Unseen and unheard

KARACHI: Bibi Gultaja picked up the end of her loose, baggy shirt a little self-consciously, revealing big, red, bumpy blotches on the side of her stomach. “It’s all over my body,” she told the doctor, pointing to the inside of her thighs and armpits, “I’m always scratching here and there”. With a quick look, Dr. Fatima Jehangir diagnosed Gultaja’s problem. “She has a fungal infection,” she said, and then wrote a prescription.

Dr. Jehangir, head of the Department of Family Medicine at Ziauddin University Hospital, and a few of her colleagues, have been running a primary care clinic in the Gulshan-e-Sikandarabad, one of Karachi’s informal settlements, for the past 14 years. They see around 40 patients daily. “This year, we’ve seen a significant rise in skin diseases like scabies and fungal infections among women and children due to Karachi’s extreme summer heat and humidity,” said Dr Jehangir, noting that fungal infections often occur in areas with trapped moisture or friction.

Karachi's escalating summer heat, which increases health risks and heat stress, is attributed by experts to its dense urban development and a shortage of green spaces. Its impact is worsened by the poor living conditions in the katchi abadis, informal settlements where 60% of the city’s residents are crowded together. These areas have little or no access to sanitation, piped water and electricity, and residents live in overcrowded, cramped settlements with poor ventilation. 

Heat waves and heat islands

“High humidity levels made the heat unbearable, significantly increasing the feels-like [heat index] temperature,” said Dr Sardar Sarfaraz, chief meteorologist at the Pakistan Meteorological Department in Karachi. For instance, on June 30, the temperature reached 39.2°C, but the heat index or 'feels-like’ temperature was 55°C even as late as 5:00 pm. 

Comparing the 2015 heatwave that killed over 1,200 people in Karachi, the meteorologist explained that although the temperature soared to 44.8°C in the city that year, this summer, was worse. “There were at least three cycles of heatwaves, one each in the months of May, June and July and which lasted much longer.” In July, for instance, the temperature was 4° Celsius higher than the monthly average for 8 days of the month. 

A metropolis with 20 million residents, Karachi exemplifies the heat island (UHI) effect, where urban areas are significantly warmer than their rural surroundings. This is due to high density, with closely packed buildings and materials that trap heat. This summer, Karachi’s famous cool evening breezes disappeared too. A Karachi Urban Lab (KUL) study revealed a 1.6°C rise in daytime temperatures and a 2.4°C rise at night over the past 60 years.

Dr Nausheen H Anwar, director of the Karachi Urban Lab at the Institute of Business Administration, equated “high-rises, pavements and roads made of asphalt, for trapping the heat coming from the ground and getting absorbed into the atmosphere" linking the rise in nighttime temperatures to the urban heat island (UHI) effect.

Lopsided urban development

Dr Noman Ahmed, head of Architecture and Management Sciences at Karachi’s NED University of Engineering and Technology, criticized current urban development trends for worsening climate change, noting that green cover in cities has dropped to under 4%, far below the recommended 10%. Natural landforms have been levelled for development, disrupting the city’s ecological balance and showing little regard for climate initiatives in policies and projects.

The city's struggles are deepened by outdated drainage systems and the relentless encroachment of these katchi abadis on its natural water sources. As Karachi’s urban sprawl spreads unchecked, the once-absorbent surfaces are overtaken by concrete, leading to intensified surface runoff and a heightened risk of flooding.

The rapidly growing population in Karachi's katchi abadis puts excessive pressure on resources. When flooding occurs and damages infrastructure, it also leads to displacement and loss of wages, pointed out demographer Dr. Farid Midhet who closely monitors population and health issues. “Karachi needs comprehensive planning to mitigate the adverse effects of climate change, with a special focus on its poorer segments,” he said. 

