One district’s water tale

When 93 percent of water supply schemes in a single district fail to meet basic health standards, we are not witnessing administrative incompetence. We are witnessing systematic abandonment. Nawabshah, officially renamed Shaheed Benazirabad but still known by its old name to most, represents everything catastrophic about Pakistan's approach to public health. The numbers are devastating, the political will absent, and the consequences measured in preventable deaths, particularly of children under five.

Pakistan ranks third globally among nations with insufficient water and sanitation, a distinction that should shame us all. But nowhere is this crisis more acute than in central Sindh, where Nawabshah's 1.8 million residents contend with water so contaminated that health officials warn against its consumption. Recent assessments reveal that approximately 70 to 74 percent of drinking water in the Nawabshah district is unsuitable for human use, contaminated with everything from E. coli bacteria to heavy metals, excessive sulfates, and agricultural pesticides.

This is not a natural disaster. This is policy failure crystallized into disease. The connection between contaminated water and death is direct and documented. In 2017 alone, Pakistan reported 2.5 million deaths from diarrhea, with water contamination implicated in half the country's diseases and 40 percent of its deaths. Nationally, waterborne illnesses kill nearly 94,000 people annually, 56 percent of them children under five. These are not statistics. They are indictments. When a nation allows more than half its child mortality to stem from something as preventable as clean water access, it has surrendered its moral authority.

Nawabshah's crisis extends beyond individual suffering to create regional and global health threats. The district sits geographically proximate to Hyderabad, the epicenter of the extensively drug resistant typhoid outbreak that began in November 2016. Between that date and June 2021, Sindh province reported 5,741 confirmed cases of XDR typhoid excluding Karachi, with 69.5 percent concentrated in District Hyderabad. Recent data shows that 57 percent of typhoid isolates from Pakistani laboratories between 2017 and 2019 were extensively drug resistant, rendering this once easily curable disease potentially untreatable. This antibiotic resistant strain has already spread internationally to the United States, United Kingdom, Canada, Australia, and Denmark through travelers, transforming a local sanitation failure into a global health security threat.

The business community's response to this crisis reveals both opportunity and moral bankruptcy. The global hygiene products market, valued at 595 billion dollars in 2024 and projected to reach 808 billion by 2033, thrives on the very conditions that kill Pakistan's children. Companies develop biodegradable formulations, recyclable packaging, and natural ingredients for consumers in wealthy nations while Pakistan's poorest quintiles bear disproportionate costs for waterborne illness. A single episode of typhoid costs an affected household 32,640 rupees, malaria 5,688 rupees, and diarrhea 1,757 rupees, amounts that devastate families already struggling for survival.

Nawabshah's children deserve better than contaminated water, preventable diseases, and early deaths. Pakistan's future demands better than a healthcare system overwhelmed by waterborne illnesses that were conquered in wealthy nations generations ago. The global community requires better than watching antibiotic resistance emerge from sanitation failures and spread worldwide.

Pakistan's own hygiene products market demonstrates both domestic demand and the inadequacy of market solutions alone. Major brands like Unilever and Reckitt Benckiser dominate the soap and detergent sector, yet half the population lacks a dedicated handwashing facility with soap at the household level according to the 2018 to 2019 Pakistan Social and Living Standards Measurement survey. This reveals the fundamental fallacy of treating public health as a consumer market problem. No amount of product innovation can substitute for infrastructure investment, regulatory enforcement, and political accountability.

The infrastructure deficit in Nawabshah is staggering and getting worse. The Shaheed Benazirabad Municipal Corporation oversees water supply and waste management across 19 union committees but operates with deteriorating drainage systems, insufficient treatment capacity, and inadequate solid waste management. Up to 80 percent of groundwater in Sindh's canal irrigated zones, including Nawabshah, is saline and unsuitable for drinking or irrigation without treatment, a fact that accelerates both soil degradation and agricultural decline. Deputy commissioners repeatedly order emergency improvements to drainage and water supply schemes, but emergency measures cannot fix systemic neglect.

