"Association of preparedness and response in flood hit areas of Pakistan"

DISCUSSION :

Preparedness and effective response are crucial in flood-prone regions like Pakistan to
minimize the impact of natural disasters.Over the past few decades, Pakistan has faced a
series of catastrophic floods that have left millions of people displaced, infrastructure
damaged, and economies disrupted. According to the National Disaster Management
Authority (NDMA), between 1947 and 2007, Fourteen major floods have hit the country
caused economic losses and damages worth USD 6 billion. Despite the recurring nature of
these floods, Pakistan, like many other nations, has struggled to adequately prepare for and
respond to these crises. The lack of preparedness and timely response has often exacerbated
the suffering of affected communities. Major percentage of the floods in Pakistan have
resulted from heavy monsoon rains , leading to riverine flooding.Inadequate flood defenses
and warning systems have contributed to the vulnerability of communities along riverbanks

Furthermore, the socioeconomic disparities in the country play a significant role in the
differential impact of floods. For instance, impoverished communities are disproportionately
affected, with limited access to resources, infrastructure, and healthcare facilities. This has led
to increased mortality rates and long-term displacement for vulnerable populations. In the
context of recent flooding, it becomes evident that natural disasters and disease outbreaks can
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have dire consequences for vulnerable populations . The convergence of these events
underscores the urgency of preparedness efforts in flood-prone regions like Pakistan. Disease
outbreaks and epidemics, as emphasized in one of the referenced articles, can exacerbate
challenges faced during disasters, underscoring the need for comprehensive disaster
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management strategies .

Several previous studies have explored disaster management challenges in Pakistan. For
instance, In Deen (2015) study, gaps in disaster response were identified despite the presence
of established agencies, underscoring the need for more effective execution of preparedness
measures. Even though disaster agencies aim to help during floods, they sometimes struggle
to work together efficiently. When a powerful flood hits, their response may not be quick
enough, and this can leave communities in need. This problem reminds us that turning
preparedness plans into effective help is not easy. It's a complex challenge that requires us to
look closely at what's going wrong within these agencies. Similarly, Rehman and Shoaib
(2019) study stressed the importance of a comprehensive disaster risk reduction(DRR)
framework involving all stakeholders, supporting the notion that community engagement is
key for effective preparedness. Pakistan stands at a critical juncture in its efforts to manage
the ever-present threat of floods. To address this, it's imperative that Pakistan not only
formulates robust policies but also enacts legislation that paves the way for comprehensive
disaster risk reduction (DRR).Building a broad-based DRR framework that garners consensus
from across the nation is essential. Such a framework would serve as a unified roadmap,
guiding Pakistan toward a more resilient future in the face of floods and other natural
disasters. A collaborative approach, with input from government agencies, local authorities,
non-governmental organizations, and affected communities, is key to ensuring that the
policies and legislation put in place are not only comprehensive but also practical and
effective.Considering the emerging transformation in global health, where health systems are
transitioning from focusing solely on 'diseases' to embracing the concept of 'Health Systems,'
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the notion of resilience gains prominence . This transformation resonates with disaster
management strategies, as disasters can strain health systems to their limits. Health systems,
much like disaster response mechanisms, need to be resilient and adaptable to handle
unconventional health challenges stemming from both natural disasters and disease outbreaks,
as noted in a referenced article.By fostering consensus and collaboration among all
stakeholders, Pakistan can lay the foundation for a more resilient nation.

Addressing flood management, Aslam (2017) study highlighted its importance, focusing on
measures like watershed management and flood structures. One of the key components of
effective flood management is the creation of new water storage systems. These reservoirs
serve as crucial buffers against floodwaters, allowing for better control of water levels during
heavy rains. Investing in such infrastructure can significantly mitigate the destructive impact
of floods.Watershed management plays a pivotal role in flood prevention. By adopting better
practices for managing watersheds, such as reforestation and soil conservation, we can reduce
the flow of rainwater into rivers and ultimately decrease the risk of flooding. Khan et al.
(2021) study also noted the inadequacy of current approaches for disaster-prone regions and
suggested Structural measures like rivers channelization,building of small dams and Non-
structural measures i.e use of weather and flood forecasting systems. To effectively manage
floods, it's crucial to control the flow of water in rivers. Channelization involves modifying
river courses and banks to direct floodwaters away from populated areas. This structural
measure can significantly reduce the risk of inundation in flood-prone regions.The
construction of small dams along rivers and tributaries serves as a vital tool for flood control.
These dams store excess rainwater during heavy rainfall and release it gradually, preventing
sudden surges that can lead to devastating floods downstream.Leveraging modern technology
and improved forecasting systems is paramount for early warning and preparedness. Timely
and accurate weather and flood forecasts provide communities with valuable lead time to
prepare and evacuate if necessary. These systems enable authorities to communicate risks to
the public and coordinate response efforts efficiently.

