（原创）巴基斯坦疫情报告-Report on the epidemic in Pakistan
Issuing time:2020-06-22 18:56Author:全球疫情报告小组Source:原创 Original
Report on the epidemic in Pakistan
This is the third IACCR outbreak report and now we turn our attention to China’s ever-loyal friend, Pakistan. In the early days of the epidemic in China, Pakistan provided us with full support, which deeply touched our hearts. Presently, however, the epidemic in Pakistan is worsening rapidly, with nearly 30,000 people diagnosed in just one week. At present, the total number has topped 100,000 and the turning point is still far from coming. At the same time, this developing country is facing the threat of the first economic recession in decades and is forced to adopt the lock-down lifting policy. Apparently, Pakistan’s prospects of fighting the war against the epidemic are not promising and people there need more support.
Pakistan is a developed country located in South Asia. According to the 2017 census, the country has a population of 208 million and more than 95% of its inhabitants are Moslem. It is one of the world’s most populous Islamic countries, second only to Indonesia. As of 8:19, June 8, Pakistan officially announced 4728 confirmed cases in the past 24 hours, keeping the country’s confirmed cases per day continuously increasing. As of the same day, confirmed cases mounted 103,662, death toll reached 2067 and cured, 34355. The worst hit areas were Sindh(38,108 cases) and Punjab (38,903 cases).
Since May, the epidemic in Pakistan has not been effectively controlled.
According to information from the China-Pakistan Economic Corridor, since the Pakistani government gradually eased the city’s lockdown in early May, the COVID-19 epidemic has experienced a rebound. In response, Pakistan’s National Command and Operation Center(NCOC) warned trade practitioners on the 16th that non-compliance with Standard Operating Procedures(SOPs) for epidemic prevention will lead to market closure. Pakistan’s special assistant to the Prime Minister in charge of national health Services, Zafar Mirza, has repeatedly stated that if the situation continues to deteriorate, it’s possible that the cities would be lockdown again. In fact, as early as the end of April, WHO had already warned the Pakistani authorities that if Pakistan could not take a more effective action, the number of confirmed cases in mid-July would reach 200,000 cases, a prediction that seems to be too optimistic now. Despite the concerns expressed by all countries from all walks of life, the epidemic is still spreading in Pakistan and not yet reached a turning point. Pakistan’s prospects of fighting the war against the epidemic are not promising.
From our point of view, the reasons why the epidemic in Pakistan has not been brought under control are as follows:
First, the political instability, large population and slow economic development make it imperative that the lockdown be lifted to preserve the economy.
Pakistan's political regime is alternated almost every 10 years between a democratically elected Government and a military Government. The complex political and religious situation in the country has long been in a state of flux. There is no political security in building the economy. The country's GDP growth rate fell to 1.70 per cent during the global financial crisis in 2008 and without a proper solution to the problem of full employment of the working population in the face of high fertility rates, the number has remained in a low profile since then. In addition, the inequality between rich and poor is serious, and the population is densely populated, with poor urban infrastructure, resulting in a large number of slums. The impact of the year-long locust epidemic on food production should not be overlooked. The continued closure of markets in response to the epidemic could exacerbate unemployment and cause social unrest. According to a recent World Bank report, the impact of the COVID-19 epidemic is likely to lead to a significant drop in per capita income in Pakistan, which would lead to its first economic recession in 68 years.
Against this backdrop, the Pakistani government was forced to adopt an easing policy— a phased easing of controls announced on 9 May. Last Monday (June 1), Prime Minister Imran Khan said that, while the industries listed on the “Negative List” will remain closed(mostly in education sector), every other industries will be opened.
He explained that the Pakistani government know exactly how Wuhan, China, and Europe are combating the epidemic, but unlike those places, Pakistan is not a country that is capable of responding to the epidemic in a proper way, since 25% of their population are in poverty, which means that nearly 50 million people do not have access to two full meals a day. Doctors, the elite and the poor all have their own voice, but the voice of the underclass is not being heard. Pakistan needs to pursue its own way. He said, "(Pakistan) should not stop doing business and developing because we have to balance between the control on the epidemic and our livelihood. Until the vaccine is not formulated, the coronavirus will not go away. We have to live with it." He also urged the industries to ensure implementation of the officially issued Standard Operating Procedures (SOPs).
Motorists and people gather at a market for shopping ahead of the Muslim Eid al-Fitr festival in Karachi on May 20, 2020. (来源：AFP Photo)
由于新冠疫情，并非所有穆斯林国家都开放清真寺，但是由于巴基斯坦国内宗教领导的强硬意见以及政府提振经济的考虑等因素，斋月和开斋节如期举行，也意味着之前的封锁措施部分解除。与此同时，抗疫保障措施显然没有得到落实——有专家建议政府以宣传为主，不过多干预百姓行为，但其结果正如巴国一些批评声音指出，开斋节前后设定的宽松政策、恢复运营的市场环境，都导致民众对疫情的严重性认识不足。根据当地媒体的报道，节日期间，民众带着愉悦、放松的节日心情（“with the satisfaction in mind”）出门，许多市场、购物中心、餐厅、电影院、游乐场等都开放了，百姓大量聚集，只有不到5%的人采取了戴口罩等防疫措施。这可能是导致六月初疫情急剧反弹的直接原因。
Second, the country has a large Islamic population and a strong religious atmosphere, and the epidemic coincides with Ramadan.
