Subh-e-Nau Magazine

Disaster Preparedness for Earthquakes in Pakistan     

More than 14 years have passed since the tragic 2005 Northern Pakistan earthquake. Environmental degradation, especially in the form of mass deforestation in this region continues to this day. Have we learned our lessons and created Pakistan a safer place to live in? 

A recent strong earthquake in the Kashmir region and associated losses indicates that we are not ready to face a bigger and major earthquake. Earlier, on October 8, 2005, a mass tragedy engulfed our country with the Northern Pakistan earthquake striking Muzaffarad at the epicenter leading to mass displacements, casualties and injuries. With more than 75,000 dead, 3.5 million displaced and more than 100,000 injured, our existing system collapsed under the weight of such a mega disaster. Pakistan was completely underprepared to deal with this tragedy both in the short and the long term.
The more recent event, which took place September 24, 2019, a magnitude 5.8 Richter scale and its epicenter at Azad Kashmir hit Mirpur and surrounding regions of Pakistan and India where tremors were felt. Aftershocks followed and 40 deaths and 850 injuries were recoded due to mainly failed buildings and constructions. Further casualties happened on September 26 as an aftershock turned deadly in this region again.
In terms of disaster management, the lack of following building codes as well no mitigation practices turned out to be deciding factors in making this natural hazard into a disaster.

The 2005 earthquake: where are we on adaptation and mitigation?

More than 14 years into the last debacle, the pertinent question that arises is: Are we ready if another such earthquake strikes?  In the wake of the 2005 Northern Pakistan disaster, the National Disaster Management Authority (NDMA) and Earthquake Response and Rehabilitation Agency (ERRA) happened, which are improvements. However, their practices are focused mostly on response and relief which have done literally nothing on the adaptive or mitigation side of improving the past and present situation.
As a present-day crisis and as a focus of adaptation and mitigation, Kashmir is more deforested than ever. The number of casualties in Kashmir and surrounding regions, near the epicenter of the 2005 earthquake, were the heaviest in this disaster. Natural defenses in the form of forests were slaughtered to a mere 10% from 42%, while “development” completely ravaged the countryside. The rapaciousness is not limited to forests but also by destroying hills for extraction of mineral resources. The impacts of both these actions have left the entire region defenseless against earthquakes. Another aspect is lack of proper implementation of building codes across the country which results in mass casualties, this must be enforced by agencies such as NDMA and ERRA to save lives if and when disaster strikes.
As a nation, Pakistan has been subjected to large scale deforestation, not just on land – but also to marine forests which comprise mainly of mangroves. The current and pathetic amount of forest cover is a less than 3% against a required 25% for a healthy environment. To make matters worse, there are no replacement strategies, and these precious and vital being has been reduced to a declining resource rather than being viewed as a respected part of our very survival and well-being.
The survival of mankind depends on trees, forest resources and the related water cycling that Nature provides. The amounts of benefits that forests and green cover provide are innumerous and vital in a very wide range. This starts with initiating the food chain cycle via photosynthesis, releasing life giving oxygen for healthy breathing, acting as deterrents to topsoil erosion and as watersheds, providing shelter with shade from excessive heat while sustaining a rich number of living organisms along with the inestimable aesthetic value.
While such benefits have been fully realized and understood, the multifunctional aspect of forests are becoming even clearer in the wake of natural disasters. Recently, Japanese researchers Akira Izumi and Takashi Omura working on Earthquake disasters have verified that the high functionality of the forests in preventing damages during earthquakes. The findings are based on the Great Hanshi-Awaji earthquake, the Nankai-Tounankai earthquake resistant investigation, a large earthquake that occurred at Chuetsu, Niigata prefecture.
Similarly, the 2005 Indian Ocean tsunami which lashed with all its fury on the coastlines of countries could have been soothed by mangrove forests, which have protected such regions from coastal calamities in the past (See Box, “Missed lessons before the earthquake”). These gifts of Nature not only enrich local communities with nutrition and life, they are natural buffers efficiently dissipating the energetic impact of high-speed winds and large-scale waves on oceans and lands alike.
On land, forests provide a natural dampening effect against seismic waves by diminishing the effects of topsoil erosion. The resulting “tightening” of the top layer by trees provides a considerable defense against uneven movement of tectonic plates. Trees also act as flexible and additional structures that absorb seismic waves. Hence, forests strengthen the capacity of the surface layer to absorb the full impact of an earthquake. In addition, forests, by this virtue, also prevent landslides and mudslides, as the ground is firmly attached to hundreds of thousands of roots, forming a tight network in keeping the soil at one place. While the epicenter of the earthquake also impacted the Indian held side of Kashmir, the impact was far less. Why so?
The sad part about Azad Kashmir, which once formed a considerable contributor to Pakistan’s forest cover has been the unchecked and unmitigated rape of the forests by the so-called ‘timber mafia’, which continues to this day. As a measure of the brazenness of this greed, the amount of forest from 1947, which was 42% of the land cover, has reduced to a mere 10%. The whole desolate and barren land, therefore, stood defenseless against the approaching calamity. The resulting landslides, due to “liquefaction”, which happens when wet sediments which are not secured by vegetation, are dangerously weakened by the strong shaking, thus causing major damage after an earthquake. This was seen very vividly in this calamity, as landslides led to create further death, terror and destruction.
In contrast, other countries have enough environmental and social consciousness with effective replacement strategies. There are no such measures taken by our government, or the environment ministry for that matter, which is a plausible reason as to why the losses were so heavy on the side of Pakistan.
The natural beauty and immeasurable environmental value of Northern Pakistan has been rendered vulnerable to earthquakes by impacts in other ways as well. This digging and drilling of hills for mineral resource extraction has led to destruction of natural distribution of stones as well as introduces cracks and crevices into land. Such activities reduce and weaken the resilience towards earthquakes, which such natural endowments provide. The building of houses on top of mountains proved to be a deadly combination in this regard, as entire villages were decimated as a result. By treating hills as pure economic resources reduces their multifunctional utility which is the ability of absorbing and damping seismic waves.
The Governments in this past decade have still taken little or no notice to cure this downward slide in deforestation in the northern regions, especially the plunder of Azad Kashmir – this ultimately and tragically contributed in increasing the death toll as well as decimating entire villages in its path. The recent billion tree in full effect by the PTI government should focus its direction towards prioritizing regions prone to disasters such as Kashmir and the coastlines as well.
Many Asian countries, owing to the pursuit of economic efficiency in many industries, have devastated forests. This has not only reduced the vitality of rural areas but has also tended to increase disaster damage these areas. Additionally, this has had an adverse impact on urban areas in the form of flooding and other disasters.
To mitigate the impact such disasters in the future, we should, therefore put an end to deforestation at all costs – not only at land but also on the coastlines so that we have resurrected the natural defenses which were senselessly lost in the decoy of “development.” Our disaster management agencies need to meet the adaptation and mitigation needs of disaster-prone communities and regions with proper actions and work in times of peace and rest.
Writer: Dr. Farrukh Chishtie

