Pakistan: What has been affecting children’s health besides the shortage of safe water?

Nowshera County of Khyber Pukhtoonkhwa Province of Pakistan is located in the vicinity of the national border with Afghanistan. Here, people suffer from a serious shortage of clean drinking water and a lack of readily-available lavatories, which are taken for granted in Japan. Besides the ordinary residents of Nowshera, nearly 40,000 Internally Displaced Persons (IDPs) and over 100,000 refugees from Afghanistan have been living here, but they are not provided with clean drinking water or sufficient lavatories. For the children living in this region, AAR Japan has been building and improving wells and lavatories in elementary schools and also providing programs to raise awareness about hygiene since 2011. This report is by Bunjiro HARA, staff member of AAR Japan Islamabad Office.

Children drink water and then suffer from diarrhea.

Nowshera, where AAR has been carrying out its activities, has no sewerage system and only 20% of this region has access to water supply. People mostly satisfy their need for water using wells, but the locations of some wells cause problems such as the infiltration of colon bacillus into the water through the surrounding drainage. As such, most of their water is not appropriate for drinking. However, there is no alternative water resource here. Our prior inquiry indicates that as many as 48% of the pupils of Pakistani public elementary schools and 69% of the pupils of Afghan refugees’ primary schools developed diarrhea within the past one month.
AAR’s support has enabled pupils to drink clean water.
At Mera Akora Khattak Pakistani Government Primary School for Boys.  (December 18th, 2013.)

“We would like to protect children’s health,” said HARA, pictured on the left with children of Mera Akora KhattakPakistani Government Primary School for Boys.  (December 18th, 2013.)

School premises are dotted with human waste.

There is a general shortage of lavatories in this region, too. Schools have a limited number of lavatories, many of which are broken, and consequently children are forced to used playgrounds and roadsides daily to answer the call of nature. The Pakistani government has been grappling with improvements to the modest school environment, but its commitment to this problem is not sufficient in this region, which is far from the urban areas.
Since 2011, AAR has built or renovated 76 wells and 98 lavatories in total for 38 public elementary schools and primary schools for refugees from Afghanistan. It has also installed water purification filters for the wells as well as water filtration systems using ultraviolet rays for sterilization. This has enabled approximately 14,000 pupils to secure clean drinking water and to use lavatories.

Before AAR’s support: there was only a latrine behind the broken door. This is at a primary school for refugees from Afghanistan.  (February 13th 2013.)
Before AAR’s support: 120 pupils used to share one latrine. At a primary school for refugees from Afghanistan. (February 13th, 2013.)

After AAR’s support: we have built 11 ordinary lavatories and one lavatory for children with disabilities, which has a slope for children with wheelchairs. At a primary school for refugees from Afghanistan.  (November 8th 2013.)
After AAR’s support: the lavatory for children with disabilities is Western in style, and has a handrail and a washbasin installed at a lower position. At a primary school for refugees from Afghanistan. (November 8th, 2013.)

“After my participation in the contest, I have got into a habit of washing my hands.”

Together with the construction of wells and lavatories, we have been running a hygiene campaign. Apart from providing hygiene education programs to teachers and parents, we have been teaching children the importance of practices such as washing their hands after using the toilet, as well as brushing their teeth.
We also held a contest at each school in which children from each school year competed to demonstrate the best hand-washing and teeth-brushing practices, which helped raise the children’s awareness of proper hygiene. Muhammad, a fourth grader and the first place winner of Ali Garh Pakistani Government Primary School for Boys, cheerfully said to us, “After my participation in the contest, I have got into a habit of washing my hands with soap and have come to check whether our classrooms, lavatories and playground are cleaned well enough or not.”
The hygiene contest in which children representing each school year competed to demonstrate washing their hands and brushing their teeth. The child with the best performance was given a commendation. 
At Ali Garh Pakistani Government Primary School for Girls. (October 31st, 2013.)

Hereafter, we will continue our contribution towards the better health of children by committing ourselves to the development and improvement of wells and lavatories – which this region has been short of – and to the promotion of hygiene enlightenment programs.

Bunjiro HARA from AAR Japan’s Pakistan Office
After graduating from university, HARA worked for an electric appliance manufacturer. But the multiple simultaneous terrorism acts in the U.S. motivated HARA to launch volunteer activities to support refugees from Afghanistan. After working with organizations such as international cooperative NGO, HARA joined AAR Japan in October 2013. HARA says, “Seeing children who happily drink water and cheerfully wash their hands has inspired me greatly.” HARA is from Shizuoka Prefecture.