Pakistan and Water: New Pressures on Global Security and Human Health

Abstract

The Indus River is the major source of water for the more than 180 million people of Pakistan. A rapidly increasing population over the past 60 years has created new pressures on water that was once a plentiful resource for the health and development of the country.

Rising tensions between India and Pakistan, which share the Indus flow, may lead to violent confrontation in an already volatile part of the globe. The recent flooding, which affected more than 20 million people, drew attention to poor management of the rivers of Pakistan.

Public health has the scientific knowledge and professional capacity to help develop water management practices that could improve population health in Pakistan.

PRESSURES ON THE WATER OF the Indus River, the major water source for the more than 180 million persons living in Pakistan, are increasing, with serious implications for the health of the population. Rural Pakistanis (more than half the population) use irrigation water from the river for domestic purposes, even though it is unfit for drinking and a major cause of stunting and diarrhea.¹ Diarrhea causes 21.6% of infant mortality in rural Pakistan.² In Karachi, a megacity of approximately 18 million people, it is estimated that more than 30 000 people, 20 000 of whom are children, die every year because of unsafe water.³ Control of river flow is still a major challenge for the country, which was tragically demonstrated during recent flooding that affected 20 million people and was described by the secretary general of the United Nations as the worst disaster he had ever seen.⁴

Beyond the direct effect on human health, disputes over the flow of the Indus may erupt into a military conflict between India and Pakistan, endangering the lives and security of millions.⁵ The future of water flow in the Indus is also threatened by regional environmental changes.⁶ Public health professionals must be fully engaged in the development of this crucial resource for the country and the health of its population.

PAKISTAN AND THE INDUS RIVER

Pakistan was created in 1947 with the partitioning of British India, becoming the first Islamic republic. With one of the fastest growing populations in the world, Pakistan had a population of 180.8 million in 2009 and is projected to reach 208 million by 2020.⁷ Approximately 20% of the population lives below the international poverty line of US $1.25 a day.⁸ Health and social indicators have lagged behind those of other South Asian countries whose economic conditions are poorer than Pakistan's.⁹

The strategic importance of Pakistan has gone through important shifts, first with the Pakistan–India conflict that began after the 1947 partition, then with the Cold War's denouement, and now with the war on terror. The geopolitical importance of Pakistan, which shares borders with Iran, India, China, and Afghanistan, also intensified when it became a nuclear power in 1998.

The majority of the people in Pakistan live near the Indus River, the longest river in the country, and the 21st largest river in the world in annual flow (∼207 km³). The snows and glaciers of Tibet, India, and Pakistan feed the river. Beginning in the Himalayas, the Indus courses the entire length of Pakistan—a total of 1976 miles—and empties into the Arabian Sea near Pakistan's major port, Karachi. As much as 65% of agricultural land in Pakistan is irrigated by water from the Indus, which accounts for approximately 90% of the country's food and fiber production.

THE INDUS WATERS TREATY

During the early years after partition, disagreements over the flow of the Indus River led to the danger of military conflict; by 1951, the two sides were no longer meeting, and the situation seemed intractable.¹⁰ India's control of the headwaters of the Indus gave it the power to turn fertile Pakistan into a desert. With the conflict over Kashmir and the trauma of partition still in vivid memory, the threat of a “water” war became imminent.

David Lilienthal, a former chairman of the Tennessee Valley Authority and the US Atomic Energy Commission, visited the region in 1951 to write a series of articles for Collier's magazine. Working behind the scenes with the US Department of State and the World Bank, he engaged the governments of Indian and Pakistan in negotiations that lasted nine years. Those negotiations led to the Indus Waters Treaty, signed in 1960. This agreement has been faithfully implemented and upheld by both India and Pakistan and has been the longest-running accord ever between the two countries.¹¹ The treaty gives India exclusive use of all of the waters of the Eastern Rivers and their tributaries before the points where the rivers enter Pakistan. Similarly, Pakistan has exclusive use of the Western Rivers. Pakistan also received a one-time financial compensation for the loss of water from the Eastern Rivers.

Continuing tensions between India and Pakistan, however, have begun to erode confidence in the treaty.¹² India has greater bargaining power over Pakistan because the upper stream is in its territory, and Pakistan's water rights under the treaty are hard to enforce. Critics of the treaty suggest that benefits have gone to major players and not to those most in need. For Kashmir, where only 40% of cultivated land is irrigated, the result has been limited economic development. One quarter of the people of Kashmir lack electricity, and 55% lack safe drinking water.¹³ Kashmir also remains at the heart of the political tensions between India and Pakistan.

