Department Of Humanities & Social Sciences, Lahore University of Management Sciences, Pakistan
Sameen Mohsin completed her PhD in Politics from SOAS, University of London in 2018. Her doctoral thesis, “Staffing the State: The Politicisation of Bureaucratic Appointments in Pakistan”, explores the use of bureaucratic appointments by both politicians and bureaucrats to achieve particular outcomes. Prior to starting her PhD, Sameen completed her MSc in Comparative Politics (Research) from the London School of Economics & Political Science, where she was a Commonwealth Scholar, and a BSc (Hons.) Social Sciences from the Lahore University of Management Sciences (LUMS).
Sameen’s teaching and research interests include governance and patterns of bureaucratic appointment, electoral management and party politics, public health, and donor engagement in LMICs. She is currently working on a public health project, “Understanding Pakistan’s Immunization Problem: A transactional approach”, funded by the Shahid Hussain Foundation’s Public Health Research Grant 2018-19 and 2019-20.
Sameen is a faculty lead at the Technology for People Initiative (TPI), a non-profit applied research centre based at LUMS.
Edited by Sanaa Alimia and Gialuca Parolin. Working Paper Series for the Governance Programme at the Aga Khan University, Institute for the Study of Muslim Civilisations, London. 2020.
"Despite a wobbly start, Pakistan dealt successfully with the first wave of the coronavirus, centralizing operations, and developing a uniform smart lockdown strategy for the entire country. Thus far, Pakistan has reported a little over 323,000 cases and over 6,600 deaths. These numbers are well below predicted levels and it is as yet unclear why this has been the case.
Like other countries in the Global South, Pakistan drew on its experience with, and infrastructure for, combating other diseases—in this case polio—to combat the virus. Pakistan has also deployed surveillance technology originally developed for intelligence purposes in its effort to track and trace cases, leading to concerns by rights groups regarding the monitoring of citizens amidst a wider crackdown on dissent and increasing media censorship.
Nonetheless, the risk of a second wave remains even as people’s regard for SOPs such as distancing, hand washing, and masking has mostly disappeared. In addition to the economic impact of the initial lockdown and the pandemic itself, a struggling economy with rising inflation is likely to cause considerable problems for citizens, including essential frontline health workers, while a resurgent opposition places the government under pressure in the months to come."
[Since the report below was published on 11 May 2020 , the situation in Pakistan has changed. Dr. Sameen Mohsin has kindly given us an update on the latest situation in Pakistan as of October 19 2020. For the original report see below and/or the "Download Questionnaire" option above.]
Submission Date: 11 May, 2020
Question #1: Public Trust
Is the government response to the pandemic being met with public approval? Please specify where this assessment is taken from, i.e. YouGov Poll, newspaper headlines, etc.
The public response to the government’s handling of the pandemic has been mixed. Though the federal government was not keen on a lockdown, the provincial governments proceeded with partial lockdowns in March 2020. Though a Gallup Pakistan poll on 21 April 2020 found that 74% of respondents approved of the lockdown, the government first allowed the construction sector to re-start work and then mosques to re-open for Ramzan (though 65% of Pakistanis supported limiting access to mosques according to a Gallup Poll at the end of April 2020), and on May 9th, further eased the lockdown.
A Gallup Pakistan poll on 28 April 2020 found that 62% of Pakistanis thought the risk of the virus was exaggerated. In part, this is due to mixed messaging from the federal government who spent considerable time playing down the threat of the virus. To their credit, they focused at the same time on expanding unconditional cash transfers under its Ehsaas cash disbursement program (including the BISP) and later, the labour relief program to support citizens in need. The response to these disbursements has been overwhelmingly positive at home and abroad. Also garnering praise is the federal government’s ‘green stimulus’ plan to hire unemployed daily wagers to plant trees.
Question #2: Accurate Statistics?
Are accurate statistics on infection rates and death rates available? If so, who is producing this information? And is this information trusted by the public?
