WASH response in vulnerable women populations during flood emergencies in Pakistan

Co-authored with Ehsan Gul and Benjamin Gilbert

Though this article will focus on gender issues in Water and Sanitation Hygiene (WASH) responses to floods in Pakistan, other knowledge from the region, and across the globe, will be relevant. Regarding flooding, the region as a whole is of interest due to the transboundary nature of many rivers, including the Indus River (Encyclopedia Britannica [online], 2016). The Indus River is a major transboundary river in Asia with nine tributaries. Its five tributaries on the left bank are the Beas, Chenab, Jhelum, Ravi, and Sutlej rivers. The Beas, Ravi, and Sutlej are also transboundary rivers, with upper catchments in India. The Indus drainage basin covers an area of about 1,140,000 square kilometers (km2) stretching from Afghanistan through China, India, and Pakistan. In addition, river systems in this region are known to be highly dynamic, due to the large number of potential water inputs (e.g. tides, rain, ice-melt, and monsoon; Encyclopedia Britannica [online], 2016) and the potential for discharge peaks to combine (Hofer & Messerli, 2008). The complex geo-hydrological structure and associated political dynamics make regional and national level coordination of flood relief and remedial efforts difficult.

Pakistan suffered from 21 major floods between 1950 and 2011—almost 1 flood every 3 years. The Pakistan floods of 2010 and 2011 were devastating, not least due to their temporal proximity and therefore the repeated inundation of already damaged regions (Shah, 2012; Shabir, 2013; UNEP, 2014). The 2010 floods caused outbreaks of diseases linked to WASH-deficiencies, such as diarrhoea and respiratory illnesses, and affected more than 20 million people across a fifth of the country (Shabir, 2013).

The provision of WASH facilities is known to improve the quality of life in a region (Hoque, 1996), thought its benefits are particularly undermined by flooding events (Chanda Shimi et al., 2010), due to their potential to disrupt water supplies (Linscott, 2007) and thereby introduce disease (Ivers & Ryan, 2006; Watson et al., 2007). Groups that are previously WASH-deficient are disproportionately affected by flooding (Hashizume et al., 2008). WASH reduces disease burdens in crises (Brown et al., 2012), though this is often forgotten when generating solutions (Bartram & Cairncross, 2010) in favour of a focus on health (Koudaio et al., 2012).

In addition, the links between climate change itself and WASH have received considerable academic attention, though the assertions of Habib et al. (2010) indicate that climate change has been underused as a frame in health research. A lack of integration in practical responses to the two issues has been highlighted; Le Masson (2013) indicated that the shift to a more sustainable development regime would inevitably reduce vulnerability to climate change-induced WASH implications and build adaptive capacity of all groups in the face of future climate change.

It must be acknowledged not to treat whole nations, or even whole settlements, as homogenous groups with homogenous reactions to future climate change and disaster risk reduction (Wilder & Morris, 2008). There have been studies of the impact of non-gendered culture on WASH. Drangert & Nawab (2011) found that, in one Muslim community in Khyber Pakhtunkhwa, liquid excreta were regarded as less unhygienic than solids, even if this liquid was merely faeces mixed with water. This follows an earlier study by Nawab et al. (2006) which found that urine-separating latrines, and latrines in general, were regarded as backwards and taboo by a Muslim community in the same province.

The National Disaster Management Agency (NDMA [online], n.d.) of Pakistan has published guidelines and advice, both for formal response structures and personal action for flood management. The formal guidelines focus on personal safety, medical provisions and sanitation systems, whilst emphasising priority care for vulnerable persons. However, advice for the general public does not mention sanitation, though it does favour the use of boiling to ensure safe drinking water. NDMA with the help of UN Agencies has also established and facilitated WASH clusters at national, provincial, hub and district levels in the flood affected areas in order to provide a mechanism for joint planning, implementing and coordination for WASH interventions. This strategy lay emphasis that in early recovery phase strengthening of WASH clusters at all levels will not only help improve provision of WASH facilities to the affected population but will also enhance coordination and experience sharing process between flood affectees, implementing partners, government departments and the donors. Non-governmental organisations have also attempted to aid in flood disaster response and recovery in Pakistan, including Oxfam, UNICEF, UNESCO, Water Aid, Muslim Aid, Save the Children, International Federation of Red Cross/Crescent (IFRC), Medicines Sans Frontiers (MSF) etc. International NGOs and humanitarian partners have employed operational research methods to generate baseline evidence to broadly guide flood risk and response strategies by NDMA and form clusters with other governmental and non-governmental partners to create synergies and to avoid duplication of efforts. Nawaz et al. (2010) has pointed out limited success in the implementation of flood risk management policies and strategies due to lack of coordination and knowledge sharing amongst key stakeholders.

