Implications of COVID-19
Pandemic for South Asia:
Civil Society Perspectives
Editors
Nimmi Jayathilake
Shavini De Silva
Ayodhya Amarajeewa
The Regional Centre for Strategic Studies
The Global Partnership for the Prevention of Armed Conflict
Contents
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Chapter 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Retreat from Democracy, Rise of Executive Authoritarianism and
Covid-19 in South Asia: Trends, Contexts and Futures
Jayadeva Uyangoda
Chapter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Regional Governance and Multilateralism in a COVID-19 World:
Casualty or Catalyst?
Mallika Joseph
Nishchal N. Pandey
Chapter 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Implications of COVID-19 on Conflict Patterns
and Regional Cooperation Process in South Asia
D. Suba Chandran
Sourina Bej
Chrishari de Alwis Gunasekara
Chapter 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Sri Lanka and the Pandemic: Bracing the Challenge
and its Implications
Akshay Senanayake
Tilia Samarasinghe
Uvin Dissanayake
Dilshan Fernando
Shakti Devapura
Chapter 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
The Implication of COVID-19 Pandemic for Pakistan:
Civil Society Perspectives
Salma Malik
Chapter 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
“New Normal” Nepal:
Implications of the COVID-19 Pandemic
Saloni Singh (Advisor)
Surabhi Singh
Aslesh Shrestha
Chapter 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
The Role of Government and Civil Society in Responding to the
Impact of COVID-19 in Bangladesh
Ashish Banik
Chapter 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
COVID-19 in India : Outbreak, Government Responses
and Civil Society Initiatives
Abigail Miriam Fernandez
Samreen Wani
Chapter 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
The Implications of COVID-19 Pandemic for Afghanistan:
Civil Society Perspectives
Lailuma Nasiri
About Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
About Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Chapter 5
The Implication of COVID-19 Pandemic for
Pakistan: Civil Society Perspectives
Salma Malik1
A
s the COVID-19 pandemic nears its one-year mark, fears,
speculations, and concerns about a second surge are resonating
worldwide. Many countries across Europe are once again facing an
increase in patients’ numbers as well as fatalities, whereas several other
countries such as the US, India and many across the European continent
are still not recovered from the initial impact. Described as “the most
serious threat we have faced in living memory,” by Pakistan’s military
spokesperson,2 human lives are not the only casualty of the pandemic.
The worst effect countries such as Pakistan have faced is in terms of
the economic fallout. With poor and unequal health care, low literacy
rate, poverty, seasonal disease outbreaks, environmental and climate
change effects, locust attacks and poor social safety networks becoming
additional threat multipliers.
Bordering the two hotbeds of COVID-19, Iran and China, Pakistan
could not have escaped the pandemic and its associated disastrous effects.
The country grappling with an economic crisis marked by slow growth,
high inflation and rising debt, the pandemic could not have hit Pakistan
at a worst time. COVID-19 has beset Pakistan in several ways. On the
one hand, with an abysmal health and healthcare infrastructure in place,
this health crisis has all but saddled the country, something that poses a
1
2
Salma Malik is a PhD in International Relations, and teaches at the
Department of Defence & Strategic Studies, Quaid I Azam University,
Islamabad, Pakistan.
Khurram Husain, “The Coronavirus Economy,” Dawn, March 29, 2020.
107
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Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
great threat to precious lives. On the other hand, the deleterious impact
on economic activities in the country, coupled with falling remittances
and tax revenues, has ensnared the country in multiple crises. Pakistan’s
response to COVID-19 channeled through the National Coordination
Committee (NCC) and the National Command and Operation Center (NCOC)
has tried to walk a tightrope between saving lives and livelihoods. Other
than increasing capacity in healthcare to deal with COVID-19, the
federal government has unveiled a 900 billion-Rupee economic stimulus
package, launched a social-protection program, Ehsaas, and attained debtrelief through timely and assiduous diplomacy. This country report will
carry out a holistic appraisal and analysis of Pakistan’s ongoing response
to COVID-19 and the economic, political and social implications of the
pandemic.
Genesis of COVID-19 in Pakistan
The first incident of Pakistanis testing positive to the novel coronavirus
(SARS-CoV-2) was in late January 2020 amongst four students studying
in China.3 However, within the country the first two cases reported were
on February 26, 2020, amongst these one belonging to the largest and
most populous city of the country Karachi which boasts an estimated
population of 16,094,000,4and the other from Islamabad, the capital
territory. Both these cases were amongst the pilgrims who had returned
from the visits of the Holy shrines of Syria, Iraq and Iran. Despite the
foreknowledge of Coronavirus being declared as the sixth public health
emergency of international concern and a global outbreak by the World Health
3
4
Sohail Inayatullah, Puruesh Chaudhary, Syed Sami Raza and Umar
Sheraz, “COVID-19 and The Futures of Pakistan: Inclusive foresight and
innovation,” Journal of Futures Studies, April 29, 2020. https://jfsdigital.
org/2020/04/29/covid-19-and-the-futures-of-pakistan-inclusiveforesight-and-innovation/ Accessed September 05, 2020.
Government of Pakistan; Ministry of Planning, Development & Special
Initiatives, Pakistan Statistical YearBook 2018 (Provisional), Pakistan Bureau
of Statistics http://www.pbs.gov.pk/sites/default/files//PAKISTAN%20
STATISTICAL%20YEAR%20BOOK%202018.pdf. Accessed September
26, 2020.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
109
Organization (WHO) as early as January 30, 2020,5 there appeared to
be insignificant preemptive or precautionary measures undertaken by
either the Federal or Provincial governments. Measures such as border
closures, health certifications, testing kits for the identification of virus
affected individuals were neither fully implemented nor followed up.
