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Pakistan floods: ‘It’s like fighting a war with no end’

Pakistan’s worst floods in years have left millions homeless and lacking clean drinking water.

More than 2,000 hospitals and health centres were damaged or destroyed in recent floods in Pakistan – and families and their children are battling malnutrition and infection in what’s now a public health emergency.

Doctors like Ammara Gohar are on the front lines of the crisis as the UN launches a fresh appeal for the world to send more aid.

“It’s very difficult for us. We attended to patients during Covid, but this is tougher because it involves environmental hazards,” says Dr Ammara, a gynaecologist four years into her medical career.

She is working out of a school in rural Sindh province, the area worst affected in the floods, which has temporarily become the headquarters for the district health office after it was submerged.

Here, Dr Ammara and her team load a van with boxes of medical supplies – everything from bandages to malaria tablets, hepatitis test kits to oral rehydration salts.

“We’re taking this to people who’ve been completely cut off since the floods,” she explains.

Pakistan flood survivors battle rising tide of diseasePakistan floods: Images show huge scale of devastation

With around 75% of districts in Sindh province still flooded – and many roads underwater – the only way people in isolated communities can access medical help is if it travels to them.

So after an hour’s drive, we reach the banks of a huge lake which a few months ago was fertile land that fed people in this area. Having swallowed their crops, it’s now stagnant water where mosquitoes multiply, and a breeding ground for disease.

Across the vast expanse live villagers who’ve been stranded for weeks.

“These people cannot survive without support in disaster-hit areas,” Dr Ammara tells us.

Her team of government doctors take to wooden boats to reach them, their efforts supported by the United Nations Children’s Fund (Unicef).

“This is a medical crisis,” Unicef’s Aadarsh Laghari tells us, as the medical team paddle to a village needing help. “Access is one of the biggest problems – every day the medical needs of these communities are rising.”

 

In the first three weeks of September alone, more than 140,000 cases of malaria were reported in Sindh, health officials say. But with many people in far-flung areas unable to get tested, it’s likely the true scale is much higher.

And that’s why mobile medical units are so urgently needed.

After we reach the shore, the team set up a health camp under the shade of a tree on the edge of the village, where cows had earlier been taking shelter from the sun.

A banner is hung from the branches to advertise the clinic; supplies which had been carried here by land and by water, are now being unpacked and laid out on plastic tables.

As a tannoy announces the arrival of the medical staff, a steady stream of villagers arrive, many of them women carrying young children. The village of Noor Shah was already impoverished but the floods have pushed people right to the edge.

 

As patients line up, a nurse measures the arm of baby Saima, with Dr Ammara looking on. The tape wound around her tiny arm moves to the red area of the scale, indicating that Saima is perilously thin.

“There are so many people like this baby,” Dr Ammara says. “At just nine months old she’s severely malnourished.”

Many families are sleeping in the open in flimsy tents next to homes which were washed away, or have crumbled to rock.

Marooned for weeks, they’re finally getting much needed medical help – but many say they’re still waiting to get food and access to clean water to drink and wash with.

At another village close by, three-year-old Gulbahar is examined by Dr Ammara. He has scabs on his face and body and is weak – the result, Dr Ammara says, of drinking and washing with contaminated water.

The UN says a lack of toilets has left people with no choice but to defecate in the same water, leading to outbreaks of illnesses.

“Because of the floods we are seeing so many young children with these skin infections,” Dr Ammara says, opening Gulbahar’s mouth to examine his diseased gums.

She hands his mother some medicines, but concedes her supplies will soon run out.

 

While diseases spike, Pakistan’s already overwhelmed healthcare system lacks the resources to help all those who need treatment. Boats are also in short supply, as are doctors – meaning efforts like this remain limited.

Many people we met in these remote communities blame the government for not doing enough.

Dr Azra Afzal Pechuho, the Sindh health minister, said: “It’s like fighting a war which has no end to it. Until the water recedes, which is going to take another two, three months, we will still be seeing a lot of health issues.”