However, these interventions have highlighted that WASH remains a gendered issue, both generally and in responses to disasters (Red Cross [online], 2016). Disasters, including flooding, have gendered impacts (Ashraf & Azad, 2015; Nakhaei et al., 2015), and international standards exist which attempt to counteract these gendered impacts (Shah, 2012). Climate change is also known to have gendered impacts (Bhuyan, 2014). According to the Women’s Disaster Resilience (2014), women in Pakistan are least resilient to disasters out of the eight studied South Asian nations. Women are at a greater risk from flooding events than men due to power relations and socially-constructed norms (Nelson, 2002). The conservative society (Miller & Arquilla, 2007) of Pakistan has been noted as a challenge in WASH provision, including by NGOs (Nawaz et al., 2010). In other flooding events across South Asia, women have been found to die at greater rates than men (Begum, 1993; Mushtaque et al., 1993), and disasters as a whole cause greater reductions in the life expectancies of women (Ashraf & Azad, 2015).

Additionally, women are regularly discriminated from learning adaptive skills and lifesaving abilities. For example, women and girls are not taught how to climb trees or swim. Both elements put them at a disadvantage when disasters hit. Usually, women are not allowed to evacuate their homes without the approval from their spouses or senior men in their families or groups. Gendered social dress codes may hinder their portability amid emergencies, resulting in more lopsided mortality rates amid numerous calamities. Climate-related disasters, such as floods, drought or famine, can also upset local security nets, leaving women and children unaccompanied, isolated or stranded because of the disintegration and breakdown of typical social controls and assurances. This makes them particularly powerless against the risk of human trafficking.

In addition, due to the aforementioned social norms, women’s domestic and reproductive burdens (Baig & Sharif, 2013; Majumder, 2013) ensure that their limited access to water and food affects the household as a whole (Raworth et al., 2008; Neogy, 2010; Bhuyan, 2014; EIU, 2014). Flooding also increases the burden on women due to their role in supplying, transporting and purifying water (Mitchell, 2007). Dankelman (2008), Bhuyan (2014), and Shabib & Khan (2014) also observed that increases in water burden reduced income from agriculture and resultant increases in fear due to climate change-related disasters disproportionately impacted women, characterizing them as socially-constructed problems. Cultural norms regarding female behaviour and restrictions on their autonomy (Jejeebhoy & Sathar, 2001) can also reduce women’s opportunity to provide details of their specific needs to aid workers (Dhungel & Ojha, 2012) or to access critical early warning systems (Mustafa et al., 2015).

Not one mention of sanitation or WASH was found in Bowles-Adarkwa & Kennedy (1997), a bibliography of global priorities for women, though the situation has since changed (Kwiringira et al., 2014), albeit not always positively. In developing nations, response to gender inequality in WASH provision has been typically limited to providing ‘toilets for women’ (Tilley et al., 2013). Advancement in this field has been hindered due to a lack of data and a reductionist approach in studying gender inequality (Tilley et al., 2013). Menstrual hygiene management, an issue which only burdens women, is often hampered by a lack of access to proper facilities or equipment (Chin, 2014; Jewitt & Ryley, 2014) and the treatment of the subject as a taboo, meaning that solutions are difficult to engender (Sehar et al., 2012). The inequality of WASH burden is further compounded by the psychosocial stress associated with environmental, social, and sexual violence stressors that unduly affect women (Hirve et al., 2015; Sahoo et al., 2015) and adolescent girls (Rashid & Michaud, 2000).

Awareness of the need for menstrual hygiene management in humanitarian crises is increasing (Sommer, 2012). However, statistical data regarding menstrual health, either in reported problems or facilitation of solutions is non-existent (MICS [online], 2016; STATcompiler [online], 2016), except in studies of why menstrual health is so poor (Rashid & Michaud, 2000). Brown et al. (2012) does not mention menstrual health at all in their list of recommendations for WASH in emergencies. Gender disaggregated data is often lacking, despite the noting of its benefits for more accurate and worthwhile interventions (Mazurana et al., 2013).

As with floods and WASH response, climate change is likely to compound already existing examples of gender discrimination that renders women more powerless than men against fatalities and decrease their future opportunities, particularly for monetarily poor women. Evidently, policy-makers, non-legislative associations, and the scholastic group need to give careful consideration to the gendered effects of climate change adjustment and effects. Climate change strategies, explorations and activities need be gender-sensitive and make women a focal point to avoid disproportionate risks and consequences. This is not a simple question of equity and balance. It also makes good economic sense.