The federal and provincial governments have over time developed the capacity to provide up-to-date statistics regarding the virus A lot of the issues with the data have their roots in poor capacity pre-dating COVID-19, e.g. the lack of systems for collating data on disease incidence and facilities, which is now being put in place. Initially, the National Institute of Health was collecting data from all over the country, however, there were some gaps in the data (Hussain 2020), discrepancies with the data from the provinces, and the data was inaccessible for download. There is now a separate government portal for COVID-19 data.
Since the federal government has provided no standardized way to either measure or report, statistical measures and reporting varies from province to province (e.g. the debate on KP’s death rate). Testing rates have been erratic (Rehman 2020) and there are wide variations both between and within the provinces, leading to variations in testing policy as well (Nihad 2020). The government’s target was 20,000 tests per day by the end of April, but this has not yet been achieved.
Question #3: Support for the Vulnerable
In instances of a lockdown, what support is available for vulnerable persons, i.e. domestic abuse victims, less able bodied persons?
“Lahore police has reported a 25% increase in [domestic violence] cases during the lockdown.”
The federal and provincial governments have been sensitive to the needs of many of those disadvantaged by the lockdown. The federal government was quick to expand disbursements under the BISP program and to provide support for those unable to work through the Ehsaas program (Nadeem and Zaidi 2020). There have been numerous photos shared where government officials are assisting less able-bodied persons access their cash. However, these are not institutional measures to assist this category of vulnerable groups.
Also at risk are those with medical conditions such as thalassemia as blood donations decline, pregnant women, those requiring hospital visits for chemotherapy (Shah 2020), dialysis, etc. Plunging immunization rates (WHO 2020; IRD Global 2020) and declining treatment for diseases such as tuberculosis and hepatitis should also be ringing alarm bells with the government.
With regard to increased domestic violence, the Lahore police has reported a 25% increase in cases during the lockdown. The Ministry of Human Rights has responded and set up a hotline to assist those in need. Another concern is child abuse. Cases have been rising for the past few years (Imdad 2019) and in March 2020 Pakistan passed a law to catch abusers. However, though child abuse cases are reported to be rising during the lockdown (Soharwardi 2020), no policy measures have as yet been forthcoming. A related issue is digital security as children increasingly go online.
Question #4: Marginalised Groups
What are some of the challenges that marginalized groups, i.e. low-income households, religious/ ethnic minorities, face with regards to the pandemic?
Even a partial lockdown has an immense impact in a country where the informal economy is extensive and unregulated (ILO). The federal and provincial governments have done well to expand unconditional cash transfers and ration distribution. However, the disbursement and selection process took time and was not accessible to everyone in need (Imtiaz 2020). There are household characteristics that render a person ineligible for a cash transfer, for example, a foreign trip. The government is now also working with the Rural Support Network Program to identify further beneficiaries. Furthermore, as the state collects data to provide relief and to trace COVID-19 patients, data protection becomes a critical concern. The data of patients of COVID-19 has in the past been public broadcast and the data of those participating in the Prime Minister’s volunteer Tiger Force has already been leaked (Jahangir 2020). The government has had data leaks in the past, which makes it essential that data be secured properly (DRF 2018).
The government has not discriminated along religious or ethnic lines in disbursement. But groups that lack national identity cards—the Hazara, the Bengali community, and women—are automatically disadvantaged (Sarwar 2020). Domestic migrants, internally displaced persons, and refugees also need special attention. Most refugees are daily wagers and though the Pakistan government has planned a special relief package for them, news reports suggest that international help has been slow in arriving (N.Khan, 2020).
“Another group facing an immense challenge are prisoners. Pakistan’s justice system is deeply flawed, and prisons are full of under trial prisoners and immensely overcrowded…Amnesty International suggests that the Pakistan government is not reporting accurate infection rates for prisoners.”