With Iran becoming the first country in the region to report an
increasing number of COVID-19 positive cases, in fact the highest after
China, several neighboring countries including Turkey and Pakistan closed
their borders but before February 23rd, 2020.6 Till the closure, the border
remained open for the Zaireens (pilgrims) and trading community, without
implementing any testing or quarantine facilities.7However, once the
provincial government of Balochistan implemented the closure, it had to
be relaxed amidst fears of a rising humanitarian crisis as thousands of
Pakistani pilgrims and traders became stranded at the border areas.8 The
Pakistani government did set preconditions such as a mandatory health
certification by the Iranian government ensuring that the returning pilgrims
were virus free, as well as a brief quarantine period in the camps set up in
the border town of Taftan by the provincial disaster management authority.
These designated quarantine facilities which had the capacity to
accommodate 2000 people, were set up as per WHO recommendations by
5
6
7
8
“Naming the coronavirus disease (COVID-19) and the virus that causes
it,” World Health Orgnisation, https://www.who.int/emergencies/diseases/
novel-coronavirus-2019/technical-guidance/naming-the-coronavirusdisease-(covid-2019)-and-the-virus-that-causes-it. Accessed September 26,
2020.
Patrick Wintour, “Turkey and Pakistan close borders with Iran over
coronavirus deaths,” The Guardian, February 23, 2020.
AmnaBajwa, “Defying the Odds: Pakistan’s coronavirus story,” Observer
Research Forum, https://www.orfonline.org/expert-speak/defying-oddspakistan-coronavirus-story/ September 29 2020. Accessed: October 15,
2020.
Michael Lipin, Hafiz UllahSherani, BehroozSamadbeygi, KambizTavana,
“Iran Coronavirus Outbreak Strands Pakistani Visitors, Fuels Fear of Prison
Contagions,” Voice of America, https://www.voanews.com/science-health/
coronavirus-outbreak/iran-coronavirus-outbreak-strands-pakistanivisitors-fuels-fear, February 26, 2020. Accessed: October 10, 2020.
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Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
the disaster management authority, where the individuals were confined
for a brief three-day period.9. The initial screenings at various points of
entries were carried out by the provincial government along with the
Directorate of Central Health Establishments’ (DOCHE). Once released from
the initial quarantine period, upon reaching their home provinces, if the
returnees manifested any symptoms, they were to be quarantined for
another fourteen days in facilities set up in different cities across major
districts and provinces.10
Unfortunately, the initial surge at the border zones proved extremely
difficult for the provincial government, which had to battle the challenge
of providing quarantine facilities to a huge number of people in a remote
semi-desert border zone, with a severe dearth of medical staff, neglected
health care system and scanty resources. Owing to a study conducted,
“Close contact conditions during quarantine, due to the lack of enough
space, resulted in multiplied infections.”11
As the Federal and provincial governments’ strived to improve
facilities, an additional pressure was to allow Pakistani nationals returning
home from international travel, or being sent back by the host countries,
as the panic regarding the pandemic finally started to take hold. Initially,
except for China,12 students, migrant workers and travelers from the Middle
East, Europe and the US returned to the country without restriction which
contributed to the spread of the virus. The government was caught in a
9
W. Gillani, H. Www, T. Com, P. Tns, W. W. Dialogue, “Pakistan braces up
for huge quarantine after coronavirus reaches via Iran.” The News, https://
www.thenews.com.pk/tns/detail/621158-virus-alert, January 06, 2020.
Accessed: October 15, 2020.
10 Nadia Noreen , SaimaDil, Saeed Ullah Khan Niazi, IrumNaveed,
NaveedUllah Khan, Farida Khudaidad Khan, ShehlaTabbasum, Deepak
Kumar “COVID 19 Pandemic & Pakistan; Limitations and Gaps,“ Global
Biosecurity,
https://jglobalbiosecurity.com/articles/10.31646/gbio.63/
Accessed: October 15, 2020.
11 B. Faiz, “Health and healthcare in Balochistan,” The Friday Times, January 06. 2020.
12 “Pakistan Halts All Flights To And From China Amid Coronavirus Fears,”
Radio Free Europe, https://www.rferl.org/a/pakistan-halts-all-flights-toand-from-china-amid-coronavirus-fears/30409783.html, January 31, 2020.
Accessed: October 10, 2020.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
111
fix, facing harsh criticism and condemnation both from the families and
the press when it tried to implement any travel restrictions, or when in the
initial phase it was unable to preempt or control the virus.
As mentioned earlier, due to the initial slippage and the lack of early
detection and preemption mechanisms, many cases went undetected and
by March 26th i.e. a month after the two initial cases had been detected, the
total number of confirmed cases countrywide reached a figure of 1179
and at least 09 deaths were reported, which was in stark contrast to the
initial 02 cases reported.13The WHO had by March 11th declared the virus
outbreak as a global pandemic. By March 31st, the federal government decided
to establish a dedicated set up, the National Command and Operation Centre
(NCOC) for the control, prevention and management of the pandemic.
The First Wave
As the virus spread across the country, there was a steady and
significant rise in the number of confirmed cases. By the 45th day i.e.
April 10, 2020, the total tally of suspected cases reported was around
54,706, with 4695 confirmed cases, 727 patients recovered, and 66
COVID related deaths. As per these statistics in the initial days the case
fatality ratio (CFR) in Pakistan was 0.8%, furthermore, the coronavirus
attack rate was estimated to be 2.3 per 100,000 people.14Even at the peak
of the first wave when on July 29th, there were 1074 cases recorded on a
single day, the CFR in Pakistan did not go beyond 2 %15 which remained
much below the alarming statistics reported from neighboring countries.
However, the CFR varied across cities and provinces, for instance the
district of Peshawar in Khyber Pakhtunkhwa province alone had the
highest recorded CFR of 6.1%.16
13 Noreen, Dil et. al.
14 K. Abid, Y. A. Bari, M. Younas, S. Tahir Javaid, & A. Imran, “Progress of
COVID-19 Epidemic in Pakistan,” Asia-Pacific Journal of Public Health, Vol.
