengue," says Shah.

He says that 40 percent of all dengue cases in the country have been diagnosed in Rawalpindi and Islamabad, and most of these have been reported from underdeveloped areas in these cities.

"Every year, an outbreak is reported from a different place. It is possible that next year some other part of the country would be the most-affected. Research is being done to understand the trends," he says.