She has called for doctors to volunteer extra hours.

“Ten days, three days, four days – whatever they feel they can give to the flood-affected areas,” she told the BBC.

Dr Ammara and her team are already working around the clock.

Without the camps, Dr Ammara fears people won’t be able to survive.

“It hurts, it really hurts, I can’t see people like this,” she says. “I feel bad that we can’t do more.”

Pakistan’s worst floods in years have left millions homeless and lacking clean drinking water. 

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Ukraine war: Kyiv secures a bridgehead across the key Dnipro River, reports

But military experts warn that advancing from positions across the Dnipro could be very difficult.

Ukrainian troops have set up positions on the east bank of the Dnipro River in southern Kherson region, reports say.The region is partially Russian-held and crossing the river could be significant in future offensives.The US-based Institute for the Study of War says Russian military bloggers have posted “enough geolocated footage and text reports to confirm” the advance.BBC Ukraine says its military sources have reported a “certain movement across [the] Dnipro” near Kherson city.

Ukraine’s military has not confirmed the movement, while Russia has denied the reports.But if the reports that Ukraine has secured a bridgehead on the east bank are correct, it could be significant in helping Kyiv drive Russian troops back.A Ukrainian advance in the area could, in the future, even cut the land corridor to Ukraine’s Crimea peninsula, annexed by Russia in 2014.However, military experts say any Ukrainian troop movements in the bridgehead area – which is crisscrossed by floodplains, irrigation canals and other water obstacles – would be a tough task.And Ukrainian advances would be further complicated by Russia’s significant advantage in the air.

Ukraine’s military has for some time publicly spoken about preparations for a major counter-offensive, without specifying where and when it could be launched.Until now, all of the Kherson region on the east bank of the Dnipro has been under Russian control, with the wide river serving as a natural barrier.The regional capital – sitting on the west bank – was liberated by Ukrainian forces last November.Celebrations as Ukraine takes back key city KhersonPutin visits occupied Kherson region in UkraineIn Sunday’s report, the Institute for the Study of War (ISW) said “geolocated footage published on 23 April indicates that Ukrainian forces are operating in areas north-west of Oleshky on the east” bank of Dnipro.

The ISW added there was not enough information to analyse the scale of the reported Ukrainian advance – or the further intentions of the Ukrainian military.On Monday, Russia’s WarGonzo military blogger reported that Ukrainian troops were “trying to gain a foothold on Bolshoi Potemkin [Velykyi Potyomkin – Ukrainian] island”, which is located between the new and old channels of the Dnipro.

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India’s population will surpass China this week, according to UN

Last week, a different UN body said the milestone would be passed later in 2023.

India is expected to overtake China as the world’s most populous nation by the end this week. A different UN body predicted last week that India would surpass China by the middle this year. The Asian nations have accounted more than a quarter of the global population since over 70 years. The UN’s Department of Economic and Social Affairs said in a press release that “China will soon relinquish its long-held position as the world’s largest country”.

The UN Population Fund said last week that India would have 2.9 million more people than China by the middle of 2023. China’s birthrate has dropped recently, and its population shrank last year for first time since 1961. India’s population will continue to grow for several decades, it said. However, fertility rates in India are also dropping – from 5.7 babies per woman in 1950, to 2.2 today. In November, the world population reached 8 billion. Experts say that the growth rate is slower than it used to be, and is now at its lowest level since 1950.

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Scientists are concerned about recent rapid ocean warming.

There’s growing concern that the oceans are heating up quickly – and scientists are unsure of the implications.

It has never warmed up this much, so quickly. Scientists don’t fully understand why. But they worry that, combined with other weather events, the world’s temperature could reach a worrying new level by the end of next year. Scientists do not fully understand why it has happened. But they are concerned that combined with other weather conditions, the temperature of the planet could reach a new alarming level by the end next year. They are less efficient in absorbing planet-warming gases.