32 No. 04, pp. 154–156. https://doi.org/10.1177/1010539520927259
15 https://www.coronatracker.com/country/pk
16 “KP records highest number of COVID-19 deaths in single day,” Bureau
Report, Dawn, June 10, 2020.
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Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
Since the first confirmed case reported by the end of October, there
have been 332,186 confirmed cases recorded, of which 313,527 people
have recovered with 6795 deaths recorded. The rate of recovered cases
has been 94.4% and as mentioned earlier the CFR is 2%. In total 4,409,537
tests have been conducted countrywide to detect and confirm the virus
spread.17Several studies have been conducted to assess and observe the
pattern and mortality rates of COVID-19. In one such study conducted
by Pakistan’s National Institute for Health (NIH), several indicators such
as the patients’ demographic, epidemiological, co-morbidities and risk
factors information as well as travel history of the first 100 deaths
recorded were taken into account. According to this study, the average
age of patients affected was 64.5 years, amongst these 75% cases
comprised of Males. 71% of the patients had a documented co-morbidity
such as hypertension, diabetes mellitus or Ischemic Heart Diseases.
Furthermore, the median duration of the illness was eight days (ranging
between 0-30 days) with most frequent symptoms being shortness of
breath (87%) and fever (79%). The median delay in reaching to a hospital
was three days (range: 0-16) while median duration of hospital stay was
three days (range: 0-28 days). The initial cases reported primarily were
among those who had a history of international travel; however of the
total deaths reported, 62% were attributed to local transmission and had
no history of international travel.18
17 “COVID -19 Stats,” National Command Operation Center, https://ncoc.gov.
pk/#, October 25th, 2020.
18 Ambreen Chaudhry, AamerIkram, Mirza Amir Baig, Muhammad Salman,
Tamkeen Ghafoor, Zakir Hussain, Mumtaz Ali Khan, Jamil Ahmed Ansari,
Asif Syed, Wasif Javed, Ehsan Larik, Muhammad Mohsan, Naveed Masood,
Zeeshan Iqbal, and Khurram Akram, MedRxiv (pre print), https://www.
medrxiv.org/content/10.1101/2020.06.07.20121939v1.full.pdf,
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
113
Figure-01: Country-wide Geographical Spread of COVID-19 Cases
Source: Abid, Bari et. al., Asia Pacific Journal of Public Health (2020)19
However, the findings of another study20 conducted under similar
parameters, placed the average age of infected ranged between 20 to 39, with
21.8% women and 78.2% males. This number also included 138 healthcare
workers who contracted the virus, the majority of these were males.21
Figure-02 : Average age of the infected
Source: Abid, Bari et. al., Asia Pacific Journal of Public Health (2020)22
19 Abid, Bari et. al., Asia Pacific Journal of Public Health (2020), opcit.
20 Ibid.
21 World Health Organization, “Pakistan: COVID-19—Situation update as of
7 April 2020.” Also see: “Updates: Ministry of National Health Services
Regulations and Coordination Dashboard; 2020.”
22 Abid, Bari et. al., Asia Pacific Journal of Public Health, (2020), op. cit.
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Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
To prevent and protect external transmissions, alongside the
border closure, international flight operations were initially suspended
for two weeks from March 21st, with increased screening for domestic
travelers.23 Special flights were arranged to bring home stranded
Pakistani citizens abroad. The two weeks’ suspension on international
travel was extended to a month and flights were resumed only to bring
back stranded Pakistani nationals from various destinations, with
flight operations carried out under strict prevention guidelines. As
the number of confirmed cases increased from March 21st, province
wise lockdown began with Punjab taking the lead, to be followed by
Sindh, Gilgit-Baltistan and a health emergency leading eventually to a
lockdown carried out by Azad Jammu & Kashmir government. This
was followed by a suspension of inter-provincial as well as commuter
transportation and strict guidelines were issued for commercial
activities, with exemptions for essential services industry. Educational
institutions, recreational facilities and workplaces were closed, with a
ban imposed on public as well as private gatherings.
Given the provincial autonomy, the federating units were allowed
flexibility in deciding whether to implement a lockdown or not and
that too within a limited or indefinite timeframe, however, by the end
of March the country moved towards a blanket lockdown, which was
both appreciated as well as criticized by the public, as many still did
not realize the severity of the pandemic. With the establishment of the
NCOC, guidelines and standard operating procedures were streamlined
and implemented nationwide, which helped in further prevention of
the spread.
Government’s Response Strategy
The task however has been extremely daunting. For a country of
207 million people, the susceptibility of individuals infected by the virus
appeared very high, owing to multiple factors, which will be discussed in
detail in the following paragraphs. Predictive estimations were made by
23 "Coronavirus: Pakistan suspends international flights for 2 weeks," Khaleej
Times, March 21, 2020.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
115
Figure 03: COVID -19 Cases (February 26 to October 31st, 2020)
Source: National Command & Operation Center Website.
applying a variety of epidemiological models to carry out an assessment
about the likelihood of the number of people to be infected. As per
one such estimation, if considering the entire country’s population as
Susceptible to the virus, in comparison to the percentage Infected and those
Immune or Recovered, it was predicted that 90 million of the country’s
population would be infected by the 35th day.24
It was further observed that 5% of the total susceptible cases
which were most critical exhibited any of the previously mentioned comorbidities that added to the severity of the disease. This percentage
implies approximately 4.5 million individuals requiring intensive medical
care, hospitalization, and likelihood of the use of ventilators and
lifesaving drugs that further puts the fragile health sector under immense
strain. Of the total number of susceptible cases, fortunately, 81% were
of mild nature (with or without mild symptoms), with 14% developing
severe symptoms that required treatment.25 The additional problem
with susceptible cases arose due to the general attitude of the public
towards not getting tested at any of the government designated facility,
24 Muhammad Asif Rasheed, SohailRaza, Muhammad Khalid Rashid,
“Transmission Potential and Severity of COVID-19 in Pakistan,” Preprints
2020, https://www.preprints.org/manuscript/202004.0004/v1, March 30,
2020.
