12th CSFSR



Feb-07-2012


Civil Society Floods Situation Report      (CSFSR)



Peoples Accountability Commission on Floods (PACF)






[Prepared and Released By]
Peoples Accountability Commission on Floods (PACF)

Sindh Lacking Resilience Power with Inadequate Relief Services and Delayed ERF.



Civil Society Floods Situation Report (CSFSR)

12th Report


Rain Flood Affected Sindh suffers badly Resilience Power due to inadequate relief services and delayed Early Recovery Framework.























Table of Contents





  1. Feedback from PACF on basis of their field visits.
  2. Charter of demands through Consultations at District level of all concerned stakeholders.
  3. Advocacy Meetings with Government Officials and humanitarian partners/clusters
  4. Focus Group Discussions with Community
  5. Media Visits to hot spots
  6. PDI Humanitarian Complaints mechanism
  1. Clusters’ Updates.
  2. Rapid needs assessment reports by WHO, UNICEF, PDMA, NDMA and other specialized agencies.
  3. Multi sector needs assessment (MSNA) by UNOCHA 
  4. Pakistan Humanitarian Bulletins on different themes
  5. Situation reports by different humanitarian partners
  6. TSSU reports
  7. PDMA/NDMA summaries and reports
  8. Sphere standards, HAP standards and Hyogo Framework for Action.
  9. Reform Support Unit (RSU) and National Health Emergency Preparedness and Response network (NHEPRN)
  10. Interim Reports by FAO, WFP & SUPARKO
  11. Media References   



Sindh already having the negative indicators in health, education, housing, economic situation, income generation and other life saving and sustaining sectors suffered two floods in 2010 and 2011. The budget allocations in the mentioned sectors by the provincial and federal governments are inadequate and underutilized.  The targets set during monetary year at national and provincial are underachieved in sectors of development indicating further efforts to match the targets.
The quality of the life has been deteriorating during these two floods in Sindh 2010 and 2011. The peoples lost houses, basic health facilities, schools, basic physical infrastructure, standing crops, Livestock, poultry, assets and Legal documents damaging the education, health, food security, shelter and livelihoods of flood affected peoples.
The resilience power has decreased in flood affected areas to cope up and resist any kind of the upcoming disaster.   The level of the response adopted during flood 2010 to flooded situation was much rapid and timely in comparison of rain flood 2011 to minimize the vulnerabilities during relief and early recovery phase. Yet targets in shelter and schools rehabilitation are twenty cent met 2010 and current damages have added fuel to fire worsening further socio-economic conditions of the peoples in disaster.     
The pre floods socio-economic situation, unmet needs and current damages with rain flood in August and September 2011 have damaged largely the resilience power of the flood affected peoples.  The reliance of the flood affected peoples for the relief and recovery support from Government and external humanitarian world increased in proportion of decrease in resilience situation.
The increase in inflation rate and inadequate opportunities for income generation and losses of households’ assets leaves no opportunity to the flood affected households to be self reliant except to demand support. Agriculture sector provided labor to great part of our society which has been damaged highly making difficult for common man to earn substance with dignity.
38% affected areas and peoples have second time experience floods in Sindh with agriculture, crop and basic structures damages.  Due to the global warming, metrological department is foreseeing heavy monsoons in coming 12 years would worsen situation further.          
As per 5th TSSS report flood affected peoples have returned to the areas of their origin after forced return from the camps and currently fifty five thousands peoples are living in 250 spontaneous camps in three highly hit districts namely Umerkot, Sanghar and Mirpurkhas.   
There is difference between the Government and UN OCHA on the figures of the affected population during rain flood 2011. Government estimates the 9 million affected population whereas UNOCHA on basis of Multi-Sector Needs Assessment (MSNA) calculated 4.82 affected peoples.  Damages in shelter, Agriculture, Schools and Health facilities are major to respond in Relief and Early Recovery Framework.      