In the last 15 years, Earth’s heat has increased by 50 percent, with the majority of that extra heat going into the oceans. This has real world implications – not only was the temperature of the oceans a record in April, but in some areas the difference over the long term is enormous. Image source: Getty ImagesIn march, sea surface temperatures along the east coast of North America reached 13.8C above the 1981-2011 average. Karina Von Schuckmann, lead author of the study and oceanographer with the research group Mercator Ocean International, said: “It is not yet clear why such a rapid and huge change is occurring.”

“We have doubled heat in the climate system over the last 15 years. I don’t think this is climate variability, but it could be. We do see the change. “An interesting factor that could influence the level of heat entering the oceans is a reduction in shipping pollution. In 2020, the International Maritime Organisation implemented a regulation to lower the sulphur in fuel burned by ships. This has had an immediate impact on reducing the amount aerosol particles released in the atmosphere. Aerosols that pollute the air also reflect heat back into the space, so removing them could have caused more heat to reach the oceans.

The average surface temperature of the oceans has risen by 0.9C since pre-industrial times, with 0.6C of that increase occurring in the last 40. This is less than the rise in air temperatures on land which have increased by 1.5C. Oceans absorb heat much deeper than land and require more energy to heat. This has real-world implications. It is especially damaging to coral reefs. Extreme weather will increase as heat from the upper ocean surface increases hurricanes and cyclones. This means they become more intense and longer-lasting.Sea-level rise: warmer waters take up more space – known as thermal expansion – and can greatly accelerate the melting of glaciers from Greenland and Antarctica that flow into the oceans.

This increases global sea levels and increases the risk of coastal flooding. Warmer water has a lower ability to absorb CO2. The oceans will absorb less CO2 if they continue to warm. This will lead to more CO2 accumulating in the atmosphere, further warming the air. “The Australian Bureau model strongly suggests a strong El Nino.” Hugh McDowell, from Australia’s Bureau of Meteorology, said that the trend has been in that direction and that all climate models have been trending towards a stronger event. Mr McDowell warned that predictions are less reliable at this time of the year.

Other researchers are more optimistic. Experts believe that a fully-formed event will follow. “If we have a new El Nino on top of that, it will probably cause an additional global warming of 0.2-0.25C,” Dr Josef Ludescher from the Potsdam Institute for Climate Research said. “The impact of El Nino is reduced a few months following the peak. This is why 2024 is likely to be the warmest year on record. “Image source, Anadolu Agency.” And we may, we’ll be close to 1.5C and perhaps we’ll temporarily go over. El Nino is likely to disrupt weather patterns in Australia and around the world. It will also weaken the monsoon. There are also more fundamental concerns that as heat is absorbed by the oceans, they may be less able store excess energy.

One scientist described being “extremely stressed and worried”. Karina von Schuckmann says that some research has shown the world warming in jumps. Little changes over years are followed by sudden leaps upwards. After El Nino subsides, temperatures may drop again. She told BBC News that “we still have a window of opportunity to act and we should take advantage of this to reduce the effects.” Graphics by Erwan RIVALL.

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Wagner in Sudan: what have Russian mercenaries done?

The Wagner group denies involvement in the current conflict, but there’s evidence it has previously been active in Sudan.

Russian Wagner mercenary forces are accused of having commercial and military ties with Sudan. However, the group denies involvement in the current conflict. Yevgeny Praighozin, who has close ties to President Vladimir Putin, has stated that “not one Wagner PMC [private company] fighter has ever been present in Sudan”. We have found no evidence of Russian mercenaries currently inside the country. There is evidence of Wagner’s previous activities in Sudan. Mr Prighozin’s operations in the nation have been targeted by US and EU sanctions. Gold-mining DealsIn 2017, Sudan’s former President Omar al-Bashir, during a trip to Moscow, signed a number of deals.

