‘Only a mother knows how this pain feels.’
Nine months after devastating floods, many areas remain underwater in Pakistan, and an impending rainy season is approaching. As threatening heat waves advance, it is the mothers and children on the frontlines of climate change who take the heaviest toll.
The patio of Kamli's house is the only place to take respite against the scorching heat. Its walls were rebuilt after the devastating floods that swamped Pakistan's village. Kamli lost her home and her only source of income — cotton picking on the once fertile lands. She survived for more than two months in temporary camps set up on the roads in Umarkot in the Sindh Province.
''We live with fear in our bodies, with the anxiety of not knowing when the next disaster will be. This is the only land I know. My ancestors are from here, we work this land, and I want to stay here. There is no other option,'' Kamli says under the watchful eyes of her daughters.
Her life was not easy before the floods. Kamli became a widow with seven children to feed when her husband died of liver disease four years ago. In 2011, she had experienced the nightmare of flooding while six months pregnant and had to be evacuated to give birth at a relative's house. After the rains her children had to work in the cotton fields, only making 50 USD a month to support the entire family. ''When it gets really hot, you barely have the energy to move',' she says while coughing.
Despite her youth, Noor, 22, has lost two babies. Her first baby passed away due to complications during her first pregnancy, and her second child was only three days old when she died during the devastating floods that hit Pakistan in August 2022. Noor is now four months pregnant and prays that her third child will survive the harsh weather conditions of the Asian country.
Turbulent rain and flooding destroyed her house in the Sindh province, and in the middle of the night, Noor had to be evacuated with the help of community members in a makeshift, improvised boat. Days earlier, Noor gave birth at home with the help of a midwife. Only three days later, her baby stopped breathing. “I was barely eating during the rains and couldn’t breastfeed. We buried my baby a few meters from home. It was still raining.”
Eight months after the disaster, Noor continues to live under a tarp. She represents a whole generation of mothers fighting for survival and for the survival of their children amid an unprecedented climate crisis in Pakistan.
In the monsoon season last summer, Pakistan was hit by its worst floods in over 100 years. During almost three months, heavy rains left one-third of the country underwater. The rainfall — nearly three times the national 30-year average — killed at least 1,739 people, including 647 children, and affected 33 million people. Homes, schools, medical infrastructure, fields, and crops were destroyed during the floods.
The impact of climate change, including floods and heatwaves, is threatening the health of mothers and children in Pakistan. In Pakistan, pregnant workers like Noor, face the increased risk of heat stress, as physical labour in high temperatures can require greater physical exertion and therefore increase the core body temperature — putting the mother and baby’s life in danger.
Benazir, 30, mother of six, stares blankly at the standing water around Balouch Zardari — a village in the Sindh province. She recounts the hardships of her life before the rains. “We did not have access to drinking water, and our children were hungry due to the lack of food. Now everything is more difficult. My husband works when he can in the banana plantations and earns around 200 or 300 PKR (3.50 USD a day). With that, we must feed six children. We can only afford bread and a little chilli for one meal a day. We have more mosquitoes and diseases, and the health centre is 15 kilometres away. We are fighting to survive. Day after day,” she accounts through her tears.
Last summer, in the middle of the rains, Benazir’s nine-month-old girl perished while they were hitchhiking in a wagon on the way to a hospital. Her older sister, Uzma, 8, has been forced to drop out of school and work in the fields to help feed her family. A nutrition emergency is threatening the lives of millions of children. More than 1 in 9 children in flood-hit areas are suffering from severe acute malnutrition — a life-threatening condition.
In total, close to 1.6 million children in flood areas could be suffering from severe acute malnutrition and are in need of urgent treatment. An estimated 7 million people, mainly children, adolescent girls, and pregnant and breastfeeding women need immediate nutrition support.
Son Bhari, 55, takes care of her grandson, Sahil, whose life was in danger just a few days ago. The eight-month-old boy suffers from severe acute malnutrition and is receiving treatment thanks to a UNICEF-supported malnutrition program.
Sahil will receive two packets of ready-to-use therapeutic food per day, for one month. The RUTF (ready-to-use-therapeutic-food) is a home‐based treatment for severely malnourished children between six months and five years. If the treatment goes well, he will start gaining weight and strength thanks to the vital nutrients it contains.
