Gregory Pappas Talks about the Earthquake in Pakistan (web article)

Soon after the October 8 earthquake, many citizens of Pakistan simply stuffed their pockets with money, drove up into the earthquake-torn mountains, got out and walked in, looking to help in any way they could.

This scene, described by Gregory Pappas, MD, PhD, in his November 3 remarks at the Johns Hopkins Bloomberg School of Public Health, crystallizes Pakistan's response: assistance efforts are vibrant and capable, but the government of Pakistan had no overall disaster-management plan ready.

“The saddest part of this tragedy,” said Pappas, chair of the Department of Community Health Sciences, Aga Khan University in Karachi, “is that Pakistan, like many nations today, has never had a plan and there are no lines of command.” In developing countries, scarce funds normally must go to pay for development projects that furnish food, health care, housing and electric power.

“Because there has been no disaster-management plan, nobody has done a good job,” said Pappas, who is also an adjunct associate professor in the School’s Department of International Health. “Still, the chaos isn’t as bad as it could have been, and the social fabric has pulled together.”

To an outsider, the evacuation of as many survivors as possible seems the obvious course of action—especially now, as the Himalayan winter is bearing down. Three million people are believed to be homeless. But Pappas argued that even if a solid evacuation plan was in place, few people would leave their land. In this part of the world, no system of land tenure exists—people have no legal deeds to their land, except by living on it. “If you were to evacuate,” said Pappas, “you might come back to find someone sitting on your pile of rubble.”

Further, a mass exodus to other parts of Pakistan would be difficult to accommodate. Karachi, for instance, is already home to 15 million people, 25 percent of whom don't have running water. And finally, Pappas noted that in its 30-year undeclared war with India over disputed parts of Kashmir, Pakistan’s government has historically tried to move more of its citizens into the region, not out.

Turning to the effects of the earthquake itself, Pappas, who along with other faculty at Aga Khan University in Karachi threw himself immediately into the relief effort, said that the destruction inside the 28,000 square-mile disaster area was unimaginable: The town of Mansehra was 40 percent rubble; Batgram, 100 percent; Muzaffarabad, 70 percent.

Not only did the quake register a 7.5 on the Richter Scale—with the main aftershock a 5—but, he explained, the surface topography of the Himalayas also stifles relief efforts: A distance that might take a helicopter 30 minutes to fly over can take 8 hours in a car that is snaking up and over and around the impossible terrain. And 20 to 30 percent of affected areas were simply inaccessible.

The current official mortality figure of around 70,000 is not particularly helpful, said Pappas, because the quake buried many villages before they had ever been counted in a census or become a dot on a map. About 100,000 dead is a more accurate number, he said.

Some of the most pressing problems:

• Diarrhea, measles, tetanus, pneumonia and acute respiratory infections have all been reported.
• Post-traumatic stress disorder is rampant.
• Winters up in the mountains yield on average three feet of snow.
• Among the 3 million homeless, perhaps 40,000 are pregnant women.
• The numbers orphans and single women—prey for human traffickers in the best of times—have swelled.

Currently, the UN is calling for winterized tents, surgeons, clean water, groundsheets, stoves and helicopters. (Donor fatigue may be dampening the response: Whereas 4,000 helicopters quickly converged to help the victims of last winter’s tsunami, less than 100 have materialized in Pakistan so far.)

Pappas noted that Pakistan has one of the largest and fastest growing populations in the world: 150 million people live in an area about the size of the U.S. eastern seaboard. Since 40 percent are under age 15, the nation will of course bounce back. But recovery, said Pappas, will take decades, in part because 8,000 teachers were killed. —Rod Graham