For Muslims, Ramadan is the most noble and festive month of the year, and the day after Ramadan ends is the Muslim festival of Eid al-Fitr, one of the two major festivals of Islam. During this time, there is also more frequent trade in various goods and it is the peak season for local sales. It is also an important time for various religious groups to raise and receive donations.
Due to the epidemic, most Muslim countries are keeping their mosques closed, but due to the strong demand of religious leaders in Pakistan and the country’s need to boost their economy, Ramadan and Eid al-Fitr took place as scheduled, which meant that the previous lockdown was partially lifted. At the same time, it is clear that the prevention and control measures against the epidemic are not being implemented - some experts suggest that the Government should focus on awareness-raising and not interfere too much in people's behaviour. However, the result, as some critical voices in Pakistan have pointed out, is that the relaxed policies set around Eid al-Fitr to resume the operation of the markets, has led to a lack of public awareness of the seriousness of the epidemic. According to local media, during the holiday season, the population is in a happy, relaxed holiday mood ("with the satisfaction in mind"), many markets, shopping centers, restaurants, movie theaters, and Amusement parks and other places were open. People gathered in large numbers, and less than 5 percent of the population took precautions against the disease, such as wearing masks. This may have been the direct cause of the dramatic rebound of the epidemic in early June.
A banner outside Karachi’s Indus Hospital announces to reach full capacity.
Thirdly, the level of health care in Pakistan is low and there are difficulties in the production of health-related commodities to combat the epidemic. Pakistan became a signatory to the United Nations Millennium Development Goals (MDGs) in 2000, and as a result, their national health policy was restructured in 2001. While the Government of Pakistan had begun preventive approaches and health-care programmes, and has boosted the advancement of public health facilities, population growth in Pakistan had led to an increase in the people’s demand on healthcare, which is still unmet. In addition, public health facilities to address major health problems are often located only in major towns.
Unlike countries like China, Pakistan does not have a health care system to deal with widespread epidemics, and preventive equipment in the country is scarce or outdated due to lack of upgrades. At the end of March, only 215 out of more than 7,600 health facilities in Pakistan were capable of segregation, and segregated beds were merely 2942. In Punjab, there are only 24 hospitals with a total of 160 ventilators. After 13 doctors were diagnosed with the disease, people protested against the lack of medical supplies and the inability to work, resulting in many arrests. Currently, with the number of infected people in the country topping 100,000, the country's health system is in a precarious state, with a shortage of beds and respiratory equipment. 3,088 medical staff were diagnosed, 29 of whom died.
Fourth, Pakistanis have not strictly followed standard operating procedures (SOPs), so they cannot achieve a balance between boosting the economy and resisting the epidemic. The specific reasons include the following:
First, the rule-making process and its result were questioned. For example, on May 18 , it was reported by local media that transportation practitioners refused to follow SOPs, they argued that regulations about separation distance caused a great income decline, there was no tax relief for that situation, and they complained that those rule makers didn’t listen to opinions from them before.
All transporter bodies except one oppose new SOPs
Second, the cost of SOPs violation is very low. Many people around Pakistan has not been following SOPs, making this procedure more of a slogan). Recently, officials said that they would enhance law enforcement, they hope the situation will be better in the future.
最后，SOPs的推行没有与之匹配的宣传，民众不理解其重要意义。根据DailyPakistan报道，民间广泛存在对SOPs影响开斋节正常举行的不满。这间接说明SOPs尚未在宗教气氛中有效立足；Newsweek Pakistan 最新发表（6月4日）的一篇社评则直接指出，各界对新冠疫情的严重性说辞不一，夸张有之、轻视有之，而权威的医疗知识普及缺位，是导致民众心理懈怠而不遵守SOPs的主要原因。
Finally，without proper propaganda, the public didn’t understand the significance of SOPs . According to DailyPakistan，there has been a public dissatisfaction toward SOPs for breaking the schedule of Eid Al-Fitr, which implied that SOPs still didn’t get support from religious crowd. On 4 June, an editorial by Newsweek Pakistan showed the various opinions toward the seriousness of epidemic, with exaggeration or with contempt. Besides, the lack of public medical knowledge from authority, is the main reason why the public slacked off (the epidemic) and violated SOPs.
Apart from epidemic, Pakistan has been facing more threaten.
First, locust had brought a lasting devastation. Since May 2019, Locust had swept countries like India, and Pakistan. India announced that the locust plague was almost over in mid-February, but Pakistan still faced a lasting threaten. It was reported that what Pakistan had suffer from was the most serious locust plague since 1993, and they were not prepared for this. The United Nations' Food and Agriculture Organization (FAO) estimates losses as high as 353 billion rupees(about $2.2 billion )to agriculture from locusts this year to winter crops like wheat or potatoes and nearly 464 billion rupees for summer crops. On 20 May ,during the China-Pakistan Economic and Trade Hotline Cloud Salon-Joint Locust Control, an officer from Pakistan's Ministry of National Food Security & Research said the next wave of locusts was expected to break out in June.