“In Karachi, the increase in population is translating into higher vulnerability of people and communities to the risks of climate change,” explained Farhan Anwar, Assistant Professor of Practice at Karachi’s Habib University. He said a large population increase is seen to be through inward migration. “These communities end up occupying high-risk, vulnerable, and insecure land spaces due to their low socioeconomic profile, thereby adding to the overall vulnerability profile of the city,” said the urban planner.

Women in informal settlement most impacted by climate catastrophes 

Climate change impacts both genders, but economic, social, and cultural inequalities exacerbate its effects on women, a factor that often goes unnoticed.  Research conducted by the Urban Institute in the slums of Delhi, Dhaka, Islamabad and Lahore found: “Climate change impacts every element of their [women’s] lives: their economic security, marital relationships, and physical well-being”. In Pakistan, women's limited roles and freedoms amplify their struggles with climate-related extreme events, making their challenges more daunting.

For 38-year-old Rakhi Matan of Shirin Jinnah Colony the worst time of the day in summer is when she is cooking. Her kitchen is in an enclosed space with no exhaust which makes the entire home hot. When the late August rains brought cooler temperatures to Karachi, Matan welcomed it with relief despite having to navigate muddy puddles and dealing with a leaky roof, considering them minor issues compared to the heat.

Perween Kanwal, lives in Orangi, another informal settlement of Karachi. Power outages in her area last between 10 to 12 hours. “While men can sit outside for fresh air, we remain indoors, struggling with heat and stuffiness,” she said. Her words are echoed by Amna Shabbir of Jinnah Colony. Shabbir said living on the rooftop means enduring intense summer heat and frequent power outages. Nights are cooler, but the all-women household can't use the terrace due to privacy issues and close neighbouring buildings.

Dr. Jehangir noted that skin diseases worsen due to water shortages, poor hygiene, heat, and non-breathable clothing like burqas and abayas, which are worn for cultural and religious reasons. And persuading families to follow prescribed treatments for skin infections remained a challenge as the overall cost rises with large family sizes, despite individual treatments being inexpensive.

Many residents of informal settlements have migrated from rural areas, leading to increased workloads for women, including external work, household chores, and caregiving for children and the elderly. Most women interviewed say their work is never-ending. For example, Matan works as a housemaid at two places and cooks for her family when she returns home at 6:30 pm.

The only time she gets to herself is when she goes to bed. But that rest is interrupted by power outages. "In the last six months I can't recall when I had a full, uninterrupted night's sleep,” she said. The rooms get so stifling they go out into the alley, using hand-held straw fans to provide inflow of air. “Tiredness is now part of my being,” she said. 

“Women in peri-urban parts of urban centres have double the burden and unlike their rural counterpart, resources are not always at arm’s length,” pointed out Arjumand Nizami, country director of Helvetas Swiss Intercooperation, a network of Swiss-based development organisations. 

Nizami, who has worked with women in both rural and urban settlements for almost three decades, says that the sisterhood rural women enjoy is absent in informal settlements  and women there often “cruise in insecure and solo environments” because these neighbourhoods comprise a medley of communities from across the country.

Economic distress

Inadequate civic infrastructure exacerbates their poor living conditions and the absence of adequate supply of water, electricity and cooking gas also adds to their economic distress. Pointing out that “women in low-income settlements face severe challenges due to poor ventilation and limited electricity”, with extreme temperatures affecting them for at least eight months a year, Dr Noman Ahmed, head of the Architecture and Management Sciences at Karachi’s NED University of Engineering and Technology, pointed to the economic impact. 

Citing the example of Pahar Ganj in North Nazimabad where daily power outages last up to 13 hours, and the average household income is  Rs. 35,000 per month, he questioned how residents could possibly meet their power needs when their primary concern is simply putting food on the table. 