The district's literacy rate of just 50.86 percent compounds every other challenge. When seven out of ten residents cannot read warning labels, public health campaigns become exercises in futility. When families lack basic knowledge about disease transmission, even access to soap cannot guarantee proper hygiene practices. The People's Medical University Hospital in Nawabshah functions as the principal tertiary referral center, but no hospital can treat its way out of contaminated water supplies. The common waterborne diseases reported throughout the district, gastroenteritis, diarrhea, typhoid, hepatitis, kidney problems, and skin conditions, reflect failures upstream from medical intervention.

International organizations recognize what Pakistan's government apparently does not. The World Health Organization estimates that unsafe water, sanitation, and hygiene services contribute to 74 million disability adjusted life years lost globally, representing 2.5 percent of total global disease burden. The Centers for Disease Control and Prevention reports that 2.3 billion people globally lack access to basic handwashing facilities with soap and water at home, while 670 million people have no handwashing facilities whatsoever. Yet research consistently demonstrates that promoting handwashing with soap can reduce diarrheal disease incidence by 30 percent, potentially preventing one million deaths from diarrheal diseases alone.

The economic burden is as crushing as the health toll. In 2018 to 2019, WASH related illnesses in Pakistan led to 32 million lost days and imposed an economic burden of 116 billion rupees. That calculation only captures direct costs, ignoring lost productivity, reduced educational attainment, and intergenerational poverty perpetuation. When children spend their formative years battling preventable diseases, when families bankrupt themselves treating waterborne illnesses, when communities lose their most productive members to typhoid and hepatitis, economic development becomes impossible.

Some will argue that Pakistan lacks resources for massive infrastructure investment. This is convenient fiction. The country finds billions for other priorities, for motorways and monuments, for military spending and political patronage. What it lacks is political will and accountability.

When municipal corporations can oversee districts where 93 percent of water schemes fail safety standards without facing consequences, when outbreaks of extensively drug resistant typhoid spread from one district to encompass an entire province and then the world, when half the country's deaths stem from contaminated water without triggering governmental urgency, the problem is not resources. The problem is priorities.

Nawabshah needs emergency intervention on multiple fronts. Immediate measures must include comprehensive water treatment infrastructure, proper sewage systems separated from water supplies, universal access to handwashing facilities with soap, and aggressive public health campaigns tailored to populations with limited literacy. Medium term solutions require regulatory enforcement that holds municipal corporations accountable for water quality standards, investment in healthcare infrastructure that can manage disease outbreaks, and economic support for families devastated by illness costs. Long term survival demands educational investment that raises literacy rates, agricultural reforms that address soil salinization and pesticide contamination, and political structures that prioritize public health over patronage.

The international community must recognize that Sindh's XDR typhoid outbreak represents a preview of antimicrobial resistance's global future. When basic sanitation failures allow disease to flourish, when inadequate diagnostic tools and indiscriminate antibiotic prescription create perfect conditions for resistance development, when economic desperation forces families to reuse medications or purchase counterfeit drugs, we create the circumstances for medical catastrophe. The cases already exported to wealthy nations demonstrate that borders provide no protection from diseases incubated in poverty and neglect.

Commercial hygiene product development, with its sustainable formulations and natural ingredients, offers technological solutions to symptoms while ignoring disease root causes. No amount of biodegradable soap or concentrated sanitizer can substitute for clean water infrastructure. No marketing campaign can replace political accountability. No product innovation can compensate for governmental abdication of basic public health responsibilities.

Nawabshah's children deserve better than contaminated water, preventable diseases, and early deaths. Pakistan's future demands better than a healthcare system overwhelmed by waterborne illnesses that were conquered in wealthy nations generations ago. The global community requires better than watching antibiotic resistance emerge from sanitation failures and spread worldwide.

The solutions exist. The technology is available. What remains absent is the political will to prioritize human life over other expenditures. Every day this crisis continues represents a choice, made consciously or through negligence, to value other priorities above children's lives. When historians assess Pakistan's first century, they will judge us not by our motorways or monuments but by how we treated our most vulnerable citizens. By that measure, we are failing catastrophically, and Nawabshah's water crisis stands as damning evidence of our collective moral bankruptcy.