Small businesses are also at immense risk. Microfinance clients have seen massive declines in income (Malik, et al. 2020). Large companies are already laying off workers, particularly in the garments sector, despite notifications and ordinances by provincial governments barring them from doing so (Naqvi 2020). Daily wagers have been most affected. Aside from the loss of income, protection from the virus itself is next to impossible in densely populated residential areas, particularly slums and informal settlements (katchi abadis) (Hasan 2020).
Ironically, it is the religious majority that is at greater risk from the virus. The government was unable to prevent thousands of people belonging to the Tableeghi Jamaat gathering in Raiwind, Lahore in March (Khattak 2020) and was slow to close down mosques (Hashim 2020b), though Christians were asked to stay at home for Easter. The government allowed mosques to re-open with SOPs in place for Ramzan. However, those SOPs are not being followed and cases continue to increase (Hashim 2020b).
Another group facing an immense challenge are prisoners. Pakistan’s justice system is deeply flawed, and prisons are full of under trial prisoners and immensely overcrowded. The Supreme Court of Pakistan refused to allow provincial governments to release under trial and vulnerable prisoners (Amnesty International 2020). Since then, Amnesty International suggests that the Pakistan government is not reporting accurate infection rates for prisoners (Justice Project Pakistan has compiled a database here).
Those in government quarantine and patients in government hospitals have faced a number of challenges too. Though by and large the federal and provincial governments did a good job setting up and managing quarantine centers and field hospitals, there was significant criticism of the handling of the quarantine of travelers from Iran in Taftan (I. Khan 2020), Balochistan. There were also instances of infected people running away to avoid being taken to these centers. These incidents speak to a lack of trust in the state and the services it provides, even in a pandemic about which people know little.
Question #5: Local Activism
How are local community groups and/or political groups responding to the pandemic in terms of providing support/ relief to vulnerable persons and/or marginalized groups?
In December 2017, the Pakistan government began a crackdown on NGOs operating in the country, claiming that they were not doing the work that they were supposed to be doing (Sayeed 2017). This move came alongside a wider crackdown on dissent.
Image credit: Aadil via Pexels.
Fast forward to COVID-19 and the ability of civil society to help with the crisis has shrunk. Pakistanis give considerable amounts as charity, particularly during Ramzan, and in time, numerous local community and mutual aid groups became active to collect donations and distribute food and other goods. Local NGOs were very active as well. Edhi provides ambulance and burial services. Rizq is an organization that donates food to the needy. Karachi Corona Virus Control Campaign provides PPE to hospitals. Akhuwat supports families in need. Slumabad assists transient populations. Numerous individuals are working in teams in their communities. A full list of relief efforts has been compiled here.
The involvement of the major political parties in distributing relief has produced mixed results. While they are undoubtedly able to reach marginalized groups due to the links party activists have in local communities (Khattak 2020), there has also been infighting during relief campaigns. In Karachi, there have been reports of politicians and local government representatives from various parties directing cash disbursements and ration to their constituents (Ali 2020). The report also notes that, in Sindh, local governments have been authorized to provide aid (Ali 2020). In Punjab, the government dissolved local governments prematurely in 2019, pledging to implement a new system in May 2020. That system has not yet materialized and therefore, there is no local government in Punjab to reach out to communities.
The Prime Minister announced the creation of a volunteer Corona Tiger Force at the end of March (Imtiaz 2020). The Tiger Force is meant to raise awareness and distribute food supplies and aid. Thousands of people registered, but it took some time to get the volunteers started with their work. The Tiger Force’s mandate is different from the volunteer force constituted by Jared Kushner in the United States so the mismanagement and corruption in procurement that resulted from the latter (Confessore, et al. 2020) will probably not be replicated in Pakistan. However, the Force’s lack of training is a major concern (Imtiaz 2020), particularly their ability to maintain social distancing and other safety protocols in their work.
Question #6: Other comments
In Pakistan, the federal government’s response to the pandemic has been somewhat contradictory. However, it is important to note that it is by no means an exceptional case—other countries are facing similar issues and challenges.
