Pakistan 1 Year Report - UNICEF Humanitarian Action Resources

“I, like others, was shocked to see the devastation from the 2010flooding and its impact on children in Pakistan. Over the pastyear, the global community, including UNICEF, has launched amassive response, reaching millions with clean water, criticalnutrition, immunizations, education and other essential servicesto protect children and their families. Today, there is still muchmore to be done to address the underlying conditions thatmade these communities so vulnerable, and to help them buildresilience. Together, we can turn the tide in the lives of childrenand families of Pakistan who have suffered so terribly.”Anthony Lake,UNICEF Executive Director©UNICEF/PAK/2010/Ramoneda©UNICEF/PAK/2010/Ramoneda

ContentsReporting period from 28 July 2010 to 6 July 2011Executive Summary 4Overview/Fast Facts 5A Year On: Hope Amidst Vulnerability 6Sector ResponsesHealth 8Nutrition 10Water, Sanitation & Hygiene 12Education 14Child Protection 16Cross-Cutting Priorities 18Stories from the Floods 20Operational Commitments 22Resource Mobilization 24Looking Forward 26UNICEF Partners 28Acronyms/References 29

Executive SummaryThe 2010 Pakistan floods represent one of the largestdisasters ever recorded in terms of area andnumber of people affected. After massive displacement,millions have returned - some immediately,others after months - to critical conditions: no homes,no food, no livelihoods, no clean water or sanitation,damaged infrastructure and depleted health and socialservices. The poorest suffered the most losses, manywithout assets to help recover from the devastation.The floods heightened the vulnerabilities of millions ofpeople, who, one year on, are still struggling to rebuildtheir lives in the face of extreme challenges.Immediately after the floods and for months subsequently,ensuring the survival of millions of children wasUNICEF’s imperative. Drawing on global resources andcritical donor assistance, UNICEF Pakistan quickly setup three emergency hubs, more than doubled staffnumbers and initiated massive supply procurement. Forthe year, huge results targets in many sectors were set,reached, and in some cases surpassed by UNICEF, workingwith government and partners. Guided by an Inter-Agency Survival Strategy comprising Health, Nutrition,WASH and Food clusters, responses were coordinatedwithin and across sectors. Some interventions reachedmillions - numbers akin to the entire population of NewZealand (in WASH) and Greece (in Health) - and thefollowing results reflect 93 per cent coverage or higher:partnering with the government and World Health Organization(WHO), UNICEF supplied measles and poliovaccines to 10.4 million and 11.7 million children respectively,in all flood-affected districts; UNICEF provideddaily access to safe water for 5 million people throughwater trucking and water scheme rehabilitation;UNICEF established systems for sustained service delivery,benefiting more than 294,000 children with educationthrough Temporary Learning Centres and 397,000children with protective Child-Friendly Spaces; andUNICEF attempted a large-scale, complex nutrition response,reaching 95,000 children under five with severeacute malnutrition and 256,000 children with moderateacute malnutrition. Initial nutrition targets were surpassedbut have been revised upwards as the floodsexposed the critical malnutrition situation in Pakistan.Ensuring early recovery efforts reached those mostin need, UNICEF led the development of a PakistanIntegrated Nutrition Strategy and aided the governmentto launch scaled-up rural sanitation through thePakistan Approach to Total Sanitation. Construction ofTransitional School Structures, with teachers trainedin child-friendly schooling and protection, is ensuringcontinued education access for children, and is providingan opportunity to increase enrolment rates forthose previously out of school.To date, UNICEF has deployed 73 dedicated staff atnational and sub-national levels to meet its accountabilitiesfor supporting strategic response coordination.From February 2011, the humanitarian clusters transitionedto Early Recovery Working Groups and UNICEFhas led the Water and Sanitation, Health and Nutrition(with WHO), and Education (with Save the Children)ERWGs and the Child Protection Thematic WorkingGroup, with the federal structures still mirrored at provinciallevel. Early recovery assessments and capacitygap analyses led to revised strategies for every sector,now being implemented; and contingency plans andemergency preparedness actions have been undertakenfor the 2011 monsoon season. The timeframe for earlyrecovery action was officially extended from July 2011 toDecember 2011, allowing for continued vital assistance.A year on from the floods, hope and a sense of normalcypervade for many; for others living on the margins,life-and-death urgency remains. Enabling new datacollection and access to vulnerable populations, thefloods exposed the full extent of inequity challengesin many areas, particularly for nutrition and sanitation,yet have also presented new opportunities to addressthese through evidence-based programming. UNICEFis committed to the poorest children and women ofPakistan and our ongoing focus will be on assistingthem as well as advocating for increased resourcecommitment from the government and strengtheningpartner capacity at all levels. The organization stillrequires US$49.5 million to continue its essential floodresponse programmes and an additional US$6.2 millionfor nutrition where UNICEF’s flood funding ceilingis reached but critical humanitarian needs remain. Withsustained support, UNICEF can continue to provideassistance, strengthen resilience, build capacities forsocial service delivery and cultivate an environment inwhich Pakistan’s women and children can thrive.4 • Children in Pakistan

