Two weeks ago, Ruqiyya Bibi fell sick. The two-year-old was vomiting constantly; her father, Mohammed Iqbal, took her to a basic health unit in Pir Koh, a impoverished town with a population of 40,000 in the mountains of Balochistan, south-western Pakistan.
Iqbal was told at first that his daughter had malaria but when treatment did not help, he took her to another doctor who said she had a blood condition.
“From Pir Koh to district headquarter hospital in Dera Bugti, no doctor knew she had cholera. No one even knew what cholera is,” Iqbal told the Guardian.
Last Wednesday, Ruqiyya died. According to local sources, as of Saturday 27 people had now died – 18 of them children – in a cholera outbreak linked to contaminated water that began in Pir Koh.
The government of Pakistan has said the official death toll stands at seven and that about 2,000 people had so far been infected, a figure disputed by local activists who claim more than 5,000 people have been taken ill.
As Pakistan experiences a brutal heatwave that has engulfed much of south Asia, Pir Koh is faced with a cholera outbreak and a water shortage crisis.
Mohammed Iqbal was not able to get enough water for his toddler’s funeral rites.
Pakistan’s prime minister, Shehbaz Sharif, has ordered “emergency relief measures” for Pir Koh; the chief minister of Balochistan, Quddus Bizenjo, announced 300m rupees (£1.2m) for the provision of clean drinking water. But people in Pir Koh say they have been left with dirty water for years.
The state-owned Oil and Gas Development Company Ltd (OGDCL) is in charge of purifying the town’s water, which comes from a spring about 26km away, and sending it to people via pipelines.
A muddy and dirty water tank was cleaned by the administration after the outbreak, but local people who spoke to the Guardian said this came too late.
One said: “The state has long left us alone at the mercy of God and it has interests in exploitation of natural resources. When the people were dying, the authorities were absent from the scene.”
When the cholera outbreak began last month, Pir Koh’s hospital was not equipped to diagnose the patients.
The district health officer, Dr Azam Bugti, said that the first case was reported on 17 April but it took another week to confirm the outbreak as samples had to be sent to Pakistan’s capital for testing.
“The water crisis in Pir Koh is decades old, and after a drought the issue was exacerbated. The lack of rain this year has caused nearby ponds to dry up. Animals and people drink the same water here in Pir Koh,” said Bugti.
“We started treating the patients after the test results,” he said. “So far seven people have lost their lives. The situation was soon under control.”
The chief secretary of Balochistan and a World Health Organization team visited the area on Thursday, said Bugti, after an online campaign was started by local students.
Gulzar Bugti – no relation – was home from university in Lahore when the crisis began. He and other students and family members started an online campaign and took to the streets to call for help, accusing the administration of doing nothing.
“People did not have water even for full ablution, the last rite for the dead. There was no clean water to drink and the authorities were not active to devise any emergency plan,” he said.
Bugti and his friends raised money to provide storage facilities and water delivery tankers. He rejected the death toll issued by the authorities, giving a list of 26 names, 18 of them children under seven.
His group says there are about 5,000 cholera patients in Pir Koh – more than double the official figure.
“We demand the government come up with a long-term plan to tackle this humanitarian crisis,” he said.
In a tweet on Sunday, the prime minister told Bugti: “We are working with the provincial government to find a permanent solution to the issue, so that people don’t face this problem again. The projects on clean drinking water will soon be completed.”
Cholera is spread mostly through dirty water and poor sanitation. Especially dangerous to children, it causes rapid dehydration through diarrhoea and vomiting and affects an estimated 3-5 million people worldwide, killing 28,800 to 130,000 people a year. Although it is classified as a pandemic, it is rare in high-income countries.
Pakistan’s minister for climate change, Sherry Rehman, said recently that Pakistan was among the most water-stressed countries in the world, and highly vulnerable to climate stress.
The country’s major dams are at a “dead level right now, and sources of water are scarce as well as contested,” Rehman told CNN, adding: “This is an all-encompassing existential crisis and must be taken seriously.”
