The emergency ward at Karachi’s Jinnah Postgraduate Medical Centre (JPMC) was full to capacity when Abida Noor, a resident of Gulistan-i-Rafi Colony in Malir Town, took her younger daughter Kulsoom there for treatment in June 2015.
Temperatures in the coastal city had risen to around 42°C that week, but a phenomenon called the Urban Heat Island Effect made the atmosphere as warm as around 47°C in several areas. Dozens of people suffered severe heat strokes that week.
Not having dealt with an emergency of that scale in the past, major city hospitals soon ran out of space.
“The hospital was full of people. Beds were being shared by two to three patients. Many lay on the floor, waiting for a doctor to free up and examine them,” recalls Noor, who teaches at a primary school in her neighborhood.
By the time a medical officer became available to examine Kulsoom, her condition had already deteriorated. Last minute efforts were unable to save the child’s life.
“It was so sudden. The temperature had started intensifying at around midday. Many families in our area lost their loved ones,” Noor says.
Malir was the worst affected town, with the highest number of deaths. Of the 1,200 deaths recorded in official documents, 197 were from Malir.
As temperatures stayed between 40°C and 42°C for around five days, at least 42,000 suffered heat-related illnesses.
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Located off the Arabian Sea coast, Karachi has a semi-arid climate. The period from May to July has been the hottest around the year, with a 30-year daily average between 1961 and 1990 ranging from 30.3°C to 31.4°C, according to World Weather Information Service’s ‘Climate Normals for Karachi (Airport)’ report. The maximum average temperature for the month of June, hottest of the summer months, has been recorded at 34.8°C.
While summers generally start off dry, a rainy spell ensues from July and goes on at least till the end of August. Official data from 2006 to 2015 shows that relative humidity can vary considerably, from 30 percent to 95 percent.
Meteorological data compiled by the Pakistan Meteorological Department (PMD) shows that in last several decades, temperatures in the month of April have never exceeded 31°C. This year, however, temperature reached 38.5°C in early April, and by the mid of the month, mercury level touched 40°C for two days straight. And in mid May, high temperatures coupled with dry winds blowing from Balochistan, that kept relatively cooler sea breeze away from the city, led to another heatwave.
As the heatwave continued during May, city and provincial authorities maintained that there were no deaths, thanks to preparations made in view of the 2015 experience. Most major health facilities, including JPMC and Indus Hospital, reported receiving no more than six to eight heat stroke patients a day during the month. However, in a 36-hour period between May 19 and 21, Edhi Foundation reported receiving 67 bodies at its two mortuaries in Korangi and Sohrab Goth with heat stroke reported as the cause of death. Another two such cases were reported on May 22, taking the unofficial tally of deaths to 69. Most of these cases were reported from slum settlements in the vicinity of the mortuaries where K-Electric, city’s sole power supplier, carried out loadshedding for at least five hours during the day.
With summers getting warmer because of human-induced climatic changes, experts worry that the frequency of spells of severe heat waves will increase in the South Asian region. Megacities like Karachi are particularly vulnerable, given the poor tree cover and the Urban Heat Island Effect.
Karachi is a city of concrete. Its built-up area is several orders of magnitude larger than its green spaces or inland water bodies. These buildings, roads, and pavements are net absorbents of heat and sun rays. “The heat gets trapped in the city and gives the effect of an urban heat island on land,” explains Nadeem Mirbahar, an expert with the International Union for Conservation of Nature’s ecosystem management team.
Besides, more heat is added to the system because of urban lifestyles. “Power generators, vehicles and almost all home appliances release heat into the city’s atmosphere,” says Mirbahar, adding that the effect gets multiplied in densely populated areas as heat gets trapped in narrow alleyways.
Since trees and plants absorb less heat and evaporate water, they are an excellent source of countering the Urban Heat Island Effect.
“We need at least 25 percent tree cover in Karachi to help ameliorate the effect of heatwaves. Green spaces constitute less than two percent of the city’s area at the moment,” Mirbahar notes.
While the 2015 heatwave took the city authorities by surprise, they have since been working on a plan to deal with such emergencies in the future.
A Heatwave Management Plan was prepared in 2017 and was put into effect for testing this year. The city authorities say that under the plan all relevant civic bodies will remain on alert every year from April 1 to October 31 every year.
The Karachi Heat Coordination Committee oversees the implementation of the plan. Besides the Additional Commissioner’s Office and the Pakistan Meteorological Department, it has representatives from provincial government’s disaster management authority and departments of police, healthcare, information, education, and labour; municipal corporations of all six districts in the city; the Mayor’s Office; and city specific government and non-government bodies like the Karachi Water and Sewerage Board (KWSB), the K-Electric, and Edhi and Chippa foundations.
The committee gets activated during a heat-related event. Based on its assessment of the situation, it can declare public holidays during a heatwave emergency and put major hospitals on alert, meaning the administration will be required to increase duty hours for staff if needed and stock up on necessary medicines.
