Two weeks ago, Ruqiyya Bibi fell ill. The two-year-old was constantly vomiting; her father, Mohammed Iqbal, took her to a basic health unit in Pir Koh, a poor town of 40,000 people in the mountains of Baluchistan, southwest Pakistan.
Iqbal first learned that his daughter had malaria, but when the treatment didn’t help, he took her to another doctor who said she had a blood disease.
“From Pir Koh to the Dera Bugti headquarters hospital, no doctor knew she had cholera. Nobody even knew what cholera is,” Iqbal told the Guardian.
Last Wednesday, Ruqiyya passed away. According to local sources, as of Saturday, 27 people had died – including 18 children – in a cholera outbreak linked to contaminated water that started in Pir Koh.
The Pakistani government said the official death toll stood at seven and around 2,000 people had been infected so far, a figure disputed by local activists who say more than 5,000 people have fallen ill.
As Pakistan experiences a brutal heat wave that has engulfed much of South Asia, Pir Koh faces a cholera outbreak and a water shortage crisis.
Mohammed Iqbal was unable to get enough water for his toddler’s funeral rites.
Pakistani Prime Minister Shehbaz Sharif ordered ’emergency relief measures’ for Pir Koh; Baluchistan Chief Minister Quddus Bizenjo has announced 300m rupees (£1.2m) for the supply of drinking water. But residents of Pir Koh say they have been left with dirty water for years.
The state-owned Oil and Gas Development Company Ltd (OGDCL) is responsible for purifying the city’s water, which comes from a source about 26 km away, and delivering it to residents through pipelines.
A muddy, dirty water tank was cleared by the administration after the outbreak, but locals who spoke to the Guardian said it came too late.
One said: “The state has long left us alone at the mercy of God and it has interests in the exploitation of natural resources. When people were dying, the authorities were absent from the scene.
When the cholera outbreak started last month, Pir Koh Hospital was not equipped to diagnose patients.
District health officer Dr Azam Bugti said the first case was reported on April 17 but it took another week to confirm the outbreak as samples had to be sent to the Pakistani capital for be tested.
“The water crisis in Pir Koh dates back decades, and after a drought, the problem got worse. The lack of rain this year has caused nearby ponds to dry up. Animals and people drink the same water here in Pir Koh,” Bugti said.
“We started treating patients after the test results,” he said. “So far, seven people have lost their lives. The situation was quickly brought under control.”
Baluchistan’s chief secretary and a team from the World Health Organization visited the region on Thursday, Bugti said, after an online campaign was launched by local students.
Gulzar Bugti – no relation – was returning from Lahore University when the crisis started. He and other students and family members launched an online campaign and took to the streets to call for helpaccusing the administration of doing nothing.
“People had no water even for full ablution, the last rite for the dead. There was no clean water to drink and the authorities were not active in developing an emergency plan,” he said.
Bugti and his friends raised funds to provide storage facilities and water delivery tankers. He rejected the toll released by authorities, listing 26 names, including 18 children under the age of seven.
His group says there are around 5,000 cholera patients in Pir Koh, more than double the official figure.
“We call on the government to come up with a long-term plan to deal with this humanitarian crisis,” he said.
In a tweet on Sunday, the Prime Minister Told Bugti: “We are working with the provincial government to find a permanent solution to the problem, so that people no longer face this problem. The drinking water projects will soon be completed.
Cholera is mainly spread through dirty water and poor sanitation. Particularly dangerous for children, it causes rapid dehydration through diarrhea and vomiting and affects around 3 to 5 million people worldwide, killing 28,800 to 130,000 people a year. Although classified as a pandemic, it is rare in high-income countries.
Pakistan’s Minister for Climate Change, Sherry Rehman, recently said that Pakistan is one of the most water-stressed countries in the world and highly vulnerable to climate stress.
The country’s major dams are at a “dead level right now, and water sources are scarce and contested,” Rehman told CNN, adding, “This is a global existential crisis and needs to be taken seriously”.