Broken Systems Within Balochistan

Broken Systems Within Balochistan
It’s not possible to fix the unfixable. This is the mantra I heard constantly in the distressed districts of southern Balochistan. Where does one begin when everything has collapsed? Is it unfixable?

This is my second visit to oversee funds raised for relief interventions in Balochistan, since the catastrophic rains and floods in the province. The incessant rains have brought misery to so many here. In a first, the incessant rain did not stop for 100 hours with only a few hours of intermittent relief. There was no electricity for eight straight days. The administration did not think it wise to restore it in fear of the electrical wires strewn about would kill and injure lives.

This time, my relief work took me to Naseerabad, Jaffrabad, Usta Muhammad Sobatpur and Jhal Magzi. The entire area looks broken and reflects the spirit of the vulnerable whose lives are already hanging by a thread. The population density in these areas varies; Naseerabad has 500,000 citizens, Jaffrabad has 500,000, Usta Muhammad has 185,000, Sobatpur 200,000, and Jhal Magzi 149,000.

The 2017 census states the area has approximately 160,000-170,000 people. These numbers must be taken with a bucket of salt when one factors in the galloping birth rates, evident if one travels to these parts. The lack of CNIC for women doesn’t provide us with an accurate census. Each family has a minimum of 5-8 children. Some 90 percent of the population is poor.

These observations clearly do not tally with the province’s population profiles.

Balochistan’s 2021 budget passed by the Balochistan Assembly was approximately Rs550 billion. With a federal transfer under the National Financial Commission award of Rs314 billion, thereby giving them a deficit of Rs245bn. The province does not raise enough direct taxes. There is no industry or industrialization nor formal businesses under local taxation. Pakistan does not tax its agriculturalists. I am unaware whether taxes are collected in Balochistan.

The expenditure on government salaries is approximately Rs340 billion. This is the exact amount of the NFC award. The health budget of 2021 was Rs33 billion -- give or take 10 percent of the NFC award or 5 percent of the overall provincial budget.

There is no money to spend on the people of Balochistan after salaries of government officials are dispatched. No wonder, when the calamity of this proportion hit southern Balochistan, the district health quarters and the basic health units were unprepared to help the most vulnerable.

At the federal level, all we hear is climate change and reparations for first world emissions causing this ‘natural disaster’. There has been no basic social infrastructure for these citizens who are already deprived of the most basic human needs. There are practically no health services for the healthy citizens, let alone those who are vulnerable.

Speaking to health officials in southern Balochistan, each DHQ has 42-46 doctors on the payroll. Official records reveal these districts have 400-500 people on the payroll, including general staff. However, when the calamity hit, barely three or four doctors were physically present in each of the districts.

A lady doctor at a relief camp said, “There are no bathrooms in our basic health units. Where should we go while at work?”

No one can work in these conditions. She added, “We are not given decent or safe housing or transportation.”

This aside, the renumeration expectations of well-qualified doctors do not meet what government offers its health officers. After getting a 5-year MBBS degrees and some qualify with further specialised skills, few want to live in such awful conditions.

There are even fewer female doctors than male, and frankly the need is the other way around acutely.

One doctor shared, “Lady Medical Officers (LMOs) are also expected to go to court for evidence and travel to remote towns on many criminal cases. They are expected to conduct autopsies for evidence in the most unsuitable social environments.”  This aspect of the job is a very serious deterrent for lady doctors in our social cultural environment in south Balochistan”. To address this hindrance in Khuzdar district, the administration removed this expectation from the LMOs. They allocated such tasks exclusively to male doctors. This has had some positive impact on incentivizing women doctors to attend their duty posts. As a result, the attendance of women doctors has increased in Khuzdar.
At the federal level, all we hear is climate change and reparations for first world emissions causing this ‘natural disaster’. There has been no basic social infrastructure for these citizens who are already deprived of the most basic human needs.

The absenteeism is not restricted to the quality of living conditions in these duty stations, but also a sense of entitlement. I heard numerous stories of fake degree doctors or nepotism playing a key role in hiring practices. The doctors on payrolls are inadequately qualified or not interested in working for their salaries. There have been instances of arrests, raids and even attempted removal of such doctors. But the ‘system is rigged’ where powerful forces intervene to occupy positions that are meant for specialized individuals. Medical officers who refuse to play this game are ridiculed and set aside. These are statements from those who have worked in this system.

I can believe this to be true, simply because this malady exists throughout the country.

Many of the medical officers seek donor funded programs where their salaries are topped up. This incentive spurs some to work for the communities outside of the BHUs and DHQs.

One LMO explained that many kinds of medicines are sold in the market. Therefore, vigilant monitoring is necessary. Still, the primary need is for more doctors’ to be present in the distressed districts.

Many I spoke to acknowledged taking money without carrying out the services was immoral, but justified it by saying no one was going to give up a free salary. This attitude is alien for me, but it’s pervasive.

This is a gloomy picture, but every cloud has a silver lining. Amid this doom there have been individual health practitioners, who have come and provided free medical services.

I can now understand why bathrooms have not been built. Peoples’ apathy towards hygiene needs to be addressed in an immediate way.

The 2022 rains and the back flooding from Sindh and Punjab canals on southern Balochistan created a health crisis which is unimaginable. Many described how first, the rains came, and came again, and then the flooding from the overflow of the canals flooded swathes of land and hamlets. Then the breaking of water gates from Punjab flooded them again. This did not end because the blocking of the water flows towards Sindh caused a back flow of reflooding of areas a fourth time.

The flooding in these areas happened four times and they expect one more flooding from Sindh draining their waters towards Balochistan.

With little safety net systems on the ground and ghost health systems, thousands were left with insufficient health workers to provide the first response to the repeated calamities.

Three months after this humanitarian crisis, compounded by the lack of social safety infrastructure, the expectation remains ‘someone else will come to our aid’. Despite the meagre external funding for Balochistan’s relief efforts, there is no indication at any policy levels that reforming this sector is on the agenda.

Naseerabad division is the most fertile region of the province. It is a canal-fed bountiful oasis. Why are the people here so starved and poor? If I compare them with their northern folks, the difference is stark. Northern Balochistanis live in much harsher water deficit physical environments, but socially, and economically more resilient. This in no way suggests northern Balochistan is not deprived of all public amenities. The citizens in the north are better fed, better educated and more economically resilient.

Will this particular social upheaval spur social mobilisation towards self help? Who will take the responsibility to build resilience in these vulnerable populations? Do we want them to rise above subsistence living? Are the numbers too little to care?

The thousands I saw on this trip, did not have the energy levels to survive without assisted food or medical supplies. We can ignore this humanitarian injustice in the name of climate injustice but for how long?

I am a firm believer in the social mobilization model of the rural support programs. But when people are reduced to this level of deprivation for generations, stripped of dignity, basic human living standards, the expectation for self help is not directed at the vulnerable, but towards those who claim to care, about our province and represent with aplomb, this vast land.