A YEAR ON:Hope AmidstVulnerability• Vulnerabilities of womenand children• Strategic early recoveryaction• Building capacity torespond to new risks©UNICEF/PAK/2010/RamonedaVulnerabilities of Women and ChildrenThe pre-flood challenges facing Pakistan in achieving theMillennium Development Goals (MDGs) - widespreadchronic malnutrition, inadequate sanitation practices andlagging school enrolment rates - were aggravated by thefloods and a year on still affect millions.• Access to improved water sources and toilet usagedropped and these remain critical issues.• The incidence rate of diarrhoea and acute respiratoryinfections has increased while access to health facilitieshas fallen.• The Flood Affected Nutrition Surveys revealed criticalglobal acute malnutrition rates in Sindh and in Punjab.• The primary school enrolment rate has been negativelyaffected.• Protection issues remain, including trafficking andexploitation, child marriage and child labour.• In north-western Pakistan, more than 1 million people(including flood-affected) remain displaced followingthe 2009-2010 militant action, with new operations in2011 displacing more than 5,000 additional families.The floods created new vulnerabilities while exacerbatingexisting ones. Debts incurred from lost crops andre-planting are high. Many communities lack services,infrastructure, safe drinking water, schools and healthclinics. The poorest of the poor - many living in flood-riskzones - suffered the heaviest proportional losses, sinkingeven further into poverty. Displacement brought thosefrom previously unreached rural areas into camps, revealingto responders the full extent of their vulnerabilities,particularly in nutrition, education and sanitation 1 .The comprehensive flooding also left fluvial structuresdamaged and vulnerable, elevating the risks of crisis thatcould occur from the regular monsoon season.Challenges continue to affect service delivery and raisecosts of early recovery efforts, including: the sheer sizeand geographical spread of the population affected andthe logistical difficulties in delivering assistance; thelimited number and capacity of partners and the negativeimpact of the floods on community service providersthemselves; and lack of access to areas and security risksdue to militant actions.Coordinated Early Recovery ActionSeeds of hope continue to be sown through strategic,6 • Children in Pakistan

Core Commitments for Childrenin Humanitarian ActionHealthSTRATEGIC RESULTExcess mortality among girls,boys and women in humanitariancrisis is prevented.The 2010 floods affected an estimated 3 millionchildren under five years of age (600,000 newborns)and 780,000 pregnant women. Extensivedamage was caused to Pakistan’s rural health care infrastructurein all four provinces, damaging health facilitiesand displacing frontline staff, including communityhealth workers and vaccinators. This elevated risks ofhigh morbidity and mortality among newborns andchildren caused by diarrhoea, acute respiratory tract infections,measles and malaria. Underlying malnutritionhas acted as an aggravating factor, with disease in turnworsening malnutrition.ImmunisationThe lack of a large-scale disease outbreak is a majorachievement for the Health sector and for the Inter-Agency Survival Strategy. Guided by global experts,the decision was taken early to immunize all childrenin flood-affected districts to prevent disease spreadand remarkable immunization efforts, achievedjointly, reached millions across Pakistan. Collaboratingwith WHO and the government, UNICEF, throughits operational partners, provided all the vaccines forcomprehensive, phased campaigns conducted in 70flood-affected districts, reaching more than 93 percent (10.5 million) of children 6-59 months of age withmeasles vaccination and 98 per cent (11.7 million) withpolio drops. Nearly 12 million children 6-59 months ofage also received Vitamin A supplementation duringNovember National Immunization Days (88 per centcoverage). In the last few months, UNICEF has increasinglydovetailed its flood response into regular routineimmunization work, including in flood-affected areas.UNICEF has played a huge role in the drive to eradicatepolio, supporting vaccination of 30.5 million childrenunder five (94.4 per cent coverage) across Pakistan in anational campaign in May 2011.©UNICEF/PAK/2010/RamonedaMaternal, Newborn and Child Health (MNCH)To restore and maintain community based health services,UNICEF supported the Lady Health Worker (LHW)network, providing 47,800 LHWs in the flood-affectedareas with cash incentives and essential month-longsupply kits (set of basic maternal, newborn and childcaremedicines, equipment and supplies) to continuedelivering services. To address the risk of increasingmortality rates in childbirth caused by the floods, 24/7Emergency Obstetric Care (EMOC) services have been8 • Children in Pakistan

IndicatorsUNICEF target(by July 2011)UNICEF totalprogress todate (peoplereached)Number of children 6-59months who received 11,250,000* 10,481,000*measles vaccination†Number of children 0-59months who received 11,955,000* 11,660,000*polio vaccination†Number of families receivingLLITN600,000 470,000Number of Pregnant Womenprovided with ANC†618,000 59,000†Figures have been rounded.*These represent both UNICEF and ERWG partner figures, since UNICEFsupplied the vaccines for campaigns reaching all children in all floodaffecteddistricts by July 2011, with partners providing additional supportfor these same interventions. † Results are expected to increase as countrywide data is being clarified and disaggregated for flood-affected areas. Thetimeframe for reaching this target is now is December 2011, in line with theofficially extended early recovery period.supported or established at health centres: in Sindh,UNICEF supported 35 existing EMOCs, as part of awider MNCH package of care, reaching nearly 18,000women with antenatal care (ANC) and obstetric servicesby December 2010; in Punjab, in 2011, UNICEF providedobstetric supplies and training for staff, benefiting41,000 pregnant and lactating women and newbornsthrough over 100 newly established EMOCs. This approachis now being taken forward by the provincialDepartments of Health.Over the year, approximately 939,000 long-lastinginsecticide treated nets (LLITN) were distributed to protectmothers and children from malaria, reaching nearly470,000 families in at risk areas (78 per cent coverage).Over 900,000 mothers of children under five, exceedingthe target of 735,000, were provided with healtheducation on major health and disease threats againstchildren - diarrhoea, pneumonia, malaria and malnutrition.Antenatal care is a continuing focus in floodaffectedareas up to December 2011: around 88,000clean delivery kits and 92,000 newborn care supply kitswere provided to beneficiaries. Challenges in disaggregatingflood-specific results from the country widedata has resulted in low reported coverage of antenatalcare interventions: so far only 59,000 pregnant women(of a target of 618,000) are reported to have benefitedfrom health facilities. However, the number reached islikely to significantly increase once the data is clarifiedin the next month. Training is also being undertaken tostrengthen results reporting in future emergencies.The Mother and Child Health Week (MCW) is a largescalecampaign that reaches thousands of families withinformation and low-cost, high-impact interventions. Inthe September 2010 and April 2011 MCWs, in collaborationwith the Department of Health, the LHWs andpartners, 13.3 million children received de-wormingmedicine (92 per cent coverage) across the five provinces,and nearly 7.8 million beneficiaries attendedhealth education sessions. The next MCW is planned forNovember 2011.Challenges and Looking ForwardThe severe damage to rural health care infrastructureand displacement and shortage of (especially female)frontline health care personnel is still a massive challenge.Women’s limited access to health care due tothe low health-seeking behaviours and socio-culturalbarriers is also a significant issue. Looking forward,UNICEF will increasingly dovetail its flood responseactivities into regular programming, continuing tobuild federal and provincial government capacity forboth campaigns and routine immunization as wellas strengthening facility-based care of diarrhoea andrespiratory infections in collaboration with partners.Another important element will be behaviour-changecommunication activities. UNICEF will also continueto strengthen Community Integrated Management ofNeonatal and Childhood Illnesses services throughtraining and equipping community health workers,and develop government and partner capacity foremergency preparedness and response.Health Funding (as of 6 July 2011)Required: US$50.8 millionFunding Gap,$4,926,04210%Allocated,$8,674,46417%Received: US$45.9 millionCommitment,$5,622,93911%Expenditure,$31,602,65562%One Year After the Floods — Turning Towards a Brighter Future • 9

