Pakistan Bulletin
An up-to-date and informed analyses of key issues of Pakistan.
Forced Migrations and Immunization in a Warming World: Navigating Pakistan’s Climate-Driven Healthcare Challenges
July 2024
Pakistan’s climate change concerns have caused problems in the country’s immunization drive against infectious diseases.
Pakistan, despite contributing less than 1% to global greenhouse gas emissions, is one of the many countries facing the dire repercussions of climate change in the form of heat waves, major flooding, and melting glaciers. With the country’s healthcare system crumbling against inflationary pressures and increasing population, the high infant mortality rate poses a major threat to the already overburdened population. According to recent data from UNICEF, poverty, coupled with lack of education and healthcare facilities, especially amongst women, has led to low immunization rates across Pakistan which eventually contribute to under-five mortality rate of 62.5 per 1,000 live births.
Prior to the recent spate of floodings, Pakistan had been at risk of infectious diseases due to poor water, sanitation and hygiene (WASH) infrastructure. According to UNICEF, immunization infrastructure throughout Pakistan suffered one of the biggest hits in 2022 with the displacement of around 33 million people, 16.5 million of whom were children. Coupled with loss to land and lives, the damage to healthcare facilities and vaccination equipment backtracked the immunization programmes in Pakistan. Despite the government’s efforts to increase vaccination rates, immunization coverage in Sindh and Balochistan remains low due to shortages in human resource and mobility constraints in reaching certain areas. Apart from the destruction of vaccination sites, another problem faced by the healthcare sector is the lack of electricity in remote areas and shortage of vaccinators, both of which were exacerbated by the recent flooding. Since many vaccinators belong to low income areas that lack the resources to survive disasters, the ratio of immunization coverage has reduced.
Sindh and Balochistan, two of Pakistan’s major provinces, were severely affected by the recent flooding. The floods destroyed the cold chain equipment essential for vaccine storage, causing immunization sessions to be cancelled and vaccination coverage to drop to an all-time low. This scenario is not unique to just these two provinces. In Pakistan’s Kohistan district in the province of Khyber Pakhtunkhwa, flash floods destroyed health facilities and markets, forcing residents to travel long distances for medical care. Similar situations were reported in Gilgit Baltistan, where floods and heavy rains hindered access to healthcare facilities, disrupting vaccination efforts.
A major driver of population mobility, especially within low income areas of Pakistan, has been the adaptive response to climate change and disasters. Climate change-induced migration often includes forced displacement due to sudden onset of environmental disasters such as floods and cyclones, which can make a place uninhabitable through increased risk to lives and a rise in food and water insecurity. With such vast changes in human migration patterns, the health sector struggles with improving vaccination rates and immunization coverage of children across the country.
Tracking immunization status across provinces with high migration rates becomes a challenge for vaccinators as the child keeps attending different clinics that might not have their record or the family might not be aware of immunization clinics in their new area.
Forced displacement increases the risks of adverse health outcomes, including morbidity and mortality associated with infectious diseases, due to crowding, poor ventilation, inadequate shelter, and lack of basic necessities such as food and water. The ability to migrate depends on people’s access to economic resources and availability and access to land which makes it more difficult for vulnerable populations to relocate quickly in times of a climate disaster. Furthermore, as gender-based violence rises in times of crises, female vaccinators become more vulnerable to attacks in remote areas where anti-vaccination sentiments have resulted in mob attacks on vaccinators. According to a report published by Safeguarding Health in Conflict Coalition (SHCC), about 16 incidents targeting healthcare workers were reported in Pakistan in 2022 and 90% of those involved violence against polio vaccinators. The report also mentioned that the number of incidents that occur are much higher than those that are reported. The attackers not only target vaccination drives and healthcare clinics, but the vaccinators’ homes as well. Hence, safety concerns in the face of violence disrupt vaccination efforts making it difficult to fight the issue of rising child mortality.
Climate change not only forces people to migrate but also makes it difficult for them to access healthcare services, including vaccinations. In Sindh, villages in the Thatta and Badin area have been abandoned as residents move in search of more fertile land. This displacement distances them from local health facilities, negatively impacting the vaccination of their children. Furthermore, during crises, securing food, water, and shelter takes precedence over immunization, making it challenging for service providers to track and ensure displaced children receive their vaccinations.
Furthermore, tracking immunization status across provinces with high migration rates becomes a challenge for vaccinators as children keeps attending different clinics that might not have their record or the family might not be aware of immunization clinics in their new area. Families often relocate to even more inaccessible areas which cannot be reached by service providers due to road infrastructure and mobility constraints making immunization administering and tracking more difficult. Rising temperatures also make it challenging for parents to travel long distances in rural areas to bring their children to vaccination centres without adequate resources. Due to this, climate change becomes a threat multiplier as it magnifies the pre-existing health poverty within low income households making their children even more vulnerable to preventable diseases.
Water-borne diseases during times of floods and heat strokes due to rising temperatures can be another cause for missed vaccinations as the caregivers might not be able to bring the child for their pending vaccines due to difficulty in traveling with a sick child and fear of worsening the symptoms and causing excess distress to the child. Household poverty due to climate induced migration can also reduce immunization rates. As families struggle to make ends meet after a huge financial shock, traveling to clinics for immunization rarely stands top on people’s priority list when the household is struggling with food, shelter, and water insecurity.
As climate change accelerates, it is crucial to develop resilient healthcare systems that can withstand and adapt to extreme weather events. This includes better anticipating and tracking population movements, enhancing infrastructure to maintain cold chain logistics, and ensuring health facilities are equipped to handle increased demand during environmental crises. Using solar powered cold chain equipment can decrease dependence on electricity and prove to be useful for rural areas where the shortage of electricity is high. Furthermore, tracking children through a centralized system of immunization across all provinces is necessary to ensure homogeneity within vaccination records and ease in accessibility of the child’s previous and future vaccination dates.
Public health campaigns must address the socio-economic factors that influence health-seeking behaviour, ensuring that displaced populations receive the necessary immunizations.
Additionally, public health campaigns must address the socio-economic factors that influence health-seeking behaviour, ensuring that displaced populations receive the necessary immunizations. Understanding people’s priorities and behaviour patterns can help tailor policies and programmes which can eventually lead to higher immunization rates. Incentivizing through monetary payments or deadlines can help convince caregivers to immunize their children. Caregivers are often nudged on the basis of receiving a conditional cash transfer or information regarding vaccination outreach programs through vital community members within rural populations or text message reminders. A better understanding of people’s preferences, biases, and behaviours can help implement a more effective system that can finally save the lives of children in Pakistan.
As Pakistan continues to grapple with the ever-increasing challenges of economic instability and multidimensional poverty, an improved and effective healthcare system that safeguards the future and health of the young population becomes a necessity against the backdrop of an increasingly unpredictable global climate.
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