Muhammad Tahir married in 2004 and had ten children, two of whom died due to severe malnutrition. These days, his one-and-a-half-year-old youngest son also suffers from severe physical weakness due to malnutrition. His condition is getting worse with each passing day.

Tahir is often unemployed and his wife’s health is also not good, due to which she is unable to breastfeed the child. So whenever he has money, he brings powdered milk for the children. Sometimes, he has to feed goats’ milk to his young children, which often upsets their stomachs.

This family belongs to the Ishiwat Union Council of the Zhob District of Balochistan. It is a village comprised of 60 houses where the only medical facility is a primary health centre where a male nurse has been posted.

Tahir explains that basic medicines are available at the health centre, but no nutritional support is available.

“Several years ago, food assistance used to be provided here, which would help malnourished children and mothers regain their health. However, now, nothing like that is available. We have heard that food assistance is still being provided in Zhob City and nearby areas, but no one has paid attention to the problems faced by the people in our village.”

The basic health centre nurse explained that when the programme to control food shortages was running, he used to determine through strapping which child or woman was suffering from malnutrition. However, now this program has been discontinued in this health centre, so he no longer has the equipment for diagnosing malnutrition.  He says he can still judge if a patient is malnourished by looking at their physical condition. Due to these issues at the dispensary and the stopping of malnutrition control, people can only be advised to go to the city and get help from a nutrition program there.

Zhob Nutrition Coordinator Ajmal Khan Mandokhel says that there are five Out- Patient Therapeutic or OTP centres in the district to control malnutrition, including Civil Hospital Zhob, Basic Health Centre Health Union Council Gurda Babar, RHC Union Council Shaikhan, Yule Dispensary Union Council Badinzai and Community Center Nasirabad.

He clarifies that Balochistan’s nutrition program is also active in Zhob, for which financial support is provided by the World Food Organization, WFP, UNICEF, World Health Organization (WHO) and USAID, while children of six to fifty-nine months of age are being provided nutritional food under the program of Emergency Relief for Refugees.

In response to a question regarding the non-availability of food aid at various health centres, Ajmal Mandokhel says that in the first six months of 2022, 1,000 cartons of nutritional food (Ready-to-Use Therapeutic Food, IFA or iron-folic acid tablets) were distributed to his district every quarter, after which the aid was stopped until December. However, this year, when the program to control food shortages started again, they received only a hundred cartons per month, which is insufficient.

While referring to the data derived from the polio program EPI, Ajmal Khan says that the number of people suffering from malnutrition in the five union councils of Zhob district is 18,215, including 7,015 lactating or pregnant women.

Murad Bibi* comes from a village about 60 kilometres from Zhob district. She visits a clinic in Zhob’s market every three months, where she and her child are given medicines worth Rs 15,000 to 20,000 every quarter to manage malnutrition.

She says that she is 35 years old and has four children. The youngest is two months old, whom she breastfeeds. She says that due to her own health problems, her milk is not enough for the baby. Since there is no government-level support for nutrition in her area, she is compelled to come here for help.

Medical expert Dr Jamila says that children of mothers who cannot breastfeed their children or do not have any alternative means to take care of their infant’s nutrition remain hungry and gradually become malnourished. Additionally, when the child is fed in a bottle that is not clean, it upsets their stomach, leading to vomiting and diarrhoea. As a result, essential nutrients are lost from their body, contributing to malnutrition.

“When a mother’s basic nutritional needs are not met, and she continues to have children every year, her and the child’s health will be affected. There should be a minimum gap of two years between children. This helps the mother regain her health and ensures that the child receives complete nourishment from the mother’s milk. This way, both are to some extent protected from the risks of malnutrition.”

The population of Zhob district is more than three and a half lakh, and about 50 thousand families live here. The annual population growth rate of the district is 2.30 per cent. According to the National Nutrition Survey 2018, the number of severely malnourished children in the Zhob district is increasing by seven per cent annually.

In recent years, water scarcity and drought in Balochistan have severely affected 20 of the 33 districts of the province. According to official statistics, about one lakh families and seventeen lakh livestock have been badly affected by water scarcity and drought, leading to serious health and nutritional problems.

According to Ajmal Khan, the nutrition program should be started in the primary health centres, but in most areas, the primary health facilities are not present at all, and even if they are, they are inactive. People avoid getting posted in health centres; if posted, they do not go there at all.

According to the information from the DHO Zhob office, the health centres are inactive or partially functional in most areas of the district, in which essential medicines are received after months and distributed in one to two days.

According to Ajmal Khan, controlling malnutrition with the five OTPs in the district is challenging. That is why UNICEF has been approached for help, which has assured that ten more OTP centres will be set up in the union councils of Zhob district, where the number of people suffering from malnutrition is the highest.

*Name has been changed to protect privacy