25 Ibid.
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Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
if they remained asymptomatic or exhibited low symptoms. This underreporting26 has not only led to a lack of accuracy in data collation but also
put people in general at higher risk of catching the infection.
Once the countrywide lockdown was in place, and the NCOC
started to function as the nerve-centre for the government’s fight
against the pandemic, not only was the government able to contain the
contagion at a certain level, but also got the chance to map and collect
essential data with regards to healthcare infrastructure. The availability of
healthcare staff, hospital beds, quarantine facilities, equipment including
oxygen tanks, ventilators, and above all proper testing facilities and kits.
The overworked medical staff was even deficient of medical protective
equipment and special protective face masks, a situation which was faced
both by the federal as well as provincial administrations. Gradually the
government through the data collected and under a singular command
structure started to devise means of tackling the problem. Using the
Trace, Test and Quarantine (TTQ) Strategy,27 COVID positive cases were
traced through the use of cellular technology, smart apps and text alerts
were sent out to all those who had come into their close contact. Through
mobile testing units, those exposed and infected were tested at home,
and depending on the severity of their exposure, they were either advised
to home-isolate or taken to quarantine facilities. The TTQ was initially
launched for a two weeks’ pilot basis, but then adopted and implemented
countrywide as it brought forth very positive results.
The first setback the government faced was the opening up of
commercial facilities, business centers and mosques as the month of
Ramadan (May) to be followed by the Eid-ul-Fitr approached, under
immense economic compulsions and pressure by the religious clergy. As
the government had through various measures managed to contain the
spread to an extent, once the commercial activities resumed (albeit at a
limited scale, with strict operating instructions and guidelines) people
26 Ayesha Tanzeem, “COVID-19 Deaths, Patients Grossly Under-Reported
in Pakistan,” Voice of America, https://www.voanews.com/covid-19pandemic/covid-19-deaths-patients-grossly-under-reported-pakistan, June
18, 2020. Accessed: October 25, 2020.
27 Amina Bajwa, op. cit.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
117
disregarded precautions which led to a sudden spiral in the pandemic.
The months of June and July registered the highest number of infected
cases as well as deaths.
Establishment & Work Function of NCOC
As mentioned earlier, given the enormity of the outbreak, there
was a critical need for a singular institution to act as a coordinating,
implementing and decision-making set up for a unified action and
response. Headquartered in the federal capital territory, the NCOC was
established on March 31st to work as the “nerve center for timely decisionmaking” on COVID-19. The NCOC performs as the implementation
arm of the National Coordination Committee (NCC) on COVID-19,
the government's lead agency in this campaign, which is chaired by the
Prime Minister and has equal representation by all four provinces, GilgitBaltistan and Azad Jammu &Kashmir.
Given the nature of the task at hand, the NCOC has brought
together a mix of the best civil and military experts, with Lt Gen
Hamood-Uz-Zaman Khan, designated as its coordinator. Combining
military efficiency with civilian expertise, amongst these are cabinet
ministers, provincial health ministers, concerned civil administrators,
heads of federal and provincial disaster management bodies, the National
Institute of Health, data operators, and all related organizations with
Special Advisor to the Prime Minister on Health as the main focal person
for national effort on COVID prevention as its representatives.28
As per its work rationale, the “NCOC is serving as a nucleus for
one-window operation to synergies and articulate the national effort
against COVID-19, optimize informed decision-making and ensure
implementation of decisions of the National Security Committee (NSC)
and the National Coordination Committee (NCC)”.29 It has therefore
been tasked to;
28 Fahd Hussain, “Inside the NCOC: An Eye Witness Account,” Dawn, April
19, 2020.
29 NCOC Website.
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Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
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Ensure effective coordination between federal and provincial
governments to deal with the pandemic.30
Given the nature of emergency, it has been formed to take unanimous decision on all related issues.
Map the existing healthcare infrastructure, staff and equipment
availability across the country, which helped the government channel resources to enhance capacity, and by importing what was required.
Discuss and implement future course of action for the containment of COVID-19.
Collate and analyze essential data.
Containment efforts in the affected areas and supply chain support.
The NCOC identifies clusters for targeted testing and isolation,
through effective TTQ strategy.
Digital tracking and tracing mechanism for identification of isolate targeted areas.
Provision of logistic arrangements to collect and transport samples,
Ensure availability of necessary medical equipment and testing
kits, swabs and transport medium to meet these requirements.
Provision of and striving to enhance the capacity of testing facilities, and kits, standardizing them to a WHO compliant status.
Availability of ventilators as well as procurement of more, in
addition to promoting efforts to build indigenous production of
such critical care equipment.
Monitor and assist law enforcement bodies specifically army in
contact tracking, tracing to identify and isolating suspected individuals to ensure containment of COVID-19 spread.
Run awareness and public health campaigns.
A 24/7 situational reporting, public helpline.
30 Fatima Javed, “NCOC takes over operational charge to contain COVID-19
in Pakistan,” China Economic Net, http://en.ce.cn/main/latest/202004/10/
t20200410_34654857.shtml, April 10, 2020. Accessed: September 16, 2020.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
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119
Provide guidelines for travel, standard operating procedures.
Public safety and services messages.
Ensure the provision of essential medicines.
Include and encourage youth participation in relief efforts and
Ehsaas (empathy) Program through which 150 billion rupees
were disbursed amongst deserving families.
Participate in chalking out a detailed plan of action through
which an uninterrupted supply and provision of essential food
items, pharmaceuticals, energy and industries for enforcement
measures to be ensured during the lockdown and after, especially
during the month of Ramadan.
The use of technology by the NCOC to provide data on virus
clusters. This later helped the government ease the blanket lockdown in the interest of economic livelihood and sustainability.