Core Commitments for Childrenin Humanitarian ActionNutritionStrategic ResultThe nutritional status of girls,boys and women is protectedfrom the effects of humanitariancrisis.Over many decades, poor feeding practices havebeen a contributing factor in chronic malnutrition.The floods forced millions from remoteareas into camps, including many rural poor previouslyunreached, revealing to responders the extent of themalnutrition problem in Pakistan. The floods also increasedhousehold food insecurity, causing damage toproperties, food stocks and standing crops, and delays inplanting. The catastrophic malnutrition situation was confirmedby the Flood Affected Nutrition Surveys (FANS),carried out in late 2010 with government and partners.Data released by the Departments of Health revealedmalnutrition levels at 22.9 and 21.9 per cent global acutemalnutrition (GAM) in North and South Sindh respectively,significantly above emergency thresholds (15 per centGAM). The GAM rate in affected areas of Punjab was 13.9per cent, nearing the emergency threshold 2 . An ongoingnational nutrition survey is also showing alarming levelsof micronutrient deficiencies.Prevention of MalnutritionUNICEF initially supported 292,500 children from 6-23months of age and pregnant and lactating women(PLW) with preventive blanket distribution of nutritionsupplementation, in partnership with the World FoodProgramme (WFP), including ready-to-use supplementaryfood, high-energy biscuits and micronutrient supplements.Around 2 million children and 600,000 PLWshave been screened for malnutrition; the PLWs were alsocounselled on nutrition, hygiene and sanitation behaviourchange.©UNICEF/PAK2010/ZaidiCommunity Based Management of AcuteMalnutrition (CMAM)UNICEF initially set CMAM response targets unparalleledby the organization elsewhere globally in 2010, aimingto reach 75,600 children under five with severe acutemalnutrition (SAM) and 180,000 with moderate acutemalnutrition (MAM) by July 2011. UNICEF and partnerssurpassed their original targets: around 256,000 childrenwith MAM have been reached through SupplementaryFeeding Programmes and nearly 95,000 children withSAM through 34 Stabilization Centres and over 800 OutpatientTherapeutic Feeding Programmes. The SAM curerate of 81 per cent met international SPHERE standards,although challenges of population movement resulted ina 19 per cent default rate. Results and targets for cluster/ERWG partners collectively and UNICEF are the samesince UNICEF has been the main provider of suppliesand implementation costs for CMAM, as well as providingregular technical assistance and capacity building ofpartners and government, to date training 155 master10 • Children in Pakistan

IndicatorsERWG Nutritionsub-sector target(by December2011)*ERWG Nutritionsub-sector totalprogress to date(people reached)UNICEF target(by December2011)*UNICEF totalprogress to date(people reached)Number of SEVERELY acute malnourished(SAM) children 6-59 months reachedNumber of MODERATELY acute malnourished(MAM) children 6-59 months reached175,000** 95,000 175,600** 95,000504,000** 256,000 504,000** 256,000Number of PLW reached with micro-nutrients 206,000** 153,000 206,000** 153,000Targets were originally set for July 2011; unless otherwise indicated, the timeframe for reaching these is now December 2011, in line with the officially extendedearly recovery period. UNICEF, as lead agency, is responsible for information management of the Health and Nutrition ERWG sub-sector and sharing overallresults achieved by ERWG partners collectively. ERWG figures include UNICEF’s programme targets and results. Figures have been rounded.* UNICEF and Nutrition sub-sector targets are the same as UNICEF is providing supplies and support for all Nutrition sub-sector partner interventions.** Targetsof reaching 75,600 children with SAM and 180,000 with MAM and 123,000 PLW were originally set for July 2011. In light of FANS data, these targets were scaledup (as above) in May 2011 and the timeframe for reaching these is now December 2011, though this is dependent on funding.trainers and 4,600 healthcare providers on CMAM.UNICEF is also collaborating with WFP on a School FeedingProgramme in temporary and transitional schools.In May 2011, UNICEF scaled up its nutrition targets to bereached by December 2011 (see table), in view of the vastneeds uncovered through the FANS.Infant and Young Child Feeding (IYCF)UNICEF has partnered with provincial Departments ofHealth, LHWs, Community Health Workers (CHWs) andvolunteers to promote key messages on IYCF acrossthe country. More than 300,000 mothers and caregivershave been sensitized on IYCF through more than 10,000sessions in the affected areas. Around 2,750 health careproviders have been trained on IYCF to ensure thatchildren receive adequate nutrition, including exclusivebreastfeeding, during their first six months of life.Nutrition CoordinationWorking to meet its nutrition coordination responsibilities,over the past year, UNICEF deployed staff at nationaland sub-national levels to identify gaps and formulatea strategy, support the implementation of the InterclusterSurvival Strategy and develop the capacity ofnational and provincial government for addressing malnutrition.From February 2011, UNICEF has led the Nutritionsubsector within the Health and Nutrition ERWG. ANutrition Information System has been rolled out in KP,Punjab and Sindh, allowing monthly performance indicatorsto be collected from partners analyzed and used fordecision-making. An evaluation is under way to reviewthe cluster/ERWG collective response progress to date.To address the chronic and early recovery nutritionalneeds of vulnerable populations, UNICEF led the developmentof the Pakistan Integrated Nutrition Strategy andaccompanying operational plan. This, based on FANSdata, has been launched as a multi-sectoral effort acrossnutrition, food and agriculture, water/sanitation/hygiene,and health sectors.Challenges and Looking ForwardSurveys and assessments clearly show high precedenceof malnutrition and micronutrient deficiency; partnerand government capacity to manage this is still limited.An exacerbating factor is the lack of dedicated leadershipfor nutrition programming within provincial governments.In light of the FANS data, UNICEF’s nutritionflood funding ceiling was underestimated; an additionalUS$6.2 million is required to address the vast remaininghumanitarian needs. Looking forward, to be sustainable,malnutrition prevention, especially IYCF, must be focusedupon, and malnutrition treatment integrated into primaryhealth care. UNICEF’s focus will be to support the expansionof the LHWs network to reach uncovered areas andstrengthen government capacity.Nutrition Funding (as of 6 July 2011)Required: US$27.5 millionFunding Gap,$16,9470%Allocated,$5,155,12619%Received: US$27.5 millionCommitment,$1,236,3334%Expenditure,$21,147,34277%One Year After the Floods — Turning Towards a Brighter Future • 11