Timely dissemination of weather and other relevant information is the bedrock of the plan. To ensure that this is done, the authorities are working with cell phone companies and software engineers to develop multiple smartphone applications to get weather alerts and to locate closest hospitals, optimal traffic routes and red zones (high risk areas). “SMS alerts will also be sent out under the plan whenever temperatures cross 40°C,” says Karachi’s assistant commissioner Dr Amber Mir, the focal person for the Heatwave Management Plan.
She says that throughout the period for implementation of the plan, the Commissioner’s Office will remain in touch with the PMD for weather forecasting. “Weather report will be updated in real-time on our website and will be communicated to the public with the help of the smartphone app,” she says, adding that elected representatives at the union council level will be asked to raise awareness about the use of the app in their areas.
The committee has set up a three-tier alert system, including hot day advisories (in yellow), hot day warnings (in orange), and heatwave emergencies (in red).
“Yellow and orange alerts will serve the purpose of raising public awareness and increasing the level of readiness for the emergency,” Dr Mir says.
Karachi heatwave was not a unique phenomenon of an extreme weather event. Many cities across neighboring India have also suffered frequent heatwaves lately. Like the El Niño Southern Oscillation (ENSO) influences that bring extreme temperatures in many parts of the world, the Indian Ocean Dipole (IOD) effects the climate of countries in the region around the Indian Ocean, stretching all the way to the west coast of Australia. The IOD is the difference in sea surface temperature between two poles – a western pole in the Arabian Sea (western Indian Ocean) and an eastern pole in the eastern Indian Ocean. It is a significant contributor to rainfall variability in the region. A research study conducted by UK based Royal Meteorological Society states that like El Niño, the IOD disturbs weather pattern and delays monsoon rains and also keeps temperatures in the western Indian Ocean hotter than averages.
These alerts will be issued based on the maximum forecast temperature on any given day. A yellow alert, or a hot day advisory, will be issued through SMS, the smartphone app, or conventional media, whenever the temperature is forecasted to cross the 40°C mark. If mercury level reaches 42°C, the committee is supposed to issue an orange alert, or a hot day warning, asking the public and relevant authorities to be prepared for an emergency.
A red alert, or a heatwave emergency warning, is triggered based on a consistent pattern of extreme weather that is expected to have significant health-related implications. “Red alerts signify heatwave emergency conditions and activate emergency procedures across all agencies in the city,” Dr Mir says.
It is issued whenever maximum temperatures remain above 42°C and minimum above 30°C for two or more days. Dr Mir says that the three-tier system was tested in April when temperatures crossed the 40°C threshold for the first time this season. A yellow alert was sent out, generating precautionary messages through SMS service and various media.
However, Sardar Ahmed, a resident of Musa Colony slum in Gulberg Town, doesn’t remember receiving any such text message. A van driver by profession, Ahmed listens to FM Radio frequently during the day. But he did not come across the message on radio either.
When she was told about Ahmed’s experience, Dr Mir agreed that there could be loopholes in the alert system, and said that the committee would look into each of the cases reported to it and fix them.
Using Geographic Information System (GIS) technology, the committee has already mapped vulnerable areas of the city, based on the number of deaths reported during the 2015 heatwave. The GIS mapping has revealed that housing quality and type, population size, low income levels and a lack of education are all factors that increase a neighborhood’s vulnerability to heat emergencies.
Since efforts to reduce vulnerability require greater resources and coordination at multiple levels of governance, the measures undertaken so far have been concerned mostly with preventing and managing emergencies.
The committee has formed mobile teams to provide first-aid and other emergency support. Once a red alert is triggered, these teams are required to report the number of heat stroke patients treated and the number of deaths every day to the Commissioner’s Office. Weekly reports of the public health impact are then to be compiled and shared with the Emergency Response Coordinator at the provincial level.
During red alerts, the committee also plans to set up roadside water stalls and cooling stations at major public places like mosques, temples, churches, and other places of worship, and bus and rail transit stations, particularly in vulnerable areas. Besides ensuring availability of all required medicines at public hospitals, the committee also plans to set up medical camps on roadsides where heat stroke patients can get first aid, while serious cases can be referred to nearby hospitals.
At the non-governmental level, Edhi and Chhipa foundations have increased their reserve of ambulances and added facilities like mobile mortuaries.
“We have bought another 100 ambulances to deal with heatwave emergencies,” says Faisal Edhi, the head of Edhi Foundation. “We have 500 ambulances in Karachi now,” he says.
The foundation has purchased mobile mortuaries keeping in view the severe shortage of mortuaries in the city during the 2015 emergency. These are air-conditioned trucks that can keep several bodies cool during the time taken to find a vacant spot for them at mortuaries across the city.
Recalling the rescue work in 2015, Edhi says most of the bodies his foundation staff picked up from across the city were of daily wagers, and most of these bodies were found in the city’s many slums. “The official figure for the death toll is 1,200, but I personally believe that the number was much higher. The authorities counted only those who were brought to government hospitals. I believe between 8,000 and 9,000 people died that week,” he claims.
Amar Guriro is a multimedia journalist based in Karachi. He reports on the environment for Daily Times.