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Why are children dying of hunger in Sindh, Pakistan? April 1, 2014

Posted by ruthgamble in : Guest authors, Pakistan , trackback

Mustafa Talpur

Watching helplessly as children die from starvation in their mother’s embrace is truly horrible.  When I began to see this happen recently, I repeatedly assumed that the children were sleeping peacefully in their mother’s arms. But when I looked closer, I realised they were never going to wake up; I realised that they were dead. The individual scenes themselves were shocking, but most shocking of all was the number of times the scene has been repeated in Tharparkar, Sindh Province Pakistan. According to media reports, more than two hundred children have died through causes linked to malnutrition in recent months. And perhaps most shocking of all was the fact that responsibility for this devastating repetition lay with the democratically elected government of Sindh, who could have prevented these deaths if it had fulfilled its obligations.

The hunger that leads to starvation is an acute form of poverty, and a denial of a fundamental human right. Making sure that children have enough to eat should be a basic function of government. Yet my experiences, and the experiences of other development workers in the region, suggest that this function is not being fulfilled by the government of Pakistan generally, and the Sindh provincial government in particular.

A substantial part of the reason for this lack of action is the nature of the hunger and consequent deaths from malnutrition that is occurring. It is non-acute, and this allows the government not to act on it. As Amartya Sen has suggested: “Hunger in the non-acute form of endemic under-nourishment often turns out to be not particularly politically explosive.”  But as Sen has also pointed out, long-term, initially invisible hunger often has serious implications. “(There are) serious impacts of early undernourishment on long run health,” he said, “even on the development of cognitive skills and functions—loss of productive abilities, skills and human capital, mortality from normal causes—may be linked to hunger, while hunger may not be visible.”

What he describes here is exactly what is happening in Sindh Province. Food insecurity and huger are widespread, but this has not become a political issue or an international priority as their effects are not immediately visible. This lack of immediate and clear causality furthermore means that the deaths caused by hunger in the region are not necessarily described as deaths from starvation.

There is no doubt this is a situation that affects the whole of Pakistan, where there are many problems of food insecurity and malnutrition. But a close analysis suggests that Sindh performs worse than any other region in the country on the two most devastating primary indicators for hunger: food insecurity and child malnutrition.

Food insecurity

The dramatic lack of food security that is today evident in Tharparkar did not occur recently. On one level, it is a reflection of the general lack of food security across the whole of Pakistan, where in 2012, 35 million people were estimated to be malnourishedThe National Nutrition Survey (NNS) carried out in 2011 found that an estimated 58% of households in Pakistan are food insecure. Along with demonstrating the generally poor state of nutrition in the country, this survey showed the special difficulties experienced by the population of Sindh, where no less than 72% of households experienced food insecurity. It was the worst province in Pakistan for food insecurity.

The NNS also noted levels of hunger, and again the situation in Sindh was more disturbing than anywhere else in Pakistan.

Country or Province Households with Moderate Hunger Households with Severe Hunger
All Pakistan 20% 10%
Gilgit Baltistan 22% 9%
Punjab 18% 9%
KP* 6% 5%
FATA** 8% 6%
AJK*** 22% 4%
Baluchistan 18% 12%
Sindh 34% 17%

* Khyber Pakhtunkhwa (KP)  ** Federally Administered Tribal Areas (FATA) *** Azad Jammu and Kashmir (AJK)

As this chart shows, Sindh performs worst on all nutritional indicators, and in many instances its rates of hunger were twice those of other provinces, even the troubled Federally Administered Tribal Areas (FATA).

As the NNS 2011 report demonstrates, while the threshold for declaring nutrition is 15%, in the south of Sindh, they have reached 21–23%. This is some of the worst levels of malnutrition in the world. In this regard, the province of Sindh is performing worse than extremely poor African nations such as Benin (8%), Niger (13%), Mali (8%) and Togo (17%). These figures are simply hidden by the relative abundance in other regions of Pakistan, which push up the national average.

Child Malnutrition

The vicious life cycle of malnutrition is not just a stand-alone problem. It also contributes to almost 35% of under-5 deaths in the country. These deaths are caused by the intense degree of malnutrition to which vulnerable children are exposed. Reducing child mortality is one of the most prominent indicators of development, but it is one area in which Pakistan generally and Sindh particularly is lagging behind.

One of the clearest, non-morbidity indicators of malnutrition is stunted growth, as it reflects a failure to receive adequate nutrition over long periods of time. As the recently launched Pakistan Demographic and Health Survey 2012–2013 revealed, 45% of Pakistani children under 5 have stunted growth and the growth of 24% had been severely stunted. Again, the situation in Sindh was much worse than the national average: 57% have experienced stunted growth, and 35% have experienced severe stunting.  Within Sindh, there were further divides between urban and rural children, and income groups: while the growth of 40% of children had been stunted by malnutrition in urban areas, the growth of 63% of them had been stunted in rural areas; and the growth of 62% of children under five in the bottom 20% of poor income groups had been stunted. The combined impact of these statistics on Sindh’s rural poor cannot be overestimated.

Repeating the Cycle

The death and stunting rates caused by malnutrition in Sindh is not just a problem now, it is a cycle that will repeat itself without intervention. The malnutrition outlined above is impacting two-thirds of rural Sindh’s population, and 40% of its urban population. This is a situation that, following Amartya Sen’s analysis, will inhibit their cognitive development and the development of skills that would enable this group to thrive. They will not be able to fulfil their human potential, and therefore provide food for their children. The tendency of these indicators to reproduce themselves is already more than evident in the accumulated data. Hunger and malnutrition statistics in Sindh have been consistently bad for a very long time.

By analysing these statistics from an alternate perspective, however, we may also find clues about how this inhumane situation is sustained. To understand this, we need to look to the one-third of the population that are not held back by malnutrition; the one-third of society that has been privileged enough to develop, dominate and control the region’s politics and society.

It is this one third that has control over the large, irrigated agriculture entities in Sindh, its rich mineral resources such as oil, gas and coal, and the urban economic base that is its largest city, Karachi. It is this third of the population that benefits from unequal land and water distribution, income disparities and unequal access to education. They are less affected by factors that exacerbate the tragedy the poor—particularly the rural poor—such as natural disasters, climatic variation, rural-urban migration and a dismal security situation. Increased poverty in the area can be directly linked to the poor delivery of essential public services, but again they are largely unaffected by this.

A critical investigation of Pakistan and Sindh political institutions shows that not only is there little representation of the rural or urban poor, but power has been captured and held by only a few families. The present power structures work for them, and they therefore perpetuate and promote inequalities. Democracy is only working for the few in Sindh, while theoretically it should work for the majority. Until there is a major shift in political and economic power in the region, poverty, malnutrition and the avoidable death of children will continue. When death and hunger do make their way into the news, they will be temporarily dealt with by the use of political gimmicks.  How long can a society with such visible disparities continue?

Mustafa Talpur is Senior Manager Policy Advocacy and Communications in Oxfam International Pakistan.

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