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Delivering better care services in disasters     

The foremost need that arose during the 2005 earthquake was quick delivery of medical attention to the victims. The lack of rehabilitation sciences in these measures was severely noticeable and the dearth continues to this day, as was demonstrated in recent earthquake in Mirpur. Better integration of these services are required for any such emergency in the future.  

Waves upon waves of tragedies emerged after the devastating Oct 8th earthquake in 2005. The foremost human element observed was the severe mental and physical anguish faced by the victims, among myriad issues in mind numbing combinations. The victims’ homeward bound journey was and has remained long and arduous to say the least, while words like “rehabilitation” did become popular media terms, while the true scope is still missing at medical institutions. While the scale of the damage caused by the recent September 2019 disaster in Mirpur were orders of magnitudes less, the provision of health services was and is still wanting.
Disasters do have silver linings – they bring communities and individuals of all backgrounds together as well as exposing the gaps within an existing system. Differences are cast aside and connections of humans with the suffering of their fellow beings happen with astonishing intensity. The Oct. 8 earthquake was no exception. After 10 years, there is, still a grim future facing those who survived the disaster. The consequences are indeed disturbing — while an entire generation in most parts of AJK and Hazara division in NWFP died, the others became disabled, posing long term problems to the society. While rehabilitation of the victims was being called upon by all authorities and agencies, a relevant question remains: Is there existing awareness or idea of infrastructure present to perform the task fully and at a sustainable level? The first priority should be attaining the well-being of the affected, and this means getting them “medically rehabilitated.” Subh-e-Nau has responded with to this need through provision rehabilitation services which continue to this day (See Box, “Community Based Rehabilitation to the Rescue”).
To this day, for most doctors, caregivers and institutions, medical rehabilitation has a rather narrow-minded focus, which limits itself to at most, surgical attention and physiotherapy. With the majority of the injured being disabled, mentally and physically, the available facilities provide credence to this myopic vision. A dismal picture comes out as there are currently limited centers in the country catering to the needs of the disabled, which too are already overburdened. The biggest and most equipped center in Islamabad, the National Institute of Handicapped for example, is overloaded and closed its outpatient operations during the emergency. It takes none after ten years from the disaster. There are more than 3 million physically disabled already residing in the province of Punjab alone, while more than 600,000 disabled in NWFP.  Hence, there is very little to provide in terms of the short and long term effects of physical and mental trauma to the victims themselves.
The number of injured from the earthquake disaster were more than 100,000, according to conservative estimates. Then, according to the data findings, replicated in similar surveys in other hospitals too, 51 per cent of patients are suffering from serious trauma or lower limb injuries, 18 per cent of upper limb injuries, 15 per cent of total trauma patients need neurological intervention while there is a growing population of amputees (lower and upper limb) besides 11 per cent patients of combined chest and pelvis trauma.
At least 50,000 serious trauma patients at the time required at least physical therapy for mobilization, avoiding post-operation complications and making them functional. Additionally, they still require equipment such as crutches, wheel chairs, walkers, commode chairs, etc. All of these needs require to be extended in reconstruction activities as well. Merely resurrecting structures that meet housing needs has not been enough, as the proper functioning of those affected requires the tailoring of these houses according to their needs. This also comes about by understanding proper rehabilitative needs of those that lie incapacitated to this day with chronic conditions such as Spinal Cord Injury. Vocational therapy is still needed as a follow-up, which is a process which involves interviews, evaluation of abilities, and tests of manual and physical skills to determine the jobs that are best suited for the person. Through the process of vocational training, disabled or disadvantaged people are evaluated, trained, and placed in jobs where they can be successful. Having a job increases a person’s ability to become independent and enhances his or her sense of purpose and self-worth.