India's plan to build a dam on a tributary of the Indus within its borders has created new tensions. The construction of the dam would give India even more control over the flow of the river.¹⁴ The collapse of a dam could cause a disaster in the Northern Areas of Pakistan, and India's history with dam failure is considerable. Ongoing political confrontation between India and Pakistan makes the future of the Indus Waters Treaty uncertain.¹⁵ Even worse, war—globally the worst threat to public health—appears increasingly likely to break out over Indian–Pakistani water issues.¹⁶ Rapidly changing issues related to water quality and access to water for basic human needs have given a new direction to global security discussions. UN Deputy Secretary General Asha-Rose Migiro said,

Projections are that by the year 2050, water accessibility for human consumption will have dropped by 40 percent. Probably the next major conflict will be about water.¹⁷

NEW PRESSURES ON THE RIVER

Intensification of water use in Pakistan threatens the quality of water in the Indus. Rapid population growth over the past half century has intensified the pressure on agriculture and the need for irrigation water.¹⁸ The management of the flow has historically been inefficient because of poor water storage capacity, seepage, and inadequate maintenance of reservoirs. Heavy irrigation and seepage have overwhelmed the drainage of irrigated land, leading to accumulation of salts on the surface of the soil and rendering large tracts of land unfit for agricultural production.¹⁹ These inefficiencies have prevented Pakistan from attaining food self-sufficiency.²⁰

Environmental degradation of the Indus River and other wetlands in Pakistan has created additional health risks for the population.²¹ Water pollution in the Indus comes from a number of sources, including return flow from agriculture, which adds sodium nitrates, phosphates, and pesticides to the river. Additionally, untreated or incompletely treated sewage from cities along the Indus is discharged into the river. The river also receives a wide range of industrial waste: organic matter and ions such as sodium, potassium, calcium, magnesium, carbonates, bicarbonates, and chloride as well as inorganic wastes such as fluoride, silica, and cyanide. Finally, thermal power plants along the Indus cause sudden increases in surface water temperature that harm marine life.

Little research has been carried out to date on the effect of river pollution on human health in Pakistan, but the problem should not be underestimated. Much of the population along the Indus depends on the river for drinking water, and boiling does not remove polluting chemicals. Water pollution in the Indus River has reduced the species diversity of fish and decreased the supply of subsistence food for many who live near the river. In parts of the lower Indus delta, mangroves that were once abundant with marine life and an important source of food for coastal populations have almost disappear because of the toxic effect of polluted water that flow into this ecosystem.

Cities near the river are major water users. Karachi needs enormous quantities of water for both human and industrial use. The Indus River to the east and the Hub River to the west are the main water sources for Karachi. Water management in the city is a serious problem; one quarter of the population has no piped water, and as much as a quarter of the city water is wasted in faulty pipes.

Sewage management has been chaotic in Karachi for many years.²² The sewage system established by the British during colonial days has been overwhelmed and is in a poor state of repair. Open sewers, raw sewage overflowing into streets, and contamination of water lines with sewage are all common in Karachi. The city has annual outbreaks of cholera. Newspaper reports document thousands of hospitalizations attributable to sewage lines breaking and merging into water lines. Half of middle-class children in Karachi have intestinal parasites.

Also dependent on the Indus are Lahore (population six million) and Faisalabad (population five million). The groundwater table in Lahore is falling at a rate of 30 centimeters per year in the central part of the city because of heavy water use by the growing urban population.²³

Regional climate change also threatens the future of the Indus water flow and the millions of people who depend on it. The recent fast pace of glacier melt and warmer temperatures may lead to a serious diminution of river flow.²⁴ One of the suspected reasons for the rapid melting of these glaciers is settling of aerosolized soot and particles on the icy surface. This “Asian brown cloud,” caused by the burning of fossil fuels and biomass by the more than one billion people who live on the subcontinent, can be seen from outer space. As the cloud settles on the white glacial ice, light and heat are absorbed rather than reflected, melting the ice.²⁵ Even a small decrease in the flow in the rivers fed by these glaciers (the Indus and Ganges) would have huge consequences for agricultural production and human life.

NEW DIRECTIONS FOR HEALTH DIPLOMACY

Health has emerged as a global security issue, and the water needs of human populations have become part of that issue.²⁶ After the partitioning of British India, Pakistan and India began sharing the Indus River, but the contentious relations between the countries have already sparked two wars and water issues could cause further conflict. New pressures on water in Pakistan include intensification of use to meet the rapidly growing needs of agriculture and industry, environmental degradation of the river, and increasing use by cities.

These new problems will have serious public health consequences for people living in the region and must be added to the agenda of health diplomacy. Improved management of the Indus River could improve the health of the people of Pakistan. Public health has an important role in achieving this goal and in global diplomacy to safeguard water supplies and human health.