Ahmed (2013) study emphasized proactive disaster risk reduction policies, finding that
successful preparedness goes beyond reactive measures.The current state of disaster risk
management (DRM) in Pakistan is characterized by a predominantly reactive
approach.Reactive DRM primarily involves responding to disasters after they occur, focusing
on rescue, relief, and recovery efforts. While these actions are indispensable, they often come
at a high human and economic cost. The reactive approach tends to overlook the critical phase
of disaster preparedness and mitigation, which can significantly reduce the impact of disasters
if implemented effectively. A proactive DRM strategy aims to reduce disaster risks before
they manifest as full-blown crises. It shifts the focus from merely responding to disasters to
identifying vulnerabilities, implementing preventive measures, and building resilience within
communities and infrastructure. Local institutions' role is emphasized by Shah et al. (2019),
these institutions serve as the bridge between government authorities and the grassroots level.
They possess an intimate understanding of the local culture, geography, and vulnerabilities,
allowing them to tailor disaster preparedness initiatives to the specific needs of their
communities. This contextual awareness is invaluable in crafting strategies that resonate with
local populations and garner their active participation. Atiq Ur Rehman et al. (2012)
highlighted the multidimensional nature of flood management. The challenge of flood
management in Pakistan is multifaceted, demanding vast resources and a comprehensive
understanding of the flood problem. A holistic approach encompasses a range of flood
management measures, a robust legislative framework, and a well-coordinated institutional
setup. By addressing these aspects in concert, Pakistan can enhance its resilience to floods
and safeguard its communities and resources from the devastating impact of these natural
disasters.

Flood preparedness extends far beyond infrastructure and policies; it relies heavily on
awareness and communication.Social media has become a common platform for accessing
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health-related information . In today's interconnected world, the dissemination of timely
information is facilitated by the growing influence of social media platforms. Raising
awareness about flood risks, preparedness measures, and evacuation procedures through these
platforms can be a game-changer in saving lives and minimizing damage. Social media not
only acts as a rapid information conduit but also empowers communities to share real-time
updates, offer support, and coordinate relief efforts during floods.Furthermore, it's essential to
acknowledge the unique challenges faced by healthcare providers, particularly in flood-prone
regions. Not only in times of unprecedented social upheaval, such as natural disasters and
pandemics but even in everyday situations, physicians and healthcare providers often find
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themselves making crucial decisions . Physicians and healthcare professionals often find
themselves in life-and-death situations, making crucial decisions amid the chaos and
uncertainty of flood disasters. Their dedication to providing care under extreme conditions is
commendable and underscores the critical need for comprehensive disaster management
strategies that prioritize their safety and support. This underlines the importance of robust
preparedness efforts that encompass various sectors and stakeholders.

Despite our study's significant contributions to understanding disaster preparedness in flood-

prone areas of Pakistan, it is vital to acknowledge certain inherent limitations that provide
valuable insights for both future research endeavors and the formulation of effective disaster
management policies. Relying on self-reported data, while a common practice in social
research, introduces the potential for bias, which may impact the precision and accuracy of
our preparedness assessments. Future investigations may benefit from a more comprehensive
approach, combining self-reported data with objective measurements to enhance the
reliability of findings. Moreover, the cross-sectional design, which captures a snapshot of
preparedness at a specific moment, constrains our ability to establish cause-and-effect
relationships or track preparedness dynamics over time, emphasizing the need for future long-
term investigations. Additionally, our study was limited to a specific geographic region within
Pakistan, and variations in preparedness and response strategies across diverse regions were
not fully explored. This geographic constraint highlights the necessity for broader studies
encompassing a more extensive range of flood-prone areas in Pakistan.Nevertheless, our
study's implications for disaster management policies are substantial. It serves as a
foundational resource for policymakers, guiding targeted interventions to address specific
preparedness weaknesses, promoting community engagement in disaster resilience efforts,
emphasizing long-term planning, and advocating for the integration of research into policy
development and evaluation. Through a nuanced understanding of these limitations and their
implications, we can continue to advance disaster preparedness and response strategies in
flood-prone regions, ultimately ensuring the safety and resilience of communities in the face
of adversity.

REFERENCES :

1) Afzal S. The Invisible Killer: Investigating the Lack of Research on Smog in Pakistan. Annals of
King Edward Medical University. 2023 Aug 15;29(2):1-2.
2) Afzal S, Gondal KM. The Journey from Medical Nihilism to Pandemic Preparedness for COVID-
19: A Global Health Challenge. Annals of King Edward Medical University. 2020 Jul 9;26(Special
Issue):97-9
3)
Tariq S. Revamping Health Professionals Education for Stronger Health
Systems. Annals of King Edward Medical University. 2016 Dec 14;22(4).
4) Afzal S. Misinformation and Misconceptions About COVID-19 Vaccination in Pakistan: The
Need to Control Infodemic. Annals of King Edward Medical University. 2021;27(4):471-3.
5)
Imran N, Khalid B, Afzal Z, Azeem S, Fatima O, Haider II, Azeem MW, Javed
A. Leadership in Undergraduate Medical Education: A Study of Pakistani
Medical Students’ Perceptions, Attitudes, and Interest. Annals of King Edward
Medical University. 2023 Aug 15;29(2).