sudden surge in the acute watery diarrhea cases in the early days of March came as a surprise for infectious disease experts at the Aga Khan University Hospital (AKUH) in Karachi. The winter season had just ended in the plains of Sindh and the Punjab, and they were expecting a pleasant spring. To their astonishment, dozens of people daily made their way to the emergency room of the AKUH with health conditions associated in Pakistan with extreme summer.

A similar situation was witnessed at several other health facilities in Karachi, including the Sindh Infectious Disease Hospital and Research Centre, hospitals in Hyderabad, and several other cities and towns of Sindh. Hundreds of children with acute watery diarrhea started reporting at the emergencies of public and private health facilities on a daily basis.

“It was just the start of March, and I felt that we had suddenly entered a hot season from the relatively pleasant winter in Karachi. A diarrhea outbreak early in the year was not common previously. Extremely warm weather and water scarcity created the environmental conditions for outbreaks of water-borne diseases, not only in Karachi but in entire Sindh, the Punjab and several areas of Balochistan,” Dr Faisal Mehmood, a leading infectious disease expert at AKUH tells The News on Sunday.

By the start of April, it was clear that this was ‘the warmest and driest’ march in the history of Pakistan. By the start of May, it emerged that April 2022 was the hottest as well as driest month in 62 years. The Pakistan Meteorological Department (PMD) declared this to be a clear manifestation of climate change. It forecast prolonged dry season as well as back-to-back heatwaves in the country.

But impacts of climate change related extreme events, which were not being observed by the PMD officials included an unprecedented rise in cases of cholera in Karachi, many cities of Sindh, Lahore and adjoining areas of the Punjab as well as in several cities and towns in Balochistan. Infectious disease experts, however, made it clear that an extremely hot and dry season early in the year, in addition to poor hygienic conditions, and supply of contaminated water led to the worst outbreak of acute watery diarrhea, acute gastroenteritis and cholera. The diseases have claimed dozens of lives across the country.

By the start of May, weather conditions had become so harsh in Sindh, the Punjab and Balochistan that hospitals had started admitting patients with acute kidney injury (AKI), a health condition caused by diarrhea and heatstroke, and healthcare professionals feared that dozens of children and some adults had lost their lives during heatwaves. Officially, the authorities did not confirm any deaths due to water-borne illnesses or heat related events despite extraordinary high temperatures in the country.

Several health officials in Sindh, including Gambat Institute of Medical Sciences (GIMS) director Dr Rahim Bux Bhatti and Sindh Director General Health Dr Jumman Bahoto; as well as University of Health Sciences (UHS) Lahore Vice Chancellor Prof Javed Akram confirmed that dozens of cases of acute kidney injury (AKI) resulting from heatstrokes, acute watery diarrhea and gastroenteritis had been reported from various parts of the country, including Sindh and the Punjab that remained in the grip of intense heatwave. The mercury jumped to 51 degree Celsius in Jacobabad in Sindh a few days ago and several other cities sizzled in intense heat for the first two weeks of May.

Dr Bahoto confirmed that a rise in the cases of acute watery diarrhea and other water borne illnesses had been reported from Dadu’s remote areas. He said some cases of heatstroke had also been reported as temperatures shot to 51 degree Celsius in some areas of the province. “We have issued directives to the health authorities to establish heatstroke camps, provide clean drinking water and ORS to patients and provide timely medical treatment to the people,” he added.

As daytime temperatures became unbearable in many cities of the Punjab, health authorities in Lahore said many traffic wardens and others exposed to sunlight had suffered acute kidney injury due to dehydration and were taken to various city health facilities in the city including Jinnah Hospital for treatment.

“Dozens of people, especially traffic wardens in Lahore, have fainted due to dehydration following long exposure to sunlight and were shifted to various hospitals. We have distributed umbrellas and awareness pamphlets among people in Lahore to prevent them from permanent disability and death due to heatstroke,” said UHS Lahore Vice Chancellor Prof Javed Akram.

The prolonged heatwave in the country compelled the National Institute of Health (NIH), Islamabad, to issue a heatwave health advisory, warning of an increase in the cases of heatstroke and water-borne diseases due to extremely high temperatures in many parts of the country.

The NIH health advisory said heatstroke was a medical emergency that could prove fatal if not managed properly. It warned that a heat stroke could lead to death or organ damage or disability if not properly managed in time. It added that infants, people above 65 years of age, diabetics, hypertension patients, athletes and outdoor workers were at a high risk for heatstroke.

Experts believe that back-to-back heatwaves due to climate change could worsen the malnutrition situation in Pakistan. The country could face a 10 percent reduction in the production of wheat as well as a 30 percent reduction in mango produce in Sindh this year due to ‘extraordinarily high temperatures’, water scarcity and other climate change-related events during March and April this year.

“March and April 2022 were the warmest and driest months in the history of Pakistan. Due to extraordinarily high temperatures in these two months, the wheat crop was badly affected and we may face a 10 percent reduction in wheat production this year,” said former director general of Pakistan Meteorological Department Dr Ghulam Rasool. He also said that production of several other crops had also been affected, resulting in shortages and food inflation that could contribute to malnutrition in Pakistan.

“Due to extraordinarily high temperatures in March, the grains of wheat could not complete their biological cycle and shrank in size. The starch content in the wheat is also lower. This may result in a 10 percent reduction in wheat crop in the country,” Dr Rasool added.

Urging people to adapt to the changing climate in Pakistan, health and weather experts say that due to extreme weather patterns, outbreaks of seasonal diseases would multiply in the days to come. They also warn that an unprecedented increase in dengue, malaria and other vector-borne diseases could be observed in the months to come due to a possibility of irregular rains.

The writer is an investigative reporter covering health, science, environment and water issues for The News International