1.      4.8 million Affected, of which 2.4 million are children and 1.2 million women.
2.      84% of the affected populations are food-insecure.
3.      46% of the health facilities were damaged by the floods.
4.      Open defecation increased by 11-17%, increasing exposure to disease.
5.      1,342 schools are fully damaged and 2,638 schools are partially damaged due to the floods. 1,100 schools were used as displacement shelters in several districts of Sindh.
6.      60% of the schools have been damaged or 9,327 schools. (Over all)

On 17th of the September Government submitted the Flash appeal requesting the humanitarian world for USD 356,759,669 amount to respond the emergency relief services against the rain flood 2011.
In response government could achieve 162,348,502 funding the 46% of the required amount showing the ineffective coordination of the Government and Humanitarian partners to resolve the relief needs of the displaced population due to the flood.



Table-1: Funding during relief activities
Category
Funded
Coordination
80%
Food Security
51%
Health
43%
Logistics
74%
Shelter/NFIs
48%
Water Sanitation & Hygiene
17%
Unspecified
00%
Total Funding against requirement
46%

Government has stopped relief services on 31st of the December 2011 and residual relief would be continuing till 17th of the March due to the some relief projects deadline of six months. Government has planned to intervene in Early Recovery Framework from January 2012 to September to restore and rehabilitate the damages occurred during the rain flood 2011.The period of the nine months have been suggested by the Government to respond in ERF which has not started yet.    
National and Provincial Disaster management authorities have submitted the appeal for early recovery projects to be started from January to September 2012. The total amount 4.15 Million has been required for ERF to launch restoration and rehabilitation in shelter, food security, health, wash, physical infrastructure, education sectors. 

Table-2: Summary of Early Recovery Projects:

Sector/Cluster
No. of Projects
Budget
%age
ER shelter-NFIS Projects
20
153,755,936
37%
ER Food Security Projects
21
61,056,561
15%
ER Health Projects
44
49,682,420
12%
ER Wash Projects
21
58,284,745
14%
ER Community Restoration Projects
23
39,771,617
10%
ER Nutrition Projects
11
24,572,720
65
ER Education Project
16
17,813,496
4%
ER Protection Project
12
10,926,052
3%
ER Projects Total
168
415,863,547

It is matter of grave concern that Government has determined the Early Recovery Projects deadline from January till September 2012 whereas one month of January has already passed out and appeal is yet with the steering committee dealt by Economic Affairs Division (EAD) government of Pakistan.
After endorsement by EAD the appeal has to undergo for the funding to the humanitarian world knowing nothing about the funding certainty. Flood affected peoples’ reliance for the external support due to the inadequate resources with Government may take more than two months further to translates the projects in the field.
Approval of the appeal is not the guarantee of humanitarian Funding and 56% gap for relief services with the weaker resilience of the food affected peoples may hamper situation further for the vulnerable peoples.      
The rain flood inflicted devastation situation across Sindh but eight districts namely Badin, Umerkot, Mirpurkhas, Sanghar, Shaheed Benazir Abad, Tando Muhammad Khan, Tando Allah Yar and Tharparkar were highly hit. Government and UN OCHA are agreed upon to prioritize these affected Districts for Early recovery interventions.  This report focuses on the caseloads in these eight districts to be covered in Shelter, Food Security, Health, WASH, Community restoration, Education, Nutrition and Protection sectors during the early recovery phase of remaining eight months.
The Economic development of Sindh largely depends on the progress and growth of Agriculture sector. The province of Sindh contributes significantly towards overall national agriculture production in major crops as 41% in rice, 31% sugarcane, 15% cotton and 21% in wheat production.
73% women in rural areas of Sindh are economically part time active and 25% women are full times workers on agriculture. The major agriculture activities performed by Women Farmers are related to crop (cotton pickers) and livestock production, post harvest management and marketing. Around 80% of the flood affected peoples depend on Agriculture for a living.
As per NDMA report more the thirteen lacks fifty thousand acres with crops damaged in eight districts affecting 293, 56 villages and 674, 7884 persons population during rain flood 2011. At initial point 111211 livestock damaged leaving the challenges of animal fodder for animals.
Table-3: Average fro all affected districts
Average for all affected districts
Crop damaged/destroyed
Livestock lost/Sold
Food stocks destroyed
72%
36%
67%

While meeting with the deputy secretary agriculture Mr. Aziz Channa the focal person of the Sindh Government in Agriculture Department it was reported that fifty five metric tons of wheat seeds have been distributed by Government in the 17 affected districts for Rabi assistance 2011.
Table-4: Response in eight worse affected districts
S#
District
Caseload
Humanitarian Response FA at Hhs level
Difference of Hhs
Gap%

1
Badin
238,205
162,231
75,974
31.89

2
T M Khan
81,351
16,351
65,000
79.90

3
Mirpur Khas
138,618
93,441
45,177
32.59

4
S,Banazirabad
217,624
50,973
166,651
76.57

5
Tando Allahyar
105,984
20,316
85,668
80.83

6
Sanghar
332,871
111,085
221,786
66.62

7
Umerkot
123,272
76,913
46,359
37.60

8
Tharparkar
151,196
32,547
118,649
78.47

Total
1,237,925
563,857
825,264
66.66


As per report 40% cultivable land is without crop due to the lack of agri-inputs and inundation and saline water damaging the labor market dependent on agriculture. To avoid the 84% food insecurity from flood affected areas Cash for work and food for work strategies may be started in early recovery food insecurity projects.         
During the relief emergency 29% need in providing temporary shelter was meet where as more than nine lacks households were denied temporary shelters in highly hit eight districts of the Sindh. As per revised appeal 37% funding has been required for early recovery projects in shelter.  In highly hit eight districts of Sindh namely Badin, Umerkot, Mirpurkhas, Sanghar, Shaheed Benazir Abad, Tando Muhammad Khan, Tando Allah Yar and Tharparkar 628,111 houses were completely destroyed and 730,046 houses were partially destroyed amounting 1,358,157 total damages in shelter. Due to the damages in shelter over 814, 8942 population is disturbed and shelter less. Comprehensive planning is needed to assure the community and environmental friendly shelters for flood affected community.
S#
District
Houses Completely Destroyed
Houses Partially Damage
Total Damage / Destroyed houses
Tents
Tarpaulins
HH Served
Gap
Coverage / Damage
1
T.M Khan
25,353
47,582
72,935
207,780
11,243
26402
-  46,533
36
2
Badin
210407
172155
382562
48753
56337
76922
-305,640
20
3
Tharparkar
81460
96896
178356
20720
11500
26540
-151,816
15
4
Mirpur Khas
87483
30627
118110
38954
44530
61219
-  56,891
52
5
Tando Allahyar
6031
64132
70163
14082
13622
20893
-  49,270
30
6
Umarkot
28655
93448
122103
20885
24390
33083
-  89,020
27
7
Sanghar
88722
125206
213928
45343
59972
75329
-138,599
35
8
S. Banazir Abad
100000
100000
200000
70084
18175
79172
-120,828
40
Total
628,111
730,046
1,358,157
466,601
239,769
399,560
-958,597
29
Funding guarantee is not certain from humanitarian partners as planned by Government and repair and reconstruction of 1,358,157 houses in eight flood affected districts within seven months is critical. Community participation through shelter committees may be assured to repair and reconstruct their destroyed and damaged houses for sake of transparency and self sustainability. Early recovery projects were to be initiated practically in the month of January 2012 but it may take one month more to start ERF therefore extension of the ERF period would be needed till December 2012.  
Table-5: Detailed gape analysis and coverage of total damages




There is need of full reed resumption of primary health-care services in flood affected rural areas where peoples have returned to their homes. More than 75% households in flood-affected areas reportedly require continuous medical support. 928,000 children need to be screened.
Nearly 99,000 in eight districts moderately acutely malnourished children and more than 59,000 severely malnourished under five need to be treated. 571,000 pregnant and lactating women need to be screened, while more than 99,900 malnourished women need to be treated.       
Basic health facilities as BHUs and RHUs are the nearer facilities to be availed by the rural population and rain flood 2011 damaged or destroyed the basic health facilities at large scale. Based on the initial rapid assessment out of total of 682 BHUs in 22 districts 224 were damaged and 20 RHUs were damaged out of 111.
In highly hit eight districts of the Sindh out of total 256 BHUs 115 were damaged requiring restoration and rehabilitations.  
Table-6: status of Basic Health Units  and Rural Health Centers
S#
District
BHUs
%
RHCs
%
Total
Damaged
Total
Damaged
1
Badin
37
19
50
11
3
27
2
Mirpurkhas
38
19
50
5
1
20
3
S,B Abad
36
18
50
8
2
25
4
Sanghar
56
28
50
5
1
20
5
T,M Khan
14
7
50
3
1
33
6
T,A,Y
14
6
43
1
0
0
7
Tharparkar
31
9
29
2
0
0
8
Umerkot
30
9
30
0
0
0
Total
256
115
45%
35
8
23%

Table-7: Brief Description of alerts and outbreaks for most common diseases
Alert/Outbreak
AWD (Cholera)
Measles
Malaria
Pert sis
Tetanus/ Neonatal tetanus
# of Alerts
247
497
13
91
92
# of Outbreaks
96
55
1
15
-
# of Cases recorded
500
1434
666711
534
95




During the relief emergency phase 247 alerts and 96 outbreaks were recorded of cholera, measles, malaria, pertisis whereas cases of Dhiarria, acute respiratory infection, iron deficiency, Dengue and general OPD cases were recorded.  The response to the health needs of the flood affected community suffered 57%.
It is critical that health sector fund in revised appeal has been allocated 12% which is critical. In health sector need for rehabilitation of BHUs and RHUs is not only needed but supply of medicine and medical equipments are also needed.      
Reform Support Unit Government of Sindh with the collaboration of UNICEF and Save the Children has currently produced the lists of the fully and partially damaged schools in 18 districts of the Sindh. As per report out of the 3710 damaged schools 1342 are fully damaged needing temporary school structures and 2368 partially damaged needing temporary learning centers. Currently in 18 districts 1100 schools have been reported as IDP camps.    



Figure-4: District Wise damages of Schools due to Rain Flood 2011
RSU 8 District
S#
District
Physical Status
IDP Camps
*CD
*PD
*TD
1
Sanghar
307
538
845
730
2
Mirpurkhas
281
224
505
34
3
Badin
221
249
470
34
4
T.M Khan
71
247
318
187
5
S.B Ababd
134
166
300
23
6
Tharparker
57
212
269
0
7
Umerkot
68
136
204
0
8
T.A Yar
17
61
78
25
Total
1156
1833
2989
1033
Above mentioned status of damages in education sector need rehabilitation of 1156 fully damaged schools and renovation of 1833 damaged schools in highly hit districts of Sindh.
Currently relief phase has officially stopped and early recovery framework is in preparation where as 75% education needs are unmet during the relief services.  As per Education cluster meeting minutes dated on 15th of the December 2011 all the projects will be transmitted to early recovery framework with collective oversight by NDMA/UNDP and OCHA which are yet under process after one month.

Pakistan Card

To provide the Cash relief to the flood-affected people, the Sindh government, NADRA and the Provincial Disaster Management Authority (PDMA) joined hands to start a relief programme in notified calamity-hit areas in Sindh. Pakistan Card an ATM card was expected to be given to each calamity-hit family after necessary validation by PDMA and biometric verification by NADRA in order to ensure transparency in cash disbursement. Pakistan Card will have a cash tab of Rs 20,000 in two equal installments of Rs 10,000 for each affected family.
NADRA has so far processed 156,612 Pakistan Cards to the heads of rain-affected families in Sindh. 136,739 cards have been distributed in Mirpurkhas, 278,680 in Badin, 81,351 in Tando Mohammad Khan , 189772 in Shaheed Benazirabad (Nawabshah), 77962 in Tando Allahyar ,347345 in Sanghar and in Umerkot 44763.
The Government of Sindh and Federation of Pakistan announced the releasing of the funds to be given to each beneficiary Rs 20,000 and both parties would withdraw one installment of 10,000 and currently Sindh government has distributed cards 1,156,612 in eight districts mentioned above districts. Yet first installment has been completed till 1o of the December with uncertain situation for next installment
With regard to the eligibility criteria for the beneficiary of Pakistan Card on has to undergo with the nucleolus family number, address of the calamity-hit area announced by the District Government and PDMA, Automated Fingerprint Identification system (AFIS) and Facial recognition system (FRS) where as field reports reveal that modification or attainments of CNIC takes prolonged time with claim of bribery from the local agents of NADRA and Pakistan Cards Facilitation Centre.
As per survey out of the fifty lacks victims of the rain floods 2011 twenty lacks and fifty thousands (2.5 Million) are in urgent need of the life saving Wash interventions in Sindh. Immediate needs of flood affected peoples in Wash sector in Early recovery framework are restoration of basic structures for latrines, protected water for drinking, Sanitation /Drainages and waste management. Access to safe drinking water and sanitation facilities remains a critical issue in flood-affected areas. The findings of the MSNA indicate that the floods reduced access to piped drinking water among the affected people and increased the number of people relying on unprotected and untreated sources of water. A recent WHO report revealed that up to 87 per cent of water sources tested were unfit for drinking. The number of people practicing open defecation has also increased. Many returnees have found their primary settlements and structures damaged and in need of major rehabilitation and maintenance. As more people return to their homes, the focus shifts to critical early recovery interventions such as the restoration of damaged water schemes and social mobilization to support improved hygiene behavior.
WHO Representative presented the technical details of Cholera outbreaks, Epidemiology, sources of infection, symptoms, prevention, and Disinfection due to the unhygienic conditions in flood affected areas of Sindh. Keeping in view the last week cholera update in District Jamshoro and District Badin WHO representative suggested integrated approach to respond holistically to the emerging challenges in Wash and such outbreaks and alerts in health sector.
In the flood affected areas, many of the commonly used water sources, such as hand pumps and piped water, are no longer useable and people are resorting to alternative water sources, often unprotected. After the floods, an estimated one million people are using unprotected water sources. In addition, many people have been displaced and are currently living in roadside camps where water supply may be limited. Since the floods there is a 10 percent decrease in the number of people getting water from protected sources and 5 percent decrease in piped water sources.

Unfortunately, treatment of water before use is not widely practiced in Sindh and 91 percent of households in Sindh do not treat the water before drinking. Due to the decline in the use of protected water sources and the limited practice of water treatment it is likely that the incidence of waterborne infectious illnesses will increase.
An estimated 40 percent of the protected water sources are not yet functional. 32 percent is partially damaged and 8 percent is fully nonfictional. Open defecation is the most common sanitation practice in Sindh and due to the damage incurred on sanitation systems in place the practice of open defecation has increased 72% among the flood affected population, mainly in Sindh. The health risk particularly for young children walking and playing around barefoot is obvious.
Hand washing is difficult. Most of the communities reported not having soap available in places of hand washing and there are few places for hand washing in the communities (14%) There are few communities with separate bathing facilities for women (7%).
With regard to the protection of a child an emergency can typically be defined as: “A situation where lives, physical and mental well-being, or development opportunities for children are threatened as a result of armed conflict, disaster or the breakdown of social or legal order, and where local capacity to cope is exceeded or inadequate.
The goal of child protection is to promote, protect and fulfill children’s rights to protection from abuse, neglect, exploitation and violence as expressed in the UN Convention on the Rights of the Child and in other human rights, humanitarian and refugee treaties and conventions, as well as national laws.
Child protection is an important component of broader protection activities aiming to ensure the care and protection of vulnerable population groups such as elderly persons, disabled persons, and the chronically ill, as well as children. This includes emergency settings where child protection practitioners work with others to provide a specialist component of overall humanitarian protection for displaced and refugee populations.
According to the newly launched National Nutrition Survey of 2011, malnutrition in Sindh remains above emergency levels. Further support is urgently needed for life-saving therapeutic interventions and education to caregivers on infant and young child feeding in order to ensure children’s rights to a healthy life.
As per recent survey conducted by UNICEF and Nutrition Cell Health Department of Sindh, It was known that flood affected people were terribly suffering the food insecurity due to the poverty and destruction to the foods stocks and crops damages during the rain flood. Regarding source of drinking water, it was found that 87% population is lacking safe sources of drinking water. Severe to moderate rate of iron- deficiencies anaemia in mothers was found between 0.6pc and 20.3 pc, while only 16.8 pc mothers had the desirable level of Vitamin D in Sindh. Survey showed that 17.9 pc children under five in the urban areas and 32.8pc children in the rural areas of Sindh faced with severe stunting. Forty-two pc children were found suffering from Vitamin D deficiency, while 38.6 pc were found to be Zinc deficient.                
The survey confirmed that maternal and child under nutrition remains the major issue for the province where only 72 pc of the households were food insecure. Mr. Andro Shilakadze UNICEF representatives in Sindh said that a high level prevalence rate of malnutrition among women and children jeopardized not only the health and future of the children but also national security.
Nearly 99,000 in eight districts moderately acutely malnourished children and more than 59,000 severely malnourished under five need to be treated. 571,000 pregnant and lactating women need to be screened, while more than 99,900 malnourished women need to be treated.
More than twenty two lacks children are in dire needs of the balance nutrition, basic health care, basic schooling, Hygiene, social psycho-Social support, and preservation of their basic human rights in highly hit eight districts of Sindh. Children supported by women household head (23%), chronic poor families and special children are facing rather more critical situation. Thousands of children dependent on mother breast feeding and under five are reported mall nourished.
AffectedFamily in a camp
In any disaster affected situation child is more vulnerable to the external health and social threats as deprivation of basic education and child labor with the potential possibility of sexual abuse. Survey showed that 17.9 pc children under five in the urban areas and 32.8pc children in the rural areas of Sindh faced with severe stunting. Forty-two pc children were found suffering from Vitamin D deficiency, while 38.6 pc were found to be Zinc deficient.                
 As per TSSU report generated in October during the relief services in 2,547 temporary settlements approximately 174,500 households and 824,000 people were hoisted. As per report 78% peoples were lacking food distribution to them in camp life affecting badly to the nutrition level of the children and pregnant women.
Women in camp life are vulnerable with regard to the dignity and privacy of matters. The challenges women face during the disaster are many but a few major challenges women face are preservation of their privacy and dignity of women hood. During the camp life 62% women were lacking proper water facilities as potable water and for bathing purpose. The settlements were not well organized lacking the boundaries, space and food services.
During the relief services 27% pregnant women were not attended by Professionals violating the privacy and dignity of women.
With regard to the potential protection issues/concerns facing children, widow, disable and elderly during the early recovery framework the meaningful access to services would be great challenge in shelter, wash, and health and education sectors. Due to the restricted mobility and inadequate documentations women may suffer denial of the services.
There are certain social safety nets as Batul Mall, Zakat and special education institutions established by the government but they are almost invisible or non functional. In this regard eligibility criteria for the various services particularity in shelter sector should prioritize women for the service receiver.
Due to the disturbed schooling children under grade three should be taken soft examination so that their schooling can be encouraged in flood affected areas.
NADRA is lacking proper facility for women to get their new or modified CNIC for the eligibility of the services as Pakistan Card. It has been observed during visits at NADRA centers that there were absence of the special care taken for the women as separate counter and female staff to support the flood affected women.
It has also been observed during the field visits that women were undergoing in critical situation to prove herself widow and to get the nucleus family number. Union council secretaries are responsible to provide the death certificate of the husband with minimum fee of 100 rupees but illegal money was being charged by UC secretary.
Withdrawal of the cash support by government in absence of the income generation sources have increased the vulnerability of the flood affected peoples and yet second installment of the                        
Pakistan Card is yet uncertain.
Destruction of 46% health facilities in flood affected areas has made peoples more vulnerable to safeguard their health. Children with malnourishment status are mainly vulnerable due to the lack of the health facilities.         
The cases of denial and discrimination with regard to receive the services by flood affected peoples have been observed in flood affected areas due to the corruption, nepotism and favoritism causing duplication of services.
During the flood response 2010 it was observed that meaningful services were not focused and shelter structures were build without keeping in view the community participation, sustainability and environmental implications.   
    
v  It is matter of grave concern that Government has determined the Early Recovery Projects deadline from January till September 2012 whereas one month of January has already passed out and appeal is yet with the steering committee dealt by Economic Affairs Division (EAD) government of Pakistan. It is recommended that Government should extend the ERF Period for three months more.
v  Community participation through shelter committees may be assured to repair and reconstruct their destroyed and damaged houses for sake of transparency and self sustainability.  
v  There is need of full reed resumption of primary health-care services in flood affected rural areas where peoples have returned to their homes. More than 75% households in flood-affected areas reportedly require continuous medical support. 928,000 children need to be screened.
v  It is critical that health sector fund in revised appeal has been allocated 12% which is critical. In health sector need for rehabilitation of BHUs and RHUs is not only needed but supply of medicine and medical equipments are also needed. In this regard it is recommended that fund should be extended to support in heath sector.      
v  The Government of Sindh and Federation of Pakistan announced the releasing of the funds to be given to each beneficiary Rs 20,000 and both parties would withdraw one installment of 10,000 and currently Sindh government has distributed cards 1,156,612 in eight districts. Yet first installment has been completed in month of the December with uncertain situation for next installment. Government should priorities cash support for rain affected peoples
v  Due to the disturbed schooling children under grade three should be taken soft examination so that their schooling can be encouraged in flood affected areas.            
v  NADRA is lacking proper facility for women to get their new or modified CNIC for the eligibility of the services as Pakistan Card. It has been observed during visits at NADRA centers that there were absence of the special care taken for the women as separate counter and female staff to support the flood affected women. In this regard privacy and dignity of the women should be protected.
v  It has also been observed during the field visits that women were undergoing in critical situation to prove herself widow and to get the nucleus family number. Union council secretaries are responsible to provide the death certificate of the husband with minimum fee of 100 rupees but illegal money was being charged by UC secretary. Corruption should be tracked to ensure the service delivery transparent.                    
v  Withdrawal of the cash support by government in absence of the income generation sources have increased the vulnerability of the flood affected peoples. Cash and Food for work should be given priority to restore the cash relief support.           
v  Destruction of 46% health facilities in flood affected areas has made peoples more vulnerable to safeguard their health. Children with malnourishment status are mainly vulnerable due to the lack of the health facilities. Restoration and rehabilitation of the health facilities should be prioritized.            
v  The early recovery sanitation related projects should ensure that direct release of untreated or partially treated sewage water in streams, rivers, irrigation systems and other natural habitats is not done. The approved national environmental quality standards should be followed in this regard.
v  Disaster Insurance for vulnerable communities should be introduced so that flood victims no longer depend on government response or donors for finance. In this regard World Bank can be contacted for financial model and mechanism to generate disaster risk financing.
v  All stakeholders should continue undertaking community mobilization and participation on importance of Girls education and in bringing children and adolescents back to schools and specially those who have never been in Schools.
v  The modalities as village model system should be developed keeping in view the environment, social and demographical implications of the shelter projects.
v Most vulnerable suffer badly and must be prioritized as old aged, child, pregnant and lactating women and special are suffering in winter season.
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