Core Commitments for Childrenin Humanitarian ActionWATER,SANITATION ANDHYGIENEStrategic ResultGirls, boys and women haveprotected and reliable accessto sufficient, safe water andsanitation and hygiene facilities.Post-floods, 14 million people urgently requiredsafe drinking water and basic sanitation facilities.The floods devastated much of the water supplyinfrastructure and many water, sanitation and hygiene(WASH) facilities throughout the country. In affectedprovinces, the use of toilets dropped drastically from anaverage of 70 per cent to 12 per cent in KP, Sindh andPunjab, signifying widespread damage 3 . Access to improvedwater sources fell from 75 to 55 per cent in theaffected areas. Water quality deterioration has renderedthe affected populations vulnerable to water, sanitationand hygiene-related diseases.Water SupplyTwo months into the response, UNICEF was alreadyreaching over 2.6 million people with clean water, including1.2 million people with water tankering, which hasnow almost ceased. Sustainable early recovery interventionssuch as water supply scheme repair/restorationand promotion of household water treatment have beenscaled up, with over 5 million people (100 per cent of target)currently accessing safe water daily across the floodaffectedareas - equivalent to the total population of NewZealand, and constituting the majority of the collectiveresponse of the WASH ERWG partners. Mass chlorinationof water sources to pre-empt disease outbreak asthe weather gets warmer has been reinitiated and willbenefit around 4 million people.SanitationThe crisis illuminated the pre-flood situation where27 per cent of the population (48 million people) werepracticing open defecation - a major challenge toimplementing a sanitation response. Despite this, currently2.9 million people (of the 5 million target) nowbenefit daily from improved sanitation. During displacement,UNICEF initiated the construction of emergencylatrines, defecation trenches and the provision of bathingcubicles. For early recovery, UNICEF has supportedthe government to scale up the Pakistan Approach toTotal Sanitation (PATS), focused on achieving an opendefecation-free environment through support for toiletconstruction, hygiene promotion, social mobilizationand improved household water treatment in vulnerablerural communities recovering from the floods.©UNICEF/PAK/2010/RamonedaHygiene PromotionOver the course of the year, almost 4.7 million people,mainly women and children, were reached with hygienemessages, of the targeted 5 million. Over 550,000hygiene kits and 1.4 million bars of soap were distributed.UNICEF and partners supported the training of12 • Children in Pakistan

IndicatorsEducation ERWGtarget (by December2011)Education ERWGtotal progressto date (peoplereached)UNICEF target (byDecember 2011)UNICEF totalprogress to date(people reached)Beneficiaries of TLCs 390,000* 350,000 248,000* 266,000Beneficiaries of assorted school supplies 1,235,000 793,000 997,000 761,000Teachers Trained 39,200 13,400 9,400 5,750Beneficiaries of TSSs** 150,000 24,000 60,000 1,150Targets were originally set for July 2011; unless otherwise indicated, the timeframe for reaching these targets is now December 2011, in line with the officiallyextended early recovery period. UNICEF, as co-lead agency, is responsible for information management of the ERWG and sharing overall results achieved byERWG partners collectively. ERWG figures include UNICEF’s programme targets and results. Figures have been rounded.* The timeframe for this target is July 2010 - July 2011; however, some TLCs are still being established as an interim measure while TSS are being constructed.** This intervention began in May 2011; targets are set to be reached by December 2011.Capacity StrengtheningUNICEF trained 5,750 teachers, of a target of 9,400,(including 2,100 women) on psychosocial support, useof emergency supplies, school management, ‘SchoolSafety and Learning Environment’, disaster risk reductionand emergency preparedness. Although challenging dueto the vast and geographically spread needs, training forParent Teacher Committees (PTCs)/School ManagementCommittees (SMCs) is ongoing in Balochistan and beinginitiated for the other flood-affected provinces. To date1,100 PTC/SMC members have been trained in schooldevelopment plans and facilitating school enrolment.Education CoordinationTransitioning from the Education cluster to the EducationERWG in February 2011, UNICEF (collaboratingwith Save the Children) continues to meet its coordinationresponsibilities with staff deployed at national andsub-national levels. In March, the ERWG coordinationteam facilitated a lessons learned exercise, commissionedby the Global Education Cluster, to review thecluster/ERWG collective response progress and informongoing response strategy. Based on this and comprehensiveassessment of existing needs and capacities,an early recovery plan was formulated, which focuseson the restoration of formal and non-formal educationin flood-affected areas, in line with government priorities,reaching the most vulnerable. A mapping of fundavailability is also ongoing to inform strategic prioritysetting. The ERWG coordination team facilitated partnercapacity building efforts, including orienting teachers,PTC/SMC members and education staff on their rolesand responsibilities and training on topics such asdisaster risk reduction, interactive teaching methods,psychosocial support and ECD.Challenges and Looking ForwardLimited partner capacity to implement and monitoreducation activities, access constraints to remote floodaffectedareas, and difficulties in obtaining accuratedata, including on damaged schools, have been challenges.Looking forward, UNICEF has prioritized itsresources for construction of TSS and providing thesewith child-friendly school packages (including teacher/community training and equipment), especially aimingto increase equity by reaching children previously outof school. UNICEF will support capacity building for keygovernment staff and partners for scaling up educationresponse and promoting global education standards.Disaster mitigation will be a key component, includingbuilding capacity for contingency planning and continuingto incorporate disaster risk reduction in TSS andpermanent school construction and in teacher trainingmodules.Education Funding (as of 6 July 2011)Required: US$36.4 millionFunding Gap,$8,144,99623%Allocated,$15,361,05042%Received: US$28.3 millionCommitment,$2,291,1956%Expenditure,$10,597,75929%One Year After the Floods — Turning Towards a Brighter Future • 15

