At least 139 children died of waterborne disease in January in Pakistan's impoverished desert district of Tharparkar, which has been devastated by drought since 2013.
Civil society groups and opposition politicians say the Sindh provincial government’s response to the crisis has been insufficient to prevent widespread hunger and disease.
"We have not seen any benefits, despite government claims,” said Kamla Bibi of a local civil society group called Thardeep.
Nisar Khuhro, the provincial government spokesman, admitted there were problems, but told IRIN that needs were being "urgently addressed".
Yet, four years into the crisis, farmers are still in need of seeds and fertiliser, according to preliminary data in an unpublished report being prepared by the Pakistan Food Security Cluster, which is led by the United Nations Food and Agricultural Organization and the World Food Programme.
New irrigation systems also need to be built and old ones repaired, according to a draft of the report obtained by IRIN.
Officials from the FAO and WFP cautioned that the survey results have not been finalised and that the findings of the report could change. But there is no doubt that people are suffering as harvests fail and livestock die.
This is especially true in the hard-hit southeast of Sindh province, where Tharparkar is located. Although 96 percent of households surveyed said they had received food assistance during the preceding two years, 90 percent said drought had adversely impacted their food consumption.
“It can be safely concluded that food deprivation caused by the drought in the southeast is increasing and worsening malnutrition, especially among children, pregnant and lactating women,” says the draft report.
In addition to lack of food, 68 percent of households surveyed in Tharparkar reported that they drew water from potentially unsafe sources, which exposes them to diarrhea that can cause malnutrition and vice-versa. The conditions “can be linked in a vicious cycle amongst children,” according to the World Health Organisation.
According to a 31 January report by Alhasan Systems, a company that specialises in gathering humanitarian data, at least 139 children died in Tharparkar in January. Alhasan Systems attributed the deaths to a combination of drought-related disease and poor access to healthcare.
Asha Bibi, who heads a local civil society group called Polki, said his organization also counted at least 100 deaths from hospital records, but he told IRIN that it was possible that adults or other children were dying.
“These are the children who die in hospitals,” he said. “There could be other deaths occurring in small hamlets and villages which we know nothing about.”
The survey carried out by the Food Security Cluster highlighted that access to healthcare is a major problem in the region. The average distance people must travel to health facilities in Tharparkar is 17 kilometres. Out of the nine districts surveyed in Sindh, researchers found: “Households in Tharparkar travel the longest distance on average to access healthcare services.”
Even if a sick person makes it to a clinic, they may not receive adequate care. There are only 298 doctors in the district, which is home to more than 1.3 million people, while more than 215 village dispensaries that sell medication and sometimes provide minor healthcare are “non-functional”, according to Alhasan Systems.
The deaths of children in Tharparkar have sparked fierce debate in the provincial legislature. Opposition members proposed in the 28 January session that the government require new doctors entering the public health system in Sindh to work for a period of time in Tharparkar.
Khuhro, the provincial government spokesman, told IRIN that the government is committed to improving health facilities, although he did not provide details of the plan.
“We are doing everything we can to improve conditions at hospitals,” he said.