Now, here is the silver lining – there is still an opportunity to introduce modern rehabilitative medicine in an integrated manner. Instead of treating those with most visibly debilitating injuries, the time is now that we address the deeper neglect of the full scope of rehabilitation, medical and otherwise. This would require a deep and long term commitment in making the disabled fully vocational, integrated and accepted with the rest of the society. Involving all known sources of social change, which notably includes the media as well as integration of existing services would be required to bring the level of social acceptance higher.
The lack of specialized facilities, as well human resources needs to be built up by institutions dedicated to this cause. Hospital facilities need to integrate their existing level of services to incorporate medical rehabilitation in the full sense of the word, and not restrict themselves to specializations that insulate themselves from this vital area of medicine.
The handicapped and disabled must be given hope that our society is willing to accept them as fully functioning and contributing members. The existing laws regarding this segment of society must, therefore, be enhanced in their vision to incorporate, recognize and appreciate such segment of the population. The active discrimination that exists to hinder their progress at all levels of functionality must be curbed.
Given our apathetic attitude towards disabled as a nation and dearth of rehabilitation facilities, available, it needs no expertise to comprehend the serious trauma that they continue to face. The plight of the disabled already existed amongst us as we slept comfortably in ignorance and indifference. Ten years later, the earthquake should wake us out of this slumber to see and work on the fragility of life and limitations of what we take for granted each day. The time is now to turn such inertia around into meaningful change, not only by building facilities but, more importantly, opening our minds to broader meanings of rehabilitation. Only then, will we be equipped to better contend with a disaster of such magnitude should it head this way again.

Community Based Rehabilitation to the Rescue

In response to this severe gap, Subh-e-Nau: An Environment and Public Health Concern (SN), an organization dedicated to health and environment issues, extended its rehabilitation program. Formulating a Disability Reduction and Rehabilitation Strategy, it apprised and advised the public and private sector towards the huge disability and rehabilitation issues that arose from this earthquake, towards concrete steps required for mitigation.  In the initial one and a half years following the disaster, SN expanded its Rehabilitation program with the assistance of international and national volunteers. SN managed to build a team of physicians, physical and occupational therapists, psychologists, and other providers to attend to the social, psychological and physical needs of the seriously disabled population in 5 major hospitals in region, the H11 Camp City housing more than 10,000 people, and convalescence/nursing centers housing more than 200 persons with Spinal Cord Injury (SCI). The main technical assistance was provided from the Pakistan Working Group at International Centre for Disability and Rehabilitation (ICDR) and Department of Rehabilitation Sciences, University of Toronto and Toronto Rehab’s Lyndhurst Institute for Spinal Cord Injury Rehabilitation.
SN continues its dedication to this population, when the disabled persons were relocated to shelters and homes in the Northern Kashmir, more specifically in the Muzaffarabad and Bagh regions. SN was and continues to be the first pioneering organization to institute a Community Based Rehabilitation (CBR) program aimed at reintegration of the disabled population. The project has delivered a holistic approach to the disability of the population, with an alignment of medical services with community development, as well emphasis on mainstreaming the disabled, and providing them with an enabling environment to become active partners. In the implementation of CBR, SN was able to achieve not only medical rehabilitation of the disabled population in the region, but also their re-integration into the community. The project provides services to 200 persons with Spinal Cord Injury (SCI) in the Muzaffarabad region, and totaling more than 5,000 persons with serious physical disabilities and their families. These have been affected men, women, children affected with various problems, which, besides SCI include stroke, cerebral palsy, arthritis, fractures, amputation, sciatica, muscular dystrophy and various other disabilities.
Writer: Dr. Farrukh Chishtie



Warm-up: Getting the basic know-how into your sports

A warm-up – what exactly strikes in your head when you think about this term and activity?      

Well, a warm-up simply means getting yourself warm enough to perform any low or high impact sport. Coming from a professional background of tennis the ride has been not so smooth when it came down to some bad injuries, I experienced due to a basic neglect of warming up the body properly. It goes a long way for optimum performance be it any sport, at any level that you play.
Let us start with the basics. The term “warm-up” simply means getting the body moving and heart beating at a rate where you feel a slight sweat breaks out. This can simply be done by doing some basic cardio moves. For example, before playing tennis a few jogging rounds, simple stretches and then playing at a low impact level ensures the body is well prepared for the actual activity. The same goes for resistance training where some cardio can be done on the treadmill or elliptical. The National Academy of Sports Medicine recommends that a complete warm up includes activities both general and specific warmup activities. The difference between the two is that a general warm-up includes activities and movements that are not necessarily going to be performed in the actual workout as the same example of doing some cardio before resistance training whereas a specific workout involves movements that mimic those of actual activity for example performing pushups before resistance training of upper body.
Warming up also depends upon the weather. A warmer day will of course help the body to be prepared earlier as compared to warming up in cooler temperatures and that is time taking so this needs to be carefully managed. The temptation to just start over any workout without realizing the importance of preparing yourself will only land the body in distress and injuries. To elaborate more, the importance of warmup mainly encompasses six important elements:

Injury Prevention

Exercising cold, or exercising without warming up, creates health issues such as injury and cardiovascular issues. It would not take much exercise to tear a muscle or break a bone. When the body receives 10-15 minutes of warm-ups, the body is warm. Warm bodies take additional force to tear a muscle because it is prepared for an extensive workout.

Cardiovascular Benefits

A cold workout means the cardio components must begin without preparation. It cannot perform at its highest peak. Consequently, if you are breathing hard, tire easily, and stress out the heart. The heart, veins, and arteries need blood pumping to perform at a high level from start to finish. Warm-ups increase energy and blood flow. It prepares the body for a rigorous, yet rewarding workout.

Mental Preparation

Too often television, technology, and thoughts racing in our head distract us from exercise. Warm-ups get our minds away from the issues plaguing us. The mind becomes calm, clear, and serene. A calm, clear, and serene mind can concentrate on the exercise routine. It helps us get the form, technique, coordination, skill, discomfort, and time correct so the exercise routine can benefit our body.

Soft Tissue Alleviation

The muscles, joints, ligaments, and tendons must prepare for routine bending. A warm up prepares those soft tissues for flexibility during exercise. The flexibility provides an easier range of motion (i.e., bending and twisting) without pain. Without a warm up, movement becomes stiff and painful, which tears soft tissue easily

Improved Reflex

Reaction times during stretching, bending, and twisting must be quick. Good reflexes ensure people complete those challenging routines safely and efficiently. Warm-ups train the body to react and adapt to challenging routines. Cold exercises delay reflex time, increasing injury and pain.

Nervous System

Warm-ups warn the nervous system about the body’s upcoming workout. It signals to the muscle how much pain to withstand and when to stop. Along with an improved reflex, the nerves will warn the muscles (and you) about any pain or discomfort felt during and after the workout.
To conclude, it can be deduced that exercise or playing sports are not rush jobs or chores done halfheartedly. The best workouts require plenty of time to exercise. When there is no hurry, you can concentrate fully on exercise. Only then will warming up become part of the workout.
Writer: Mahvish Chishtie
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