Virus clustering data enabled the government to implement
smart lockdowns in hotspots all over the country. It proved to
be a very effective strategy.
NCOC: Public Service & Effective Mating of Technology
The NCOC has used social media as well as computer applications
for not only public awareness through nationwide campaigning, but also
for information dissemination. Enlisted below are the key applications
available on the NCOC portal, which were of immense utility to the public.
•
•
•
SOPs Violation Reporting: the NCOC launched a WhatsApp number for the registration of COVID Related Violations by the
Public.
Smart Lockdowns: aimed at restricting maximum number of infected people in a targeted manner to an identified hotspot
through App, with a view to contain/ retard local COVID-19
spread and break the transmission cycle of disease.
Resource Management System: A well-structured IT based national framework conceived for credible health resource mapping.
Rolled out on 31 May 2020, it currently spans about 4000
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Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
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COVID/ non-COVID hospitals of the entire country. The system facilitates decision making in terms of the establishment of
correct need assessment and capacity enhancement. It also energizes public utility app Pak Negheban which provides its users,
location-based guidance to the nearest COVID treating hospitals.
Pak Neghayban App: Provides real-time visibility of hospitals
based on location and colour coded status as per availability of
beds/ vents. Pak Neghayban app is being used by various emergency response organizations.
Integrated Disease Information Management System (IDIMS): forms the
national repository for all COVID related data and is integrated
with all provincial systems for near real-time data exchange. The
system forms the basis for advance data analytics for disease projections and identification of smart lockdowns.
Education Institutes Monitoring System (EIMS): pioneering effort to
establish a national central database for more than 275,000 educational institutes of all kinds currently running across country.
The EIMS has multipurpose utility as comprehensive and updated
statistics of educational institutions would be available at national
level, to ensure SoP compliance and real time situational reporting.
National Helpline & WhatsApp Chatbot for Healthcare Workers: to
register complaints with concerned government authorities.
These complaints are handled by a complaint management
team of National Health Services Regulations and Coordination
(NHSRC), and then forwarded to the relevant focal point at federal and provincial levels for actions.
COVID-19 Telehealth Portal: Doctors in Pakistan can (and in a
large number did) sign up to volunteer their time for free consultation with patients.
SehatTahaffuz Helpline: was launched by Dr. Zafar Mirza, Special
Assistant to the Prime Minister on Health on February 06, 2020
to provide health-related information services to the people.
Through the Helpline citizens will be able to obtain immediate
assistance to their queries and concerns related to Polio and rou-
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
•
•
•
•
•
•
•
121
tine immunization services and thus it is not specifically restricted to pandemic control.
Isolation Hospital & Infectious Treatment Centre (IHITC): established
in a record 40 days’ timeframe these are state of the art facilities
established for medical assistance of patients suffering from viral diseases.
Community Mobilization: is being carried out through already established Rural Support Program (RSP) as the fight against the
pandemic warranted a synergetic response from all segments of
society. Active in 66 x Districts, the community mobilization is
being carried out in collaboration with respective District Administrations in undertaking activities including awareness campaigns, assistance in trace & quarantine, disinfection of public
places, data collection, hospital duties of volunteers, ration collection & distribution, utility store inspection and price control
& hoarding.
Prime Minister's Relief Fund: was set up to fight the pandemic.
The general public was encouraged to donate towards this fund
which is being used to take care of all those who have been made
destitute by the lockdown. The call for funding received an enormous response from the general public.
We Care: A national campaign was launched for protecting
and supporting our frontline health workers in the context of
COVID-19. It aims at providing adequate personal protective
equipment (PPE) to the health workers, orienting them on using
various PPE items as per international standards, and creating an
overall psycho-social environment of care and support.
Tiger Force: was launched by the prime minister to voluntarily aid
the Government in food and ration distribution to the poor and
create awareness about COVID-19 in areas under lockdown.
Ehsaas Emergency Cash Program: has been introduced in the context of economic hardship being experienced by the vulnerable
due to the ongoing coronavirus crisis.
Yaran e Watan: a public-private initiative brought forth by the
Ministry of National Health Services, Regulations and Coordi-
122
Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
nation (MNHSRC) and the Ministry of Overseas Pakistanis and
Human Resource Development (MOPHRD) with support from
the Pakistani diaspora health organizations.
The NCOC in its fight against the pandemic has been actively
assisted by the armed forces in taking necessary actions to implement
the former’s decisions. Furthermore, basic production of essential
items is being carried out by various armed forces institutions to
manufacture personal protection equipment, hand sanitizers, testing
kits, as well as research in virology and disease control and prevention
is being conducted. The medical facilities run by the armed forces were
also dedicated and made available to COVID affected patients, As
stated by the director general of inter services public relations at a press
conference, “all medical facilities of the armed forces have been geared
up, and measures are being taken to make them available for extreme
emergency situations, … with only elective surgeries being performed
at these institution so that these could be used during emergencies.”31
The armed forces are also assisting civil administration by providing
security and management of various quarantine camps set up across
the country.
Public Attitudes
As mentioned earlier, for countries such as Pakistan, the fight against
the pandemic has been extremely arduous. In addition to the multiple
challenges, the biggest impediment was to convince the population as to
the reality and severity of this outbreak. From outright denial to seeking
refuge behind conspiracies, hearsay, and faith, there has been a slow
acceptance and recognition of the pandemic as a real threat to life. As
aptly stated,
The journey of most countries’ experience with COVID-19 can
be compared to the five stages of grief. It started with questions
31
Rizwan Shehzad, “Pakistan Army fully determined to curb coronavirus:
DG ISPR,” The Express Tribune, March 19, 2020.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
123
on the existence of the virus and the denial of its threat. Next
came anger, mostly towards government inaction and policy
delays. This was followed by the aggressive spread of the virus
and a collective human bargaining; governments regretted
the decision of not controlling the virus at infancy, import
orders of ventilators were being placed on an urgent basis
and people started praying and asking God for mercy. Then
came depression; hospitals were choked, people were dying in
hundreds and the feeling of helplessness grew. Finally, people
have entered a stage of acceptance, realising that COVID-19 is
here to stay, at least until a vaccine is developed and deployed.32
As in other parts of the world, many people even in Pakistan
initially believed it to be a viral outbreak confined and specific to China.