These included an agreement to establish a Russian naval base at Port Sudan along the Red Sea as well as “concessions on gold mining” between Russian company M Invest, and the Sudanese Ministry of Minerals. The According to a CNN investigation, gold was transported overland into Central African Republic where Wagner operates – exports that were not recorded in Sudanese trade data.

The BBC has not independently confirmed these images. In 2021, a Wagner linked Telegram channel published photos of an unnamed top Wagner leader awarding Sudanese soldier memorabilia during a ceremony that took place two years earlier. TelegramAnd, in July 2022 this channel distributed a clip allegedly showing Wagner’s mercenaries performing par The same source linked the Instagram profile of a Russian mercenary who called himself a “freelancer”. He shared stories of his exploits on Sudan in posts dating from August and Oct 2021. How influential is Wagner? The US Treasury claims that the Wagner Group has been involved in “paramilitary activities, support for maintaining authoritarian regimes and exploitation natural resources”. The relationship between the Royal United Services Institute and the UK-based Royal United Services Institute has grown since then.

“In 2018, they had around 100 men actively training Sudanese forces,” says Dr Joana De Deus Pereira from the UK. Sudanese media reported that the number grew to 500 and that they were mainly based in the south-west, near Um Dafuq and close to Sudan’s borders with the Central African Republic. According to Dr Samuel Ramani who wrote a book on Russia’s activities throughout Africa, the Wagner Group created its own media campaigns in order to keep President Bashir in power. Image source: AFP. This caused friction with the president’s security forces and Wagner switched its support to General Abdel Fattah al-Burhan, who overthrew him.

Dr Ramani says that while the Foreign Ministry in Moscow opposed the coup, Prigozhin, and the Wagner Group, welcomed al-Burhan’s takeover. According to Dr Ramani it was between 2021 and 2022 when the Wagner Group increased their connections with the Rapid Support Forces, which is currently fighting Sudan’s regular army led by Gen Burhan. Mr Pri “Wagner had links with both General al-Burhan and Mr Hemedti in different degrees and ways,” she says. Wagner’s presence in AfricaWagner fighters are widely reported to be in the Central African Republic for several years, guarding diamond mines in the country, as well in Libya and Mali. 

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Sudan fighting: Foreign nationals and diplomats evacuated

Several countries are helping their citizens leave the capital, Khartoum, following a week of fighting.

Several other countries have also started organising evacuations, starting on Sunday. France, Germany Italy and Spain have also started organising evacuations. A vicious power struggle has caused violence throughout the country. The UK government was able to airlift British diplomatic staff and their families out in a “complex” and “rapid” operation. Foreign Minister James Cleverly stated that options to evacuate remaining British nationals were “severely restricted”.

The German army reported that the first of three flights had left Sudan bound for Jordan with 101 people aboard. Italy and Spain evacuated citizens – the Spanish mission included citizens of Argentina, Colombia, Ireland Portugal, Poland Mexico, Venezuela, and Sudan. Canada’s Prime Minister Justin Trudeau announced his government had evacuated diplomatic staff. More than 150 people were evacuated to the Saudi Arabian port Jeddah by sea, including citizens from Egypt, Pakistan, and Gulf countries. Many foreign students from Africa, Asia, and the Middle East have also been trapped in Khartoum. They have made desperate calls for assistance.

The US announced on Sunday that a disaster response team will be sent to the region to “coordinate humanitarian response to those in need, both within and outside Sudan.” “Samantha Power, from the US Agency for International Development(USAID), said that the team would initially work out of Kenya and give priority to getting “life-saving humanitarian assistance to those in need.” The World Health Organization reports that the fighting has injured thousands and killed more than 400.

The death toll may be higher than 400, because people are unable to access healthcare due to the closure of most hospitals in the city. The fighting has also affected the western region of Darfur where the RSF was first formed. The UN has warned that 20,000 people, mostly women and children, have fled Sudan in search of safety in Chad across the border.

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