The heat and the lack of food have caused enormous emotional and physical stress for Sahil’s mother. “My daughter is in hospital. She suffers from anaemia, is unable to breastfeed, and had complications after giving birth. I hope she returns soon. Her baby needs her,” says grandmother, Son Bhari, as she feeds Sahil one of the packets made of peanut paste.
Pakistan is the fifth most inhabited country with a population of over 240 million people. Despite causing under 1% of global greenhouse emissions, according to the U.N. Framework Convention of Climate Change 2021 report, Pakistan is one of the countries most vulnerable to climate change. Extreme heat is breaking records in Pakistan and putting enormous pressure on the health and livelihoods of vulnerable Pakistani communities. Last Thursday, June 1st, the temperature in the Sindh Province reached 47 degrees Celsius.
Dr. Ayesha Jameel works as the head of the Kotla Eason Health Center in South Punjab Province. The activity in the small center is frantic, and despite the heat, about twenty mothers, many of them pregnant, wait their turn while fanning themselves with their veils.
''Sadly, newborn deaths and serious complications during pregnancy are part of our work. There is no doubt that climate change is wreaking havoc on the health of mothers. Many have no other option than to go back to work in the fields under the sun after a week of giving birth. The minimum amount of rest we recommend is three months of rest so that their body can recover," she says from her office.
‘‘Mothers have a survival instinct to save their children’’
Shahida, has four boys and two girls. She almost lost her 10-month-old little girl, Ayat, during the rains of 2022. She had to be evacuated in an ambulance from her flooded house, with the help of her husband, to give birth.
''I was terrified. As a result of stress and anxiety, I lost consciousness. I could not breastfeed my little girl and felt very weak. It was so hot. It was a nightmare. I do not remember anything.''
Shahida suffered from anemia and malnutrition, and her dizziness was due to her high blood pressure. For three days, her husband and one of her daughters had to hold the child close to her chest to save her life. ''It's a miracle she's here and I love everything about her''.
The raising average temperatures and increase in frequency, intensity, and duration of heatwaves are exposing populations in the country to heat stress, which is contributing to significantly negative health outcomes, particularly for infants, children, and pregnant women. Heavily pregnant women — those in their second and third trimester — are considered acutely vulnerable to extreme heat due to physiological changes that occur during pregnancy.
Mothers who work for hours under the sun and at more than 40 degrees Celsius are exposed to high levels of dehydration. "This added to the extreme heat, can lead to serious problems in the development of the fetus and higher risk of early contractions, high blood pressure, seizures, hypertension, and maternal stress," says Dr. Jameel.
Nasreen Bibi was pregnant with twins before the rains came. The nurses from the health center where she gave birth helped her to deliver the first baby. Due to complications during childbirth, she was referred to the Rajanpur hospital, where she gave birth to the second baby in the early morning. Sadly, none of her babies survived.
The first died hours after birth, and the second suffered from severe malnutrition and frequent diarrhea, which presumably caused his death five months after birth. "My body couldn't take it anymore. I couldn't breastfeed my son, who got sick, and in a matter of days, he stopped breathing," she says.
Nasreen has been back at work for a few weeks. The lands where she works have started to recover after the floods. Every day she takes her six months old baby to the fields and takes breaks in the shade to breastfeed and drink some water. Forty days after giving birth, she was back in the fields.
The historic floods damaged most of the water systems in affected areas, forcing more than 5.4 million people to rely solely on contaminated water from ponds and wells. Even before last year’s monsoon season, only just over one-third of water in Pakistan was considered safe for consumption. Women and young girls in Muhammad Pur Ghamand village, South Punjab, must fetch contaminated water daily from a pond after the water tap in their village was damaged by the floods.
Climate-related crises do not affect everyone equally. Mothers and children will suffer more than adults, with those in the poorest communities bearing the biggest burden. The scale of devastation is unlike anything we have seen before in Pakistan. It will take months, if not years, for Pakistan to recover. For Pakistan, it is not a question of whether another large-scale climate disaster will strike, but when.
Bherawaan, a mother of seven, gave birth in the darkness at home as rains forced all her neighbors to leave their homes.
“Only a mother knows how this pain feels. Who knows what our destiny will be?”