Government officials in Pakistan have been slow to themselves adopt social distancing and universal masking, even as they asked people to be responsible and take precautions and respect the lockdown. Any restraint the government is exercising in terms of easing the lockdown, for example not opening public transport, is due to the reservations of the provincial governments.
“A WHO situation report form May 4th 2020 claims that Pakistani doctors are most affected by the virus. In Punjab, health workers went on hunger strike to protest lack of PPE, and were beaten up in Lahore and Quetta.”
The federal government has decided to pursue a ‘smart’ lockdown from 9th May onward. While developing countries ought to contextualize their response to the pandemic (Marquette 2020), a smart lockdown is premised on extensive data collection, responsive policy-making (Haas, Khan, and Khwaja 2020; CERP 2020), mapping, universal masking (Abaluck, et al. 2020), ‘an aggressive test, trace, isolate strategy’ (Sridhar, April 13, 2020), and scaling up health system and governance capacity (Khan and Roy 2020). Though testing rates have started going up as of the first week of May, the intelligence service’s mobile tracking service is being used to trace patient contacts, and the provincial governments are working to enforce SOPs, more work is needed to expand random testing, build health sector capacity (beds, ventilators, etc.), and provide PPE and testing for frontline health workers. This last is critical: while one appreciates the government’s concern for the poor and their inability to cope with a lockdown, the government needs to follow up this concern with sufficient (Stratford 2020) and decisive action to mitigate the risk of infection and protect health workers. A WHO situation report form May 4th 2020 claims that Pakistani doctors are most affected by the virus. In Punjab, health workers went on hunger strike to protest lack of PPE, and were beaten up in Lahore and Quetta (Hashim 2020a; I. Khan 2020). Across the country doctors have held press conferences to beg the government to tighten the lockdown, especially on mosques. The government’s decision to ease the lockdown while cases are still rising, while comparing it to Italy, Spain, and France easing their lockdowns after they had passed the peak of this wave of the virus, has also led to criticism from health workers, and concern about health care system capacity.
Concerns over capacity have led to the fear that the Pakistan government might be walking into a situation where the adopted strategy—unwittingly—becomes one of herd immunity, but without a vaccine available. This connects to the other critical issue: communication. Effective communication is an aabsolutely essential requirement for handling a pandemic. Since the government has not made the specifics of its epidemiological model public (Hussain 2020) and claims that the situation is ‘not bad’, there are understandably a number of questions being raised about the strategy going forward. In the midst of all this, politicians have indulged in clashes on television and social media, some politicians have spread dangerous misinformation, and governments have at times been unreceptive to questions and criticisms from journalists and others. While tempers fray and the mudslinging continues, the pandemic rages on.
Abaluck, Jason, Judith A. Chevalier, Nicholas A. Christakis, Howard Paul Forman, Edward H. Kaplan, Albert Ko, and Sten H. Vermund. 2020. The Case for Universal Cloth Mask Adoption and Policies to Increase Supply of Medical Masks for Health Workers (April 1, 2020). http://dx.doi.org/10.2139/ssrn.3567438
Malik, Kashif, Muhammad Meki, Jonathan Morduch, Timothy Ogden, Simon Quinn, and Farah Said. 2020. COVID-19 and the Future of Microfinance: Evidence and Insights from Pakistan. Oxford Review of Economic Policy. http://simonrquinn.com/MicrofinanceCOVID.pdf
The Governance Programme critically assesses current thinking on governance in relation to Muslim contexts. It aims to address the deeply rooted religious and cultural sensitivities prevalent in matters of governance by exploring their impact on the way reforms are received and the way in which institutions are perceived and managed. While focused on Muslim contexts, the programme adopts a comparative approach as the majority of Muslims face the same challenges as other communities in the developing world. Key goals of the programme are to improve the quality of life by promoting the public good in the developing world. By generating key information in accessible, multi-lingual formats, the programme is committed to encouraging healthy and informed debate among scholars and the public alike
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