Examples of the Mad Cow Disease, SARs outbreaks of previous
decades were cited, which had miraculously been confined to geographic
zones. Then for many it was just a severe case of influenza or at worst
a pneumonia that happened in extreme cold weathers, which would not
sustain in climatical zones such as South Asia, so there was no cause of
concern. Thirdly, it was also believed that the novel coronavirus strain
was a biological weapon genetically coded to affect certain profiles of
people and Pakistan was not amongst the target group.
Furthermore, it was also considered by the general public, an attempt
by an alleged cabal comprising of pharmaceuticals and health sector
representatives to spread a malicious rumor to earn donor agencies’
funding. There was also the apparently mundane but popular opinion
that it was due to peculiar eating preferences and being Muslims (largely),
who consumed Halal food, the population would remain unaffected, as
perceived during the mad cow disease outbreak. Last but not the least, the
most powerful was faith based. Being Muslims, death, disease, and health
are all predetermined and unavoidable, and the true test of one’s faith is
to have unflinching belief in destiny. Muslims do not fear death, and such
occurrences should not take precedence over one’s fundamental belief
systems.
32
Bajwa, ORF, op. cit.
124
Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
For this reason, the government, despite its instructions for
disallowing public gatherings and avoiding physical contact initially stood
helpless in the face of even the least empowered localized faith leaders
who from their pulpits would order, “It is all in the hands of Allah … we
should fear God, not a pandemic.”33 Capitalizing on their street power,
in sheer defiance of the government’s directives, the Mullahs would
announce that, “Today, you all will shake each other’s hands before
leaving the mosque. Perform namaz (prayers) standing shoulder-toshoulder and ankle-to-ankle in the rows!”34
As the month of Ramadan approached (May), the pressure on the
government mounted, as not only religious entities but even common
people sought the opening up of mosques to function. Even though
Muslim countries including Saudi Arabia, Kuwait and Qatar imposed
restrictions on congregational prayers, to the extent that Saudi Arabia
even restricted the Umrah by issuing fatwa, it remained difficult for the
Pakistani government to impose a ban on mosque prayers and large
religious gatherings, due to fear of a backlash from Islamist groups.
The government had to ease down the mosque closure eventually with
instructions to maintain a safe social distance, not having a gathering of
more than five individuals, restricting it for senior citizens, but people
defied and ignored official orders to offer prayers. “"It is all in the hands
of Allah, …we should fear God" – not a pandemic.” said one person
attending the Friday prayers.35
After the initial return of the Zaireen from Iran, a mid-March
Tablighi Jamat’s annual congregation in Lahore proved to be the biggest
spreader of the pandemic. More than 100,000 people from all over the
country attended the annual event, despite the government’s directives to
avoid such mass contact gatherings. This resulted in a 60% increase in the
virus spread in the province of Punjab alone. The authorities managed
33 DiaHadid, “Pakistan Calls Off Limits On Mosque Attendance In Time For
Ramadan,”. WRVO Public Media, https://www.wrvo.org/post/pakistancalls-limits-mosque-attendance-time-ramadan , April 14, 2020. Accessed
October 26th, 2020.
34 Inayatullah, Chaudhry et. al. op. cit.
35 Hadid, opcit.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
125
to identify and quarantine some 20,000 Tablighi Jamaat followers who
attended the event, of whom 539 have tested positive in Punjab, the only
province to publish data about them.36 The rest remained untraceable
till reports about infections were brought to surface from various areas
of the country, a situation made worse, as the organizers maintained no
record of attendees.
The government eventually requested an edict (Fatwa) regarding
the suspension of Friday’s prayers to prevent the further spread of
disease, from the supreme council of ulema at the Egypt’s Al-Azhar
University.37 Prominent religious clerics and authorities were also taken
into confidence and asked to convince people about the impact of the
virus. For a country with 59% literacy rate, deeply faith based general
lack of awareness and negative attitudes regarding routine immunization
as well as disease prevention, it became an uphill task for the government
to enforce preventive measures and containment. However, once the
reality of the situation sank in, people remained confined to their homes,
scared and uncertain about the situation. Looking at the plight of the
low-income groups, people from within and outside the country also
donated enormously and helped in establishing food and ration supply
lines.
Economic Challenges
Besides the devastating impact of the pandemic on human lives
and health, the worst hit area both globally as well as specific to Pakistan
has been the economic sector and its negative impact on average peoples’
livelihoods. Due to the drastic drop in various segments of the services
sector, according to the Asian Development Bank’s (ADB) assessment, the
initial loss incurred by Pakistan was five billion rupees.38Correspondingly
36 Tom Hussain, “Coronavirus: Pakistan struggles to track down 100,000
attendees of Tablighi Jamaat religious event,” South China Morning Post, April
07, 2020.
37 “COVID-19: Ulema of Al-Azhar University issue fatwa banning
congregational prayers,” The Express Tribune, March 25, 2020.
38 Noreen and Dil, op. cit.
126
Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
the expected loss to the GDP was 10%, which is an additional 1.1 trillion
rupees.39
Prior to the global lockdown owing to the pandemic, the International
Monetary Fund (IMF) had projected a positive per capita income growth
for more than 160 countries including Pakistan. However, this trend
totally reversed as after six months of economic shutdown the countries
concerned were exhibiting negative per capita income growth. Closure of
industries big or small had a drastic impact on the livelihood of people.
If shutting down of small or medium range enterprises affected modest
to daily wager employees and persons whose livelihood is attached to
the domestic industry, the closure of big industries further eroded the
growth of domestic product, as service industries such as airlines, hotels,
big industries, trade, and commerce came to a sudden halt, impacting
revenue generation.
Despite IMF’s projected growth rate, Pakistan was already
facing a mild recession prior to the outbreak. While deciding for a
nation-wide lockdown, the dilemma was double edged - between
saving lives or livelihoods. Lagging severely behind in the Human
Development Index, the federal government had to ease the complete
lockdown enforced for seventy five days with a gradual and phase
wise opening of the services and industrial sector, as the possibility
of further slipping down the poverty line became a real time risk.
Having more than 24.3% of the country’s population living below the
poverty line,40 the daily wagers small scale vendors and labour class
has been the most vulnerable economic group during the lockdown.
Linked to this, are the Micro, Small and Medium Enterprises (MSMEs)
which are highly dependent on and driven by market demand, supply
chains, export orders, raw material, and uninterrupted transportation
system. In Pakistan’s case the MSMEs form the proverbial backbone
of the country’s economy as they contribute collectively towards 40%
39 Ibid.
40 World Bank Global Poverty Working Group, “Poverty headcount ratio at
national poverty lines (% of population),” The World Bank, https://data.
worldbank.org/indicator/SI.POV.NAHC. Accessed October 10, 2020.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
127
of the GDP with over 40% to export earnings. And constitute over
90% of the estimated 3.2 million business enterprises.41 The volume
of economy linked to the MSMEs, implies that they also are a major
source of employment and income generation and any disruption
driven by domestic or external factors has a drastic impact on this
sector and the overall economic profile.
For this reason, the government from the onset of the pandemic
was in a quandary whether to impose a complete lockdown or not. To
support the daily wagers and vulnerable economic groups, not only were
the social welfare programmes already in place, such as the Zakat and
Baitul Maal, Ehssas program, Langar Khanas were used, relief packages,
and relaxation on utility bills and subsidies were provided especially to
lower income groups. To identify the low income and daily wagers, as
well as the unemployed, the government used and further expanded
the National Socioeconomic Registry (NSER), a pre-existing central database
for the Benazir Income Support Program (poverty reduction program
functioning since 2008) and was managed to identify around five million
people, besides the daily wagers and unemployed who were previously
not part of the Registry.42 Another challenge faced by the government
was bringing some of the neediest into this database, who were previously
not registered and not part of any formal data either. For this the youth
volunteers’ Tiger Force was used, who not only helped in the distribution
of ration packs and income support but were also able to expand the
database.
With regards to the industry, the government announced a Rs. 1.2
trillion economic relief packages with Rs. 150 billion allotted specifically
to low income groups, and Rs. 100 billion assigned to support small
industries and the agriculture sector. 43The industry faced the biggest
41 Mohsin Shafi, Junrong Liu, Wenju Ren, “Impact of COVID-19 pandemic on
micro, small, and medium-sized Enterprises operating in Pakistan,” Research
in Globalization, Vol 02, 2020. Available at: http://www.sciencedirect.com/
science/article/pii/S2590051X20300071. Accessed November 01, 2020.
42 Khurram Husain, “The Coronavirus Economy,” Dawn, March 29, 2020.
43 Government of Pakistan, “COVID-19 and Pakistan,” Board of Invetment,
Nov 09, 2020. https://www.flandersinvestmentandtrade.com/export/
128
Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
impact of the lockdown, as in Karachi alone, out of 2700 factories; only
50 could operate as they were handling essential services such as food
and pharmaceuticals. All else was shut down, even the port was operating
on minimal manpower. A pressing concern faced by the industry has
been its resilience and survivability in the face of a prolonged lockdown.
In a study conducted to observe this trend, except for only 2 % industries
who could survive for 06 months, majority could stretch their capacity
for 02 months only.44In order to survive a mortal blow, many support
industries, such as textile, food, and soap sought to be placed as essential
services as well.
The economic stimulus package has been highly substantial but the
challenges faced by the government are bigger. After the lifting of the
lockdown on commercial activity, as per a Bloomberg study, there has been
witnessed a visible boast in economy, “as worries about new COVID-19
infections fade in an economy that contracted for the first time in seven
decades. …Evidence of momentum returning can be seen from growing
cement-to-fuel sales and demand for home appliances to cars.” Furthermore,
Pakistanis both home and abroad have contributed very generously to the
government’s support initiatives, which has provided a modest boast to
the remittances. Through the Ehsaas Kafalat Program, the government has
enhanced the monthly cash stipend for poor women from 4.6 million to
7 million rupees.45Yet, the losses incurred by the industry, at immediate to
long term basis need to be addressed. The industry seeks protection and
guarantees from the government in return of its compliance.
The government did not have to deal with the pandemic as a
challenge to economy but an array of threats, amongst which the locust
infestation that heavily damaged the crops in South Punjab, Sindh and
Balochistan has also caused substantial economic loss. These twinning
threats are a massive challenge for the already fragile economy to handle
and have to be dealt with simultaneously.
nieuws/coronavirus-situation-pakistan . Accessed November 10, 2020.
44 Shafi, op. cit.
45 “Coronavirus - The situation in Pakistan,” Flanders Trade, November 09,
2020.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
129
These losses will trigger a contest where the three main
constituents of our political economy — the state, big business
and the citizenry — will vie to push the cost on to each other.
