Karachi is Pakistan’s biggest city and greatest hope, with aspirations of becoming the next Shanghai. But in the way of its rapid progress stand its slums, but plans to transform it are being met with fierce opposition. Rows of corrugated iron shacks are packed with the belongings of the hundreds of families who live there. Young children play with stray dogs among the filth and rubbish. There is little sign of clean drinking water and the sanitation facilities are appalling – up to 80 people are forced to share one toilet. Slums including Lyari, Machhar Colony and Azam Basti bear all the hallmarks of Pakistan’s most crippling problems. “We want change and for conditions to improve for the people who live here. There is nowhere for my grandchildren to play but I cannot afford to move from here, says 60-year-old Razman, who has been living in Lyari for 10 years.
There is a small stove in one corner and a tired old fan, if arms are stretched out, one can touch both walls of the room that is home to the five members of his family, including two small children. “My vision would be that it [Lyari] would be transformed into one of the better suburbs of Karachi. There will be state-of-the-art modern amenities and a lot of happy people living here,” Ramzan adds.
But many of the residents have other ideas. They refuse to be transformed by international companies, which have little or no idea of their community and what it needs.
Their neighbourhood may be plagued by a crippling infrastructure but at the heart of
Karachi is a bustling business district that generates up to $39 million a year.
The tiny alleys that lead through the maze that is Lyari are packed with small workshops. Here tanners thrash the hide of freshly cut leather and paint the square strips to be sewn into handbags. It is the kind of business that keeps half of the residents like Aslam Khan in employment.
“I would not be able to afford the cost of hiring a room outside Lyari,” he says.
Visitors to the slum are struck by the uniqueness of Lyari – most describe it as being like a city in itself, with a community of people living and working together which many wish to preserve.
ADULT MORTALITY IN CITY’S SLUMS: According to verbal autopsies for adult deaths under active surveillance in five slums of Karachi, male mortality exceeded female. Non-communicable diseases claimed 59 percent of deaths, communicable and reproductive 27 percent and injuries 15 percent. The leading identified death rates among women were: circulatory disorders, maternal causes, tuberculosis, and burns.
Among men, they were circulatory disorders, tuberculosis and road traffic accidents. Overall, the Karachi adult mortality was 3.7 times the Japanese rate. Compared to Japan, adults in Karachi had one to two orders of magnitude excess mortality due to maternal causes, tuberculosis and burns.
Circulatory disorders and tuberculosis accounted for 47 percent of excess male mortality; these plus maternal causes and burns accounted for 55 percent of excess female mortality. These mortality levels and patterns compel interventions and research for poor urban adults beyond maternal health. Women’s health would equally benefit from tuberculosis control or burn prevention. Men need safer travel. Both need improved cardiovascular health.
CHILD MORTALITY IN SLUMS: Pakistan has an infant mortality rate of 90.5/1000 live births, and the country’s child mortality level of 117.5 is worse than in other South Asian countries. Rapid population growth combined with rural-to-urban migration has led to the creation of urban slums in which morbidity levels are usually higher than in rural populations. According to a study in six slums of Karachi where the Aga Khan University has operated primary health care programmes, researchers recorded the deaths of 347 children under the age of five years due to diarrhoea and acute respiratory infections. A total of 235 mothers of these children were interviewed.
The following risk factors for under-five child mortality were identified: use of traditional healers, poor nutritional status, incomplete or no immunisation, quick change of healers, inappropriate child care arrangements and mother’s literacy and short birth interval, bottle feeding, and nuclear family structure.
Maternal autonomy, appropriate health-seeking behaviour, and child-rearing processes identified in the study point to the need for intervention strategies which go beyond the usual primary health care initiatives and involve communities in developing social support systems for mothers.
Extract from the Hamdard Institute of Management Sciences, Business Research Methodology’s report on Slums of Karachi