其次，近期与印度在克什米尔问题上爆发大规模冲突。两国在该地区的矛盾由来已久，近期联合对抗蝗灾的短暂合作结束后，便再次暴露出来。5月6日，Daily Pakistan报道印度军方杀死了两名克什米尔青年；印度媒体5月31日指责巴基斯坦违反停火协议导致平民受伤。 Pakistan Today在五月中旬报道，克什米尔的断网措施还影响到了追踪新冠疫情患者。
Second, a large-scale conflict with India recently broke out on the Kashmir issue, which has had a long history. After the short-term joint cooperation against the locust, the conflict was exposed again. On 6 May, Daily Pakistan reported that the Indian military had killed two Kashmiri youths; on 31 May Indian media accused Pakistan of violating the ceasefire agreement and causing civilian injuries. In mid-May Pakistan Today reported that Kashmir's blocking of internet also affected the tracking of COVID-19 patients.
Inside Pakistan, religious terrorist attacks never stopped. According to reports from Chinese security companies such as Hedgehog Safety, Zhongan Huadun who had concern over the safety of overseas Chinese, although Pakistan had intensified efforts to fight terrorism, their safety had still been threatened by those religious terrorist and violent extremist ; especially around religious and traditional festivals , "Islamic State terrorist organizations often launch attacks against government, military and police facilities, Shia Muslim or Christian religious gatherings and densely populated areas." According to the unofficial statistics of the above-mentioned enterprises, in mid-May the Pakistani anti-terrorist department thwarted several terrorist attacks and killed nearly 10 terrorists.
On 26 May the Pakistani Chinese newspaper "Huashang Weekly" wrote an article to express concerns about the mental health of local people. According to this article, there were only 500 psychologists in Pakistan, and there are fewer students who graduated in medical psychology every year. Recently, because of the COVID-19 and the rare locust plague, there has been a great increase in the number of the unemployed and domestic violence in Pakistan. Meantime, the home isolation had caused a huge increase in the autism, anxiety and paranoia among the elderly and children. It was not helpful to gather and pray in mosques, on the contrary, it might increase the risks of religious extremism, terrorism activities and eventually cause more crimes.
On the other hand, Pakistan is also of great advantages in epidemic resistance.
In the past decade, Pakistan had vigorously developed Internet intelligence in the economic field. A new wave of innovation was driven by the introduction of 3G/4G technology, the increase in Internet penetration and the emerging entrepreneurial ecosystem. In the medical field, 60 million Pakistanis have smart phones, they could get access to online medical information, make appointment with doctors, order medicines and request to participate in medical experiments. There were also some startups that were developing online medical data preservation service. In the field of social assistance, Hammad Azhar , Federal Minister for Industries & Production Division, said on 28 April that he was working with the Ehsaas team to establish a portal on which people can apply for the assistance plan. In terms of life, Pakistan also has a well- developed online shopping and takeaway platform.
During the epidemic, Pakistan has received continuous supports from China. According to local media , on the evening of April 26, Pakistan received a 18-ton-weight medical equipment from China, which could run 40,000 virus tests. The National Disaster Risk Management Fund (NDRMF) has collaborated with the National Disaster Management Authority (NDMA) to purchase medical equipment worth $50 million from China. Thousands of front line medical staffs were able to protect themselves from infection by medical donations from the Chinese government ,Chinese people and their companies in Pakistan.
“I must appreciate our donors for providing us with the abundant supply of urgently needed medical provisions. Their magnanimity and concern for health and safety of fellow human beings is not only a manifestation of their humane character but also offers an insight into peaceful and benevolent traits of Chinese civilization.” Naghmana Hashmi，Pakistan Ambassador to China, said in a Chinese Economic Net interview.
The epidemic also promoted the joint construction of China-Pakistan Digital Silk Road. With more interaction on the intelligent field, more citizens would be benefited from various digital techniques and services, such as Internet of Things, 5G, artificial intelligence and cloud algorithm.
According to report by “HuaShang Weekly” on 8 April, the Asian Development Bank (ADB) is funding around $105 million to the NDRMF for procuring more medical equipment, which would be provided to the federation and the provinces through the NDMA. The World Bank (WB) would also give $60 million to Pakistan for the purpose. Negotiations are nearing conclusion with the French Development Bank for $40 to 45 million to procure more medical equipment.
Minister for Planning Development Reforms and Special Initiatives Asad Umar said on 16th May that with the efforts from home the abroad, their test capacity has increased by around 30 times, the country has 70 labs to test Covid-19 samples. According to a report by Xinhua Net on 3rd June, Pakistan had increased their efforts on test, the new infections were detected after conducting a maximum of 17,370 tests in a day. The authorities have so far carried out 595 thousands tests in the country. The reservation of medical supplies were catching up.
IACCR will pay more attention to the members of Asian-pacific and Africa area, we are in preparation for the next step.