Core Commitments for Childrenin Humanitarian ActionCHILDPROTECTIONStrategic ResultGirls and boys rights toprotection from violence, abuseand exploitation are sustainedand promoted.In Pakistan prior to the floods, an estimated 32 per centof girls married before age 18 and 3.3 million childrenunder age 14 were engaged in child labour. Thefloods caused insecurity in household food and income,elevating protection risks, and also increased children’svulnerability to trafficking and exploitation, disruptedcommunity protective networks, heightened psychosocialdistress and risk of physical and sexual abuse, andreduced family and individual abilities to cope. In areasaffected by militant action, flood-affected children alsorequired protection from unexploded ordnance.Safe Spaces and Support ServicesAfter just one month, Child-Friendly Spaces (CFSs)were benefiting 13,000 children. Over the year coveragehas expanded more than thirty-fold, at the peak reaching397,000 children (including 186,000 girls) in 1,200locations served by static and mobile CFSs, providingeducation, recreation and psychosocial support services.This is 120 per cent of the target, since maximum usageof mobile CFS was achieved, reaching many childrenin multiple, less accessible locations. Around 163 safespaces specifically for women benefited 11,000 womenin four provinces. UNICEF established 1,500 Child ProtectionCommittees, reaching 54,000 children with supportand service referral. Working with partners, 532,000 nonfooditems - such as blankets, shoes and utensils - weredistributed to vulnerable children and families. UNICEFalso supported the establishment of 14 Child ProtectionUnits within Departments of Social Welfare, registering17,000 children and providing 12,000 of those withservices. From April up to December 2011, Child ProtectionCentres (CPCs) are being established either newly orfrom converted CFSs, to strengthen national institutionsin their provision of sustainable protection for vulnerablechildren, through monitoring of child rights and supportingservice mapping and referral.©UNICEF/PAK2011/ElsbyStrengthening Child Protection SystemsUNICEF and partners have conducted training in childprotection in emergencies for authorities and governmentstaff in all affected provinces. In Balochistan,UNICEF facilitated the establishment of a Child ProtectionTransit Unit under the Social Welfare Departmentand two Child Abuse Care Units in district hospitals,training staff to identify and manage cases of childsexual and physical abuse; to date 32 children havebeen identified and referred to appropriate care. Withinthe Gender Based Violence (GBV) Working Group,UNICEF has supported the development of nationallevel standard operating procedures (SOPs) and aninformation management system, supporting child16 • Children in Pakistan

IndicatorsChild ProtectionTWG target (by July2011)Child ProtectionTWG total progressto date (peoplereached)UNICEF target (byJuly 2011)UNICEF total progressto date (peoplereached)Number of beneficiaries of CFS 441,000* 553,000 330,000* 397,000Non Food Items distributed 1,075,000 680,000 715,000 532,000Number of beneficiaries of CPCs** 188,000 32,000 70,600 22,000UNICEF, as lead agency, is responsible for information management of the CPTWG and sharing overall results achieved by TWG partners collectively. CPTWGfigures include UNICEF’s programme targets and results. Figures have been rounded.* Initial CFS beneficiary targets as previously reported were revised, based on the situation on the ground. ** This early recovery intervention began in April2011; targets are set to be reached by December 2011.survivors. Training of 35 capacity promoters on GBVprevention and response took place in April 2011, withadditional training of 30 government staff and partnersplanned for July 2011. To strengthen systems forsupporting unaccompanied and separated children,UNICEF is developing SOPs, strengthening informationmanagement systems, and will conduct training for 60provincial government staff in August 2011.Mine Risk Education (MRE)To address mine risk concerns - elevated as the floodwatersexposed previously hidden unexploded ordnanceand landmines resulting in the injuries of 16children - UNICEF continued to lead the coordination ofthe MRE Working Group, while supporting MRE in KP -so far reaching 238,000 people (of a target of 300,000),including 184,000 children with awareness messages.Child Protection CoordinationTransitioning from the Child Protection sub-cluster tothe Child Protection TWG in February 2011, staff continueto work at national and sub-national levels to meetUNICEF’s coordination responsibilities. A CPTWG strategy,standards and action plans have been developed,with an equitable focus on reaching the most vulnerablechildren. UNICEF developed a Child ProtectionCommunication for Development in Emergency Guidethat was disseminated amongst partners and used todeliver messages on child labour, birth registrationand separated children to around 110,000 beneficiaries.The CPTWG has undertaken capacity developmentwithin the NDMA’s Gender and Child Cell and forCPTWG partners on leveraging child issues, achievingthe integration of children’s needs into cash for workschemes and ERWGs’ projects across sectors. Serviceshave been mapped at district level to inform strategicplanning. UNICEF co-led GBV coordination from Julyto December 2010, then handing over to UNFPA, andcontinues to be a strong participant in the GBV TWG.Challenges and Looking ForwardSupporting positive changes in social norms, attitudesand behaviour is human resource dependent and timeintensive, and the number of capable partners is stilllimited. Original flood funding requirements (nowmet) proved inadequate given the scale and evolutionof needs; additional funding is critical for supportingservice delivery at scale. Looking forward, UNICEF willcontinue to strengthen local government and partnercapacity to set up community-based social services,provide referral services, strengthen GBV/child protectioncase management and meet global standards.CFS will be transformed into community-based CPCsand the Child Protection Committees into CommunityBased Organizations, to ensure sustainability. UNICEFwill also continue to strengthen government informationmanagement systems and child rights monitoringand reporting mechanisms.Child Protection Funding (as of 6 July 2011)Required: US$12.5 millionFunding Gap,$113,4141%Allocated,$602,2865%Received: US$12.4 millionCommitment,$2,419,21819%Expenditure,$9,378,78275%One Year After the Floods — Turning Towards a Brighter Future • 17

Core Commitments for Childrenin Humanitarian ActionCross-CuttingPriorities• HIV/AIDS• Gender Equality• PLANNING, MONITORING &EVALUATIONHIV and AIDSThe floods caused disruption to specialized health caresuch as Antiretroviral Therapy (ART), treatment of opportunisticinfections and exacerbated under-nutrition, elevatingthe vulnerability of People Living with HIV (PLHIV)in Pakistan - around 97,400 5 - most of whom are in thelower socio-economic bracket. In response, UNICEF, withUN partners and national/provincial AIDS control programmesconducted a rapid assessment to determinethe number of PLHIV in flood-affected districts and theirimmediate needs. Based on this, a Treatment, Care andSupport Package was developed that included food, nonfooditems, ARTs, multivitamins and condoms. Throughnational and provincial AIDS control programmes, 1,202PLHIV were reached in 2010.Since January 2011, two Family Health Days were conductedin flood-affected districts of Punjab and VoluntaryConfidential Counseling and Testing services wereprovided to 124 families, with those testing HIV positivereferred for HIV treatment and care. Capacity building ofhospital staff in three affected districts of Punjab was alsoundertaken to improve awareness of HIV and strengthenPrevention of Parent to Child Transmission (PPTCT).Dissemination of HIV prevention messages as part ofgeneral health campaigns continued in 2011. UNICEF andUNAIDS supported an assessment of eight flood-affecteddistricts in 2011 to identify issues for follow up by theWorking Group on HIV in Humanitarian Concerns, inwhich UNICEF participates.Stigmatization and cultural barriers hinder the efficacyof programmes promoting access to information onreproductive health and sexual well-being. UNICEF willcontinue to focus on scaling up the PPTCT continuum ofcare, as well as supporting the provincial AIDS controlprogrammes in KP, Sindh and Punjab to ensure womenat risk of or infected with HIV, and HIV-affected families,have access to prevention, treatment care and supportservices.© UNICEF/PAK2010/RamonedaGender EqualityThe floods further exacerbated social and cultural factorsthat in some affected districts inhibit the mobility ofwomen and girls and their ability to access public spacesor articulate their needs, even within IDP camps. Initialpost-flood gender needs assessments found a shortagein female service providers and women and girls hadlimited access to information and aid distribution, due tothe distance of services (and related security concerns).Committed to realizing positive humanitarian outcomes18 • Children in Pakistan

during the flood response, UNICEF has ensured thatits programmes promote the safety, protection andadvancement of girls, boys and women by integratinggender equality considerations into project design andthe response activities of government and partners. Continuedefforts to strengthen awareness and understandingaround gender equality programming are essential.Specific activities included:• WASH projects were reviewed to ensure they addressedgender equality and protection concerns - includingseparate, well-lit latrines for girls and women and provisionof sanitary materials and separate washing facilitiesfor women. In KP for example, clear separation ofwashing areas resulted in increased use by women.• Awareness sessions for education staff were conductedand based on disparity analysis, UNICEF educationprogrammes actively promoted girls education throughprogrammatic interventions, building schools and workingwith communities to promote girls’ attendance.• UNICEF health programmes promoted the work ofhealth sector female staff in remote flood-affectedareas, including Lady Health Workers, to ensure availabilityand access to health services by women, andheld an orientation and gender sensitivity session washeld for government management staff of the LadyHealth Workers programme.• UNICEF provided targeted services to women andgirls through safe spaces for women. UNICEF alsopromoted education, protection and access of informationto women and girls on gender based violence(GBV) through Child-Friendly Spaces (CFSs) by raisingcommunity awareness, also supporting establishmentof service referral mechanisms.• UNICEF supported the establishment and capacitybuilding of a gender and child cell within the NationalDisaster Management Authority in late 2010, throughoutthe response, promoting gender equality, supportingwomen and girls and leveraging gender inupstream policy work.• As lead agency for multiple ERWGs and as part of theinter-agency Task Force on gender, UNICEF supportedthe application of gender markers to the PFRERRP andencouraged disaggregation of data by sex and age,which strengthened strategic gender equality practice.Planning, Monitoring and EvaluationIn support of inter-agency assessment efforts, UNICEFfinanced staff for the Multi-cluster Rapid AssessmentMechanism (McRAM), which undertook the rapidassessment of the flood impact in September 2010,to inform response planning, fund raising and implementation.In March and April 2011, UNICEF led clusterpartner capacity gap and needs assessments, in orderto update the early recovery project sheets in the floodresponse appeal.Strengthening monitoring and evaluation systems iscritical to identifying gaps and informing ongoing programmeresponse. UNICEF Pakistan improved monitoringof the humanitarian response, utilizing results-basedmonitoring approaches developed for the revisedCCCs (UNICEF’s central policy to uphold the rights ofchildren affected by humanitarian crisis). In addition toprioritizing indicators and strengthening partner reporting,programme monitoring - consisting of site visitsby UNICEF staff, government and NGO partners - wasstrengthened using out-sourced third party field monitors,who conducted both quantitative and qualitativemonitoring of UNICEF-funded interventions, in consultationwith affected populations. Findings are shared withUNICEF’s provincial and hub offices on a weekly basisand with ERWGs where relevant. Periodic review of themonitoring and reporting tools has strengthened thissystem. The third party approach has proved successfulfor strengthening programme performance monitoring,including for remote monitoring in high security-riskareas in Pakistan.Each financial and supply disbursement is carefullychecked against the agreed implementation plan andbudget. In 2011, UNICEF Pakistan began conductingfinancial capacity assessments of NGO partners - nearly90 have been conducted to date - leading to a rating ofrisk, and in some cases, a risk mitigation plan. To ensurerobust oversight, five quality assurance specialists werehired to provide strong additional support, and periodicon-site reviews of implementing partners’ financialrecords have been conducted, alongside programmaticmonitoring of activities and supplies.As well as undertaking an internal flood responsetimeline/history exercise to document key decisions,UNICEF Pakistan supported the OCHA-led Inter-AgencyReal Time Evaluation of the flood response and cluster/ERWG evaluations of sector-wide response to ensurelearning is documented and recommendations areimplemented. UNICEF also participated in the Healthevaluation and is leading the Nutrition and Child Protectionsector evaluations also.One Year After the Floods — Turning Towards a Brighter Future • 19

© UNICEF PAK2011/Aamir QureshiStories from thefloodsThe floods affected millions of people andeach survivor has a story to tell. Over theyear, UNICEF and its partners have worked toreach women and children across vast areasaffected by the floods with vital services.One year on, there are millions of individualperspectives and stories which are yet to betold. The following are two personal accountsof those whose lives have been affected, bothby the floods and the subsequent responseefforts.A UNICEF-supported PEACE nutrition and hygiene educatorchecks Fiza Gul (1), held by father Ibrahim, for malnutritionand she passes with flying colours.FIZA GUL, ONE YEAR OLD,NOWSHERA DISTRICT, KP PROVINCESince the floods destroyed his crops, teacher and fatherof-fourIbrahim (36), has been struggling to make endsmeet for his family. Ibrahim’s two youngest children FizaGul and Sohaib were identified this year as having severeacute malnutrition.When a UNICEF-supported community health workercame to Ibrahim’s home in Nowshera district in KP, shefound that they were both in need of urgent help.“I was wondering why they were getting weaker andweaker,” says Ibrahim. “I was very worried about them.”Both children were admitted to a health centre supportedby UNICEF and other agencies, and run by implementingpartner People’s Empowerment and Consulting Enterprise(PEACE). They visited the health centre weekly formonitoring and to receive supplies of therapeutic food -sachets containing a highly nutritious peanut-based paste.After about a month, the children had made good progressand were given supplementary food.“I was so happy to get this help for my children,” saysIbrahim. “Fiza Gul and Sohaib are much happier now,have more energy, and are more interested in things. I’mjust worried that it could happen again.”Before the floods, the family income was supplementedfrom the sale of wheat grown on his land near the KabulRiver. The flood waters inundated his fields and leftbehind a layer of mud, making the ground unusable. Thefamily resources have since been severely stretched, andthe quantity and quality of food for his children suffered.Nutrition cluster Coordinator, Dr. Najeeb of UNICEF, saysthat chronic malnutrition existed prior to the floods andthe impact of the disaster has exacerbated the situationfor children. “Children living in low-income householdswere already vulnerable to malnutrition, but the effect ofdisplacement, lack of adequate water and sanitation, lossof livelihoods, and inadequate primary health care has inmany cases made them even more vulnerable.”UNICEF and partners have screened almost 730,000 children,aged between six and 59 months, for malnutritionin flood-affected areas of KP and FATA. Of these, morethan 62,000 children have received treatment either forsevere or moderate acute malnutrition. With partners,UNICEF is continuing to scale up efforts to address theunderlying causes of chronic malnutrition.Ibrahim was interviewed on 28 June 2011 by DavidYoungmeyer20 • Children in Pakistan

SHAHBAZ, 11 YEARS OLD, MUZAFFARGARH DISTRICT, PUNJAB PROVINCE“The flood water took everything awayfrom us, yet gave our children an opportunityfor better education,” says MukhtarAhmad, head master of the GovernmentPrimary School (GPS), Mullanwala.The unprecedented floods of 2010 devastatedMullanwalla, a small village in Muzaffargarhdistrict of Southern Punjab. When theflood water receded, not a single structurein the village was standing.As people started to rebuild, UNICEF and itsimplementing partner, Jahandad Society forCommunity Development (JSCD), establisheda Temporary Learning Centre (TLC)in a tent to bring the village children back toschool. The Education Department formalizedthe TLC by granting it the status of GovernmentPrimary School (GPS), Mullanwala.Shahbaz (11), a grade 3 student at the Government Primary School,Mullanwalla, had never been to a formal school before the floodsbut now has the opportunity to complete his primary education inthe UNICEF constructed Traditional School Structure.As part of its initiative to provide improved educationfacilities to children affected by floods, UNICEFplans to construct 500 Transitional School Structures(TSSs) in three flood-affected provinces. A prototypewas constructed in Mullanwala and students fromthe TLC moved into the new school structure. Manyof these children had never been to a proper schoolbefore the floods. Shahbaz (11) is one of them.“The mosque school was very small and we had tosit under a tree. Flood water destroyed everythingin the village. When we returned, school restarted ina big tent but it would get very hot inside. Our newschool is very nice. It is close to my house. I enjoystudying here and my parents are happy,” saysShahbaz.Having received his early informal education in thevillage mosque school, Shahbaz’s first exposure toformal education was in the UNICEF-supported TLCMullanwala. He is a grade 3 student and feels proudto be in his new school.Hina Farooq, the Project Coordinator for UNICEF’simplementing partner JSCD, says, “With UNICEFsupport, we have introduced ‘Friendly Schooling’methodology in GPS Mullanwala. There is no corporalpunishment in the school, which has made thecommunity realize that physical abuse is detrimentalto a child’s growth. Early Childhood Education(ECE) for children up to five years of age preparesthem for enrolment in grade 1. Youth groups whichinclude boys and girls 13 to 18 years of age help uswith management issues and motivate parents inMullanwala and surrounding villages to send theirprimary age group children to school.”The three-room school structure has all amenities,including safe drinking water, sanitation, adequateschool supplies, learning material and a playground.It stands out in the village environmentand is an attraction for children and parents alike.As a result, enrolment has increased to 361 as opposedto 217 in the TLC.UNICEF’s Education Officer, Yasir Arafat says, “Thisschool is an example to be replicated. It has motivatedthe entire community towards education.The rapid increase in enrolment has convincedus to build two more rooms in the school and theEducation Department has also sent an additionalteacher to support increased student numbers.”Shahbaz was interviewed on 30 June 2011 by A.Sami Malik© UNICEF/PAK2011/SamiOne Year After the Floods — Turning Towards a Brighter Future • 21

Core Commitments for Childrenin Humanitarian ActionOperationalCommitments• Security• Human Resources• SupplyThe floods prompted a massive operational responsefrom UNICEF. Field presence was bolsteredthrough the establishment of three new emergencyfield offices in Multan (Punjab province), Sukkur andHyderabad (Sindh province), with staffing to cover programmes,administration, operations, security, finance,supply and logistics. These offices have been critical forextending UNICEF’s reach to the worst-affected children,and enabling rapid scale up of response. The Hyderabadoffice closed on 31 May 2011 with staff relocatedto Karachi and Sukkur; the Sukkur and Multan officeswill remain open through to December 2011, coincidingwith the official extension of the early recovery period.Local operational capacity is particularly critical given theimpending monsoon rains of 2011.SecurityUNICEF has successfully passed through this turbulenttime without a single major incident involving staff.However, the last year has seen an average of 220weekly security incidents - with about 40 per cent relatedto militant operations or terrorist activities. In May 2011,all UNICEF offices temporarily closed for a week due tosecurity concerns. The safety and security of UNICEF staffhas always been an important part of UNICEF’s programmaticimplementation, but the challenge has been to extendprogrammes rapidly yet safely to new areas whereUNICEF did not have a presence before the floods. Staffsecurity is ensured through the provision of equipment,including radios and armoured transport, enhancementsto rented office space to meet UN Minimum OperatingSecurity Standards and introducing protocols to increasestaff protection. The UN recently changed to the SecurityLevel System where risk is managed through the SecurityRisk Assessment, with greater emphasis on assessingthe critical nature of programmes, in insecure contexts.Since January 2011, this new system has brought muchgreater integration of security into planning and executionof programmes, to be strengthened further by theongoing inter-agency programme criticality process.© UNICEF/PAK2010/ZaidiHuman ResourcesTo meet urgent response needs, human resourcecapacity was rapidly scaled up and largely maintainedover the year. At the peak of the relief phase in October2010, 247 new or surge staff were deployed across thecountry, in addition to the 291 existing pre-flood staff - astaffing increase of 85 per cent. To meet its Cluster Lead22 • Children in Pakistan

Agency (CLA) commitments for ensuring response coordinationacross the clusters/ERWGs it leads, over theyear UNICEF deployed large numbers of coordination,information management and support staff at provincialand federal levels; 73 staff were deployed in total,and of these, 80 per cent were deployed for six monthsor longer. Currently, 44 such staff are still in place to coordinatethe UNICEF-led ERWGs. As of July 2011, thereare currently 147 staff deployed for the flood responseincluding 82 staff recruited and redeployed to the establishedemergency field offices in Multan and Sukkur; 76new fixed-term positions have been requested. Throughthe year, additional staff were sourced from the recruitmentof new staff; temporary deployment of UNICEFstaff from other offices; ‘stand-by partners’ from INGOsand governments - critical at a time of serious fundingconstraints - and the Rapid Response Mechanism underthe Global WASH Cluster. To support the well-being andefficiency of staff in a high stress environment, UN andUNICEF stress counsellors provided support to the offices.Human resource preparedness plans are in placefor the upcoming monsoon season.120100806040200Procurement/Distribution Trends in US$ MillionsAug Sep Oct Nov Dec Jan Feb Mar Apr May JuneOffshore Local Total DistributionTable 1. Values of supplies distributed* by sector todate (in US$)SectorDistributionHEALTH & NUTRITION**† 27,508,824WASH 16,529,857CHILD PROTECTION 1,799,482EDUCATION 7,187,107TOTAL 53,025,270* “Distributed” is defined as distributed to beneficiary, or to partner orgovernment for onward distribution. ** The UNITRACK system has beenset up to log these supplies together. † This figure does not includevaccinations of value US$1.57million.SupplySupply procurement and distribution to the affectedpopulation through partners has been a crucial elementof UNICEF’s response. UNICEF scaled up infrastructureand supply systems and established new supplierand distributor agreements and four new warehousesaround the country. Logistics and warehouse specialistswere deployed to warehouses and field offices tohandle complex logistics operations, support quality assuranceand facilitate local procurement. In September,at the height of the relief response, UNICEF was ableto move supplies through its warehouses in a 48-hourperiod to be distributed to beneficiaries or UNICEF partners.Logistics challenges remained significant for thedistribution of supplies to the dispersed, remote andoften insecure flood-affected populations due to disruptionsof communication and the transport network.Insufficient supply storage capacity of partners andlack of expertise in warehouse management was also achallenge. To address this, efforts were made to distributesupplies to pick-up and drop points, which aidedin delivering a limited volume of supplies. Building onlessons learned, additional Long-Term Agreements withsuppliers, warehousing and transport providers are beingput in place for each UNICEF field office to speed upthe transportation of supplies.In total, UNICEF purchased supplies worth US$99.2 millionincluding 41 per cent in local procurement, contributingto economic stimulus. In addition, in-kind assistancewas received from Department for InternationalDevelopment (DFID), the French National Committee,OCHA, Office of U.S. Foreign Disaster Assistance(OFDA), Procter & Gamble, Lever, IKEA and the Governmentsof Luxembourg and Switzerland.For supply monitoring, UNITRACK databases wereinstalled in Islamabad, Karachi, Peshawar, Multan andSukkur with recruitment of experienced logistics stafffor smooth tracking and distribution of supplies to thepartners/end-users. Following the 2010 floods, the Supplyand Logistics unit was restructured to ensure thatearly recovery needs were met more quickly and emergencypreparedness measures are now in place, workingto enable pre-positioning and continued smoothdistribