1. Allama Iqbal Medical College, Lahore, Pakistan; tahirjamil@gmail.com
2. Allama Iqbal Medical College, Lahore, Pakistan; shamsi_089gt@gmail.com

*             Correspondence: shamsi_089gt@gmail.com

Keywords: readiness, responsiveness, flooding, Pakistan

1. INTRODUCTION

Pakistan is one of the developing countries not having any satisfactory disaster management organizations and hence face immense problems in these times. Steps should be taken in prevention of these disasters and once struck with them, they should be managed carefully as to reduce the likelihood of destruction and fatalities. Since 1973, Pakistan has experienced seven major flood catastrophes which affected more han 4 crore people. The floods in 2010 caused immense destruction of farms, livestock and had an impact on 1.8 crore of the total population of Pakistan. The floods were a combination of flash floods and slow onset floods that hit the northern areas and plain areas of the provinces respectively [1]. Besides, flood hit areas also causes water pollution which mainly results in many epidemiologically significant waterborne illnesses which claim lives of many people and also causes the eradication of farms and livestock. Floods are the major natural hazards of South Asian countries particularly Pakistan and these are responsible for much of the financial losses to provide relief [2]. One of the statistical analysis carried out in the district of Khyber Pakhtunkhwa indicated that preparedness levels against floods are generally low in Pakistan. Study findings showed that only 12 percent of the family had a family emergency plan in the times of floods but only 5 percent of them executed these strategies at a domestic level. Furthermore, only one fifth of institutes had a backupescape route, rallyzones for students and means of conveying messages at the time of emergencies [3]. Pakistan experiences tremendous disasters due to floods especially during monsoon rainy season. These are the cause of consistent flash floods in a large number of Pakistani cities. Inadequate infrastructure, passive government, and low danger of disaster management account for these destructions [4].  Urban areas are especially at risk of most damage because these are densely populated, contain high value assets and industries, the cessation of which can disrupt the economical chain and also cause unnecessary loss of lives [5]. There is also a lack of guiding principles on management of flood relief camps which are vital at times of flood based calamities. Due to no particular guidelines, most of the healthcare workers are untrained and instead of copying from specific guidelines, they are working based on experience [6]. It appears that the Pakistani government is unable or unwilling to put disaster risk reduction and climate change adaptation strategies into effect when there are climate-related disasters, the government alleviates their responsibility by simply quoting it as ‘a will of God’ [7]. There is also a low level of coordination of private institutions such as NGOs at a local level. The old disaster management policy which was centralized performed quite well than National Disaster Management Authority but it lacked trained and responsible staff that was not able to cope with the presented challenges [8]. As these natural hazards like floods are not going to seize in the near future, proactive steps should be taken to manage them efficiently and save the lives of the people and prevent economic prosperity.

2. MATERIALS AND METHODS

A Systematic review was conducted. Systematic reviews are articles that combine information about a common subject through comprehensive search to locate all published relevant research articles to find, select and generate evidence that is available.  Through systematic reviews we can stay updated. The review was followed by the PRISMA guidelines for systematic reviews and meta-analysis. Data bases used for this review were Pubmed and Google Scholar. Searches were done in March and April 2023. The search strategy used was Preparedness and response* AND Flood hit areas* AND Pakistan*. The results available on first 30 pages of Google Scholar were used for further Screening. All the Qualitative researches and review articles that discussed the association of readiness and responsiveness in flood hit areas of Pakistan were included. The requirements include setting English language as a main language i.e., only those articles will be included which have been written in English or have been translated into English. The time duration that was set was from 2012 to 2023. The main focus of inclusion criteria was the articles that discussed preparedness policies made by the Government of Pakistan as well as the gaps in the preparedness in the flood hit areas and those areas which are at high risk of flooding in Pakistan. Papers that lacked originality and editorials based on original papers were excluded from our study. Papers that only discussed floods as a disaster without addressing preparedness methods were also excluded. The results obtained using the search strategy initially were about 360 articles. Three of the researchers did the screening process. They first eliminated the duplicates from the dataset and then screened the articles based on the titles and abstracts and selected 30 articles. Full text screening was then done based on inclusion and exclusion criteria and 8 articles were selected for data extraction. The data extraction process involved collecting information such as the author’s name, study year, article title, country of study, study design, and the mentioned preparedness methods and outcome.

3. RESULTS AND DISCUSSION

We selected total 360 articles. Duplicates were removed and articles are screened on the basis of titles and abstracts. Using this strategy we selected 30 articles which are than full text screened and total 8 articles were selected for data extraction The 8 articles selected for this systematic review include review articles/ surveys (n= 5) and qualitative studies (n= 3).   From these articles we searched for the preparedness methods discussed in each. Preparedness and effective response are crucial in flood-prone regions like Pakistan to minimize the impact of natural disasters. Over the past few decades, Pakistan has faced a series of catastrophic floods that have left millions of people displaced, infrastructure damaged, and economies disrupted. According to data from the National Disaster Management Authority (NDMA), the country encountered a total of fourteen major floods between 1947 and 2007, leading to economic losses and damages estimated at USD 6 billion. Despite the recurring nature of these floods, Pakistan, like many other nations, has struggled to adequately prepare for and respond to these crises. The lack of preparedness and timely response has often exacerbated the suffering of affected communities. Major percentage of the floods in Pakistan have resulted from heavy monsoon rains , leading to riverine flooding. Inadequate flood defenses and warning systems have contributed to the vulnerability of communities along riverbank. Furthermore, the socioeconomic disparities in the country play a significant role in the differential impact of floods. For instance, impoverished communities are disproportionately affected, with limited access to resources, infrastructure, and healthcare facilities. This situation has resulted in higher death rates and extended periods of displacement for at-risk communities. In the context of recent flooding, it becomes evident that natural disasters and disease outbreaks can have dire consequences for vulnerable populations [8]. The convergence of these events underscores the urgency of preparedness efforts in flood-prone regions like Pakistan. Disease outbreaks and epidemics, as emphasized in one of the referenced articles, can exacerbate challenges faced during disasters, underscoring the need for comprehensive disaster management strategies [9]. Several previous studies have explored disaster management challenges in Pakistan. For instance, In Deen [10] study, gaps in disaster response were identified despite the presence of established agencies, underscoring the need for more effective execution of preparedness measures. Even though disaster agencies aim to help during floods, they sometimes struggle to work together efficiently. When a powerful flood hits, their response may not be quick enough, and this can leave communities in need. This problem reminds us that turning preparedness plans into effective help is not easy. It’s a complex challenge that requires us to look closely at what’s going wrong within these agencies. Similarly, Rehman and Shoaib [11] study stressed the importance of a comprehensive disaster risk reduction (DRR) framework involving all stakeholders, supporting the notion that community engagement is key for effective preparedness. Pakistan stands at a critical juncture in its efforts to manage the ever-present threat of floods. To address this, it’s imperative that Pakistan not only formulates robust policies but also enacts legislation that paves the way for comprehensive disaster risk reduction (DRR).Building a broad-based DRR framework that garners consensus from across the nation is essential. Such a framework would serve as a unified roadmap, guiding Pakistan toward a more resilient future in the face of floods and other natural disasters. A collaborative approach, with input from government agencies, local authorities, non-governmental organizations, and affected communities, key to ensuring that the policies and legislation put in place are not only comprehensive but also practical and effective. Considering the emerging transformation in global health, where health systems are transitioning from focusing solely on ‘diseases’ to embracing the concept of ‘Health Systems,’ the notion of resilience gains prominence [12]. This transformation resonates with disaster management strategies, as disasters can strain health systems to their limits. Health systems, much like disaster response mechanisms, need to be resilient and adaptable to handle unconventional health challenges stemming from both natural disasters and disease outbreaks, as noted in a referenced article. By fostering consensus and collaboration among all stakeholders, Pakistan can lay the foundation for a more resilient nation. Addressing flood management, Aslam [13] study highlighted its importance, focusing on measures like watershed management and flood structures. One of the key components of effective flood management is the creation of new water storage systems. These reservoirs serve as crucial buffers against floodwaters, allowing for better control of water levels during heavy rains. Investing in such infrastructure can significantly mitigate the destructive impact of floods. Watershed management plays a pivotal role in flood prevention. By adopting better practices for managing watersheds, such as reforestation and soil conservation, we can reduce the flow of rainwater into rivers and ultimately decrease the risk of flooding. Khan et al. [14] study also noted the inadequacy of current approaches for disaster-prone regions and Proposed approaches such as the modification of river channels, construction of small dams, and the implementation of non-physical strategies like employing weather and flood prediction systems. To effectively manage floods, it’s crucial to control the flow of water in rivers. Channelization involves modifying river courses and banks to direct floodwaters away from populated areas. This structural measure can significantly reduce the risk of inundation in flood-prone regions. The construction of small dams along rivers and tributaries serves as a vital tool for flood control. These dams store excess rainwater during heavy rainfall and release it gradually, preventing sudden surges that can lead to devastating floods downstream. Leveraging modern technology and improved forecasting systems is paramount for early warning and preparedness. Timely and accurate weather and flood forecasts provide communities with valuable lead time to prepare and evacuate if necessary. These systems enable authorities to communicate risks to the public and coordinate response efforts efficiently. Ahmed [15] study emphasized proactive disaster risk reduction policies, finding that successful preparedness goes beyond reactive measures. The current state of management of risks associated with disasters (DRM)in Pakistan is characterized by a predominantly reactive approach. Reactive DRM primarily involves responding to disasters after they occur, focusing on rescue, relief, and recovery efforts. While these actions are indispensable, they often come at a high human and economic cost. The reactive approach tends to overlook the critical phase of disaster preparedness and mitigation, which can significantly reduce the impact of disasters if implemented effectively. A proactive DRM strategy aims to reduce disaster risks before they manifest as full-blown crises. It shifts the focus from merely responding to disasters to identifying vulnerabilities, implementing preventive measures, and building resilience within communities and infrastructure. Local institutions’ role is emphasized by Shah et al. [16]. These institutions serve as the bridge between government authorities and the grassroots level. They possess an intimate understanding of the local culture, geography, and vulnerabilities, allowing them to tailor disaster preparedness initiatives to the specific needs of their communities. This contextual awareness is invaluable in crafting strategies that resonate with local populations and garner their active participation. Atiq Ur Rehman et al. [17] highlighted the multidimensional nature of flood management. The challenge of flood management in Pakistan is multifaceted, demanding vast resources and a comprehensive understanding of the flood problem. A holistic approach encompasses a range of flood management measures, a robust legislative framework, and a well-coordinated institutional setup. By addressing these aspects in concert, Pakistan can enhance its resilience to floods and safeguard its communities and resources from the devastating impact of these natural disasters. Flood preparedness extends far beyond infrastructure and policies; it relies heavily on awareness and communication. Social media has become a common platform for accessing health-related information [18]. In today’s interconnected world, the dissemination of timely information is facilitated by the growing influence of social media platforms. Raising awareness about flood risks, preparedness measures, and evacuation procedures through these platforms can be a game-changer in saving lives and minimizing damage. Social media not only acts as a rapid information conduit but also empowers communities to share real-time updates, offer support, and coordinate relief efforts during floods. Furthermore, it’s essential to acknowledge the unique challenges faced by healthcare providers, particularly in flood-prone regions. Physicians and healthcare professionals frequently find themselves making critical decisions, not just during times of extraordinary social upheaval, such as natural disasters and pandemics, but also in routine circumstances [19]. Physicians and healthcare professionals often find themselves in life-and-death situations, making crucial decisions amid the chaos and uncertainty of flood disasters. Their dedication to providing care under extreme conditions is commendable and underscores the critical need for comprehensive disaster management strategies that prioritize their safety and support. This underlines the importance of robust preparedness efforts that encompass various sectors and stakeholders. Despite our study’s significant contributions to understanding disaster preparedness in flood-prone areas of Pakistan, it is vital to acknowledge certain inherent limitations that provide valuable insights for both future research endeavors and the formulation of effective disaster management policies. Relying on self-reported data, while a common practice in social research, introduces the potential for bias, which may impact the precision and accuracy of our preparedness assessments. Future investigations may benefit from a more comprehensive approach, combining self-reported data with objective measurements to enhance the reliability of findings. Moreover, the cross-sectional design, which captures a snapshot of preparedness at a specific moment, constrains our ability to establish cause-and-effect relationships or track preparedness dynamics over time, emphasizing the need for future long-term investigations. Additionally, our study was limited to a specific geographic region within Pakistan, and variations in preparedness and response strategies across diverse regions were not fully explored. This geographic constraint highlights the necessity for broader studies encompassing a more extensive range of flood-prone areas in Pakistan. Nevertheless, our study’s implications for disaster management policies are substantial. It serves as a foundational resource for policymakers, guiding targeted interventions to address specific preparedness weaknesses, promoting community engagement in disaster resilience efforts, emphasizing long-term planning, and advocating for the integration of research into policy development and evaluation. Through a nuanced understanding of these limitations and their implications, we can continue to advance disaster preparedness and response strategies in flood-prone regions, ultimately ensuring the safety and resilience of communities in the face of adversity.

4. CONCLUSION

In conclusion, our study reaffirms that importance of preparedness in the flood hit areas of Pakistan and establishes connections with existing research. This study emphasizes on the importance of proactive disaster risk reduction policies, integration of local institutions, and multidimensional disaster management approaches. The review reveals that disaster preparedness and response studies in flood-prone areas of Pakistan are essential but exhibit notable lack of standardized outcomes. By addressing the formidable challenges such as significant gaps in disaster response, limited execution of preparedness efforts, and disparities in response capacities across communities, and by building upon our findings, policymakers and researchers can refine and strengthen disaster management strategies, ultimately nurturing community resilience in flood-prone regions of Pakistan.

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