Each will mobilise their narratives. The state will say “we are
fighting the virus.” Industry will say “we are running our payrolls
even though our plants are shut.” The exporters will add “we
are bringing in valuable foreign exchange” — an argument
that will ring all the louder because other inflows would have
suffered and foreign debt servicing will remain in place.46
To address these challenges, the government has already announced
a 1.5 percent rate cut, and in the longer run may have to borrow from the
IMF or friendly countries like China. As the government gears up to face
the impact of the second wave of the pandemic, several measures are and
can be adopted to ease the pressure off the government, while ensuring
safety and health measures. These may include, better digitization,
telecommuting and flexible work regimes, protection of employees and
information accuracy, sharing and adopting best practices and building
resilience. Transforming and incentivizing MSMEs to incorporate
digitization and new trends, fast tracking existing projects.47
Health Sector Challenges
Where sustaining economy and a nationwide preventive strategy
towards the pandemic has been a twinning concern for the government,
the health sector has proved to be the weakest link in the chain. Primarily
a state-run system, public and more so private sector health care facilities
are now rapidly increasing. The health sector in proportion to the
population is severely under-capacitated both in terms of facilities as
well as human resource. As per the annual economic survey issued by
the government, for a country with a population touching 22 million
there are close to 1300 hospitals and 220, 829 doctors only. Whereas the
overall health budget allocated is less than 1% of the annual GDP, which
46 Hussain, Dawn, op. cit.
47 Mamoona Naz, “Post COVID-19 Economy And Investment Strategy
Response,” Prime Minister’s Office Board Of Investment (BOI), 2020.
130
Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
is one of the lowest worldwide.48The statistics provided in the following
figure provide a portrayal of the health care sector.
Figure - 04: Latest Health Care Statistics in Pakistan
Health facility
and human resource for health
Public Sector Hospitals
Basic Health Units
Rural Health Centers
Dispensaries
Registered Doctors
Registered Dentists
Registered Nurses
Population per doctor
Population per dentist
Population per nurse
Population per bed
Source:
Figures/Indices
1279
5527
686
5671
220,829
22,595
108,474
963
9,413
1962
1,608
Economic Survey of Pakistan, 2019.
With a population which has an annual growth rate of 2.1%, and
a high density, these statistics portray a dismal picture of the healthcare
sector, both in terms of infrastructure as well as human resources. The
pandemic has therefore proven to be additionally debilitating for this
fragile sector, despite the NCOC’s establishing of special Isolation Hospital
& Infectious Treatment Centre (IHITC). At the time of the outbreak, the
total number of ventilators available at the public and private sector
hospitals was around 1650, and intensive care facilities for critically ill
patients were also grossly insufficient. All of these factors listed, puts
Pakistan at a much higher risk in contracting of the pandemic.
48 Government of Pakistan, “ Health and Nutrition,” Economic Survey of
Pakistan 2019.
The Implication of COVID-19 Pandemic for Pakistan: Civil Society Perspectives
131
However, during the first wave, and as discussed earlier, both in
terms of figures and CFR, Pakistan has faired much better. Yet, the public
attitude and non-seriousness towards the pandemic has given a sudden
rise in the number of affected at the onset of the second wave. Much like
the first wave, people are reluctant to go for testing and prefer to stay at
home and self-medicate. Though the health sector was allocated Rs. 12,
671 in the 2019 budget, but in the face of long term neglect, the need is
for a focused and committed health care restructuring and reforms.
During the first surge, the health care staff was also one of the
worst hit by the coronavirus. The government, in anticipation of the
second surge must carryout appropriate measures, both preemptive as
well as preventive to ensure the safety and health-security of the medical
respondents and enhance the infrastructural facilities and capacity.
As part of capacity building, the government plans importing 10,000
ventilators.49 Furthermore, emergency preparedness, PPEs, testing kits,
diagnostic equipment, SOPs and trainings are being ensured to have a
better and superior preparation. Yet, none of this can be successful, if
not sustained over time, and will in turn have a crushing impact on the
economy.
Conclusion
Security in the contemporary world is not restricted to the physical
domain alone. It is envisioned comprehensively through the lens of
human security, that guarantees a safe, sustainable, and healthy society.
Although the novel coronavirus outbreak has indiscriminately affected
people worldwide, it has also brought to light the glaring reality, that
every country regardless of its global power potential has struggled
to face this challenge, and health care facilities remain questionable.
Countries such as China have been successful in flatlining the curve of
the disease through extra-ordinary stringent measures, which given the
economic challenges faced by Pakistan may not be possible. Since the
first reported cases, Pakistan has had 359,032 confirmed cases, of which
49 “Aiming to acquire 10 , 000 ventilators to increase Pakistan ’ s capacity , says NDMA
chairperson,” Dawn, March 29, 2020
132
Implications of COVID-19 Pandemic for South Asia: Civil Society Perspectives
323,824 recoveries have been made, and 7,160 deaths have occurred.
This puts the CFR at 2% which is still a modest figure, yet the second
surge is proving to be more widespread and resilient.
In the fight against the coronavirus, Pakistan’s civil military
leadership stands united and the government, despite its limited capacity
and multiple governance challenges has, and is doing its best to preempt,
prevent and counter the pandemic, yet its efforts can only be successful,
if the public in general shows collective responsibility and understanding
towards the issue. So long as the public considers it to be a conspiracy
or a mere myth, any amount of efforts would remain insufficient. Given
the economic challenges, the government has and remains hesitant
towards imposing a stringent country wide lockdown. Yet, the need is
for once again enforcing protocols for travel, public gatherings, and daily
public interactions. There remains the dire need to realize and implement
health sector reforms and improvements, which is the weakest link in
Pakistan’s response to counter the outbreak. Incorporation of digital
technology, cellular connections, innovative work scheduling and online
education is now part of the new normal that we must embrace better.
Social distancing, better hygiene and sanitizing practices are the basic
prerequisites for personal safety. Yet we must also keep in mind that
threats such as vulnerability to climate change, crops destruction due to
abnormal weather patterns or locust attacks or any such infestations, as
well as cross border developments and practices have a far worse and
debilitating impact on a country, than a physical incursion.
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pk/tns/detail/621158-virus-alert, January 06, 2020. Accessed: October 15, 2020.
World Health Organization, “Pakistan: COVID-19—Situation update as of 7
April 2020.” Also see: “Updates: Ministry of National Health Services
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