Kanwal of Orangi said many in her area use firewood due to gas outages and lack of electricity.  She relies on gas cylinders for cooking but has to buy food from a nearby hotel when the gas runs out and electricity is unavailable, adding unnecessary expenses. Matan of Shirin Jinnah Colony noted that while salty well water remains free, they pay a high price for sweet water and buy filtered water for drinking. “Two years ago, we paid Rs 2,500 per month for meetha pani (sweet water), but now it costs us Rs 4,000 for the same amount,” she explained. Sweet water is used for washing clothes, bathing, and cooking, while salty water is used for mopping and washing bathrooms.

Kanwal’s water problems have improved since moving within Orangi, where she now gets unlimited piped water for Rs 300. Previously, she paid Rs 6,500-7,000 monthly for insufficient water for her family of five, saying the lack of water and electricity makes her irritable, affecting the mood in her home.

Gultaja’s visit was her first to this  clinic. Eight months ago, she consulted another doctor who prescribed medication and soap, advising a six-month treatment. "It cost me Rs 5,000, but I had to stop after three months due to the expense," she said, noting her concern that her eight-month-old son, whom she is breastfeeding, also has developed rashes. Her husband, a self-employed photographer at Clifton Beach, barely earns enough to cover expenses, and she doubts he can afford the treatment this time.

The mother of five said her husband, who refuses to use family planning methods, avoids intimacy due to infection fears. But it suits her well. “I can’t handle more children; we’re struggling to feed the ones we have, all born via C-section”.  Top of FormBottom of Form

She explained that arguments arise when she asks her husband for more money, leading to him hitting her and claiming he can't do more. And asking for more money leads to arguments, with him hitting her and insisting he can’t contribute more.

Mental health issues

Dr. Jehangir observed that 90% of women seeking treatment are candidates for anti-depressants due to significant stress, a finding supported by Dr. Ayesha Sami, who works in Machhar Colony, near Lyari. 

Dr. Sami said mental health issues among women are widespread but often unrecognized. Women often present with physical ailments like body aches, sleep disturbances, and high blood pressure, which may be linked to underlying mental health problems. “Their biggest challenges are male aggression and minimal financial support,” she pointed out.

This forces women to seek informal home-based work while managing household duties and caring for the elderly and children. "Depression is common among these women," she said, noting they often don't share their problems.

Conclusion

Conditions will worsen over time. The IPCC's Sixth Assessment Report predicts more extreme weather, including heatwaves and flash floods, in South Asia. Pakistan ranked eighth most vulnerable globally by the most recent Global Climate Risk Index (2021), and the southern province of Sindh with its port city of Karachi is especially at risk.

In 2019, UN Secretary-General António Guterres had stated that the climate battle would be "won or lost" in cities during the C40 World Mayors Summit in Copenhagen. Karachiites are frequently warned of tropical cyclones like Phet (2010), Nilofar (2014), Tauktae (2021), and Biparjoy (2023), though they all veered away from making landfall in the city.

The recent cyclone Asna, though diverted at the last moment, caused significant damage to Amna Shabbir’s home in Shirin Jinnah Colony. The strong winds knocked a solar panel onto their rooftop, collapsing it. Fortunately, Shabbir’s mother and sister, who were inside, were unharmed. The landlord and neighbours helped the traumatized women by rescuing them from the debris. 

Matan, who has lived in Shirin Jinnah Colony with her maternal grandmother since the age of eight, reflected on how the area has undergone a dramatic transformation over the past 35 years, leading to a noticeable decline in quality of life. 

As a member of the global climate change team, Nizami said that with increasing extreme weather events, women should acquire skills such as vertical or rooftop farming, which can provide cooling and food security during economic crises. She advocates for urban sponges and rooftop planters to absorb heat and increase green cover.

Nizami also urged the government to improve safety for women in informal settlements, who face higher harassment risks due to the breakdown of family structures and men’s long work absences.

Women of Karachi’s katchi abadis absorb the brunt of the impact of climate change on the city, and yet have no seat at the table during discussions on the issue. As part of a community in the frontline of climate change, their participation is critical. Not only could this give them the agency to change the decisions that shape their own lives, but their participation could inform decisions taken in global summits which have a much wider global impact.