As of 6 May, Pakistan has reported 22,550 infections and 526 deaths, along with around 6.217 recoveries. For a population of more than 210 million, these figures seem tiny, especially in comparison to the hotspots in Europe and the United States. However, this is not a reason for joy or relief: where extremely little testing is being done, most infections run undetected. For weeks, only about 400-500 daily tests were carried out. Now, daily tests have been increased, but still remain below 10,000, which, again, is hardly worth mentioning considering the size of the population.
Medical care unattainable for the poor
The country’s health care system remains weak. Quality and coverage are unsatisfactory. With only one percent of the GDP being spent on health, the dependence on expensive private health providers is high. There are a number of excellent hospitals and good doctors in some major cities, but for millions of Pakistanis, quality medical care is out of reach. Many people are so poor that they cannot visit a doctor.
If a daily labourer or an agricultural worker is suffering from fever or a cough, he or she will hardly seek treatment. For COVID-19 cases, this means that even if large-scale testing was to be rolled out, people who never go to see a doctor, cannot be diagnosed. For Pakistan’s nascent middle class, the picture is somewhat different. Awareness about the danger posed by the coronavirus has risen steadily, even more so after Prime Minister Imran Khan was also tested following a contact with an infected person.
A lockdown difficult to enforce
In the early days of the crisis, Pakistan’s society and political decision-makers displayed an astonishing lack of concern in dealing with the pandemic – all the way into mid-March. The bustling bazaars were as busy and hectic as ever. And even though some media outlets stressed the need for stronger social distancing rules, most people did not appear to bother. A few days later, after the WHO officially declared COVID-19 a global pandemic, the country witnessed an abrupt change. While the prime minister seemed hesitant to declare a lockdown fearing the devastating impact on the country’s already troubled economy, the influential Pakistani military insisted on tougher measures.
From there, things moved fast. As in many other countries, most shops were closed, with the exception of pharmacies and grocery stores. Large sections of the capital Islamabad quickly became a ghost town. In the few shops still open, customers were only allowed to enter with face masks. A few shops admitted customers only after they had been checked for fever and disinfected their hands.
A harsh reality for informal workers
Soon, a picture similar to many countries across the Global South emerged. While movement restrictions and social distancing are warranted to curb the spread of the coronavirus, they are enormously difficult to sustain. Not only are rules and regulations in Pakistan already difficult to enforce in normal times, the economic hardship that lockdowns produce is impossible to bear for the poorest. Even before the crisis, millions of daily labourers had difficulties to make ends meet, hardly generated income that would last for more than a couple of days and had no social safety net. To expect them to now stay in their often crowded makeshift homes for weeks, is a sacrifice they are unable to make. For the millions of Pakistani workers in the informal sector and beggars on the streets, a lockdown is not an option.
Being able or not being able to adhere to the lockdown measures clearly is a matter of class and social status. While people in the well-off districts of major cities, including the capital, have the means to observe the rules almost to their fullest extent, others don’t have this privilege. In addition, and perhaps unavoidably so, many government measures even lead to more gatherings of people. For example, in many places the governmental program to pay 12,000 Rupees (about two-thirds of the official minimum wage) to families in need means that people convene in larger crowds and long queues again.
Balancing public health and piety
Certainly the biggest challenge lies in enforcing strict measures during Ramadan and thereby limiting the traditional ways Muslims are marking the holy month. This is a highly sensitive political matter. Many governments, not just in the Islamic Republic of Pakistan, shy away from putting public health before piety. In the case of Pakistan, many COVID-19 infections were apparently imported by Shiite pilgrims returning from Iran, travelling back to their home regions in crowded buses and trains and without proper checks. A major Sunni religious gathering held in March in the city of Raiwind with tens of thousands of people in attendance is now known to have been the source of many more infections across the country. All sides, not least religious officials and representatives of religious parties, continue to hesitate to cancel prayers in mosques and refrain from asking people to pray alone at home.
According to a study by the local community organization PATTAN, a partner of FES Pakistan, about 80 percent of mosques in the province of Punjab do not adhere to the agreement between the Ulama and the government. This presents a genuine dilemma for the government: it seems culturally unimaginable and politically unfeasible that the authorities would use police officers to enforce social distancing standards and movement restrictions in religious institutions.
Is the worst still to come?
Some expert accounts and experience from other countries suggest that the worst is still to come for Pakistan. A major outbreak is all but impossible, if it is not already partly underway undetected. Authorities have to walk a tight rope between state policies and religious practices. Fatigue, exhaustion and the economic hardship caused by the lockdown are driving people back to the streets. For day labourers and many other informal workers, this is the only way forward anyway. But others too are taking back to public life and seem increasingly less disciplined, for instance in the way they are wearing (or not wearing) their face masks.
In addition, political conflicts over how best to deal with the virus have begun – in particular between the central government, with the prime minister keen to loosening restrictions and restarting the economy, and the provincial government of Sindh, which is taking far more drastic measures to restrict movements. It is an uncertain future for Pakistan and a crisis that could exacerbate even further.
Dr. Jochen Hippler is the Director of the FES Pakistan office. He previously served as Adjunct Professor and Senior Fellow at the Institute for Development and Peace (Institut für Entwicklung und Frieden, INEF) at the University of Duisburg-Essen. He is a renowned international affairs specialist and has published widely on the Middle East, Afghanistan and Pakistan.
The views expressed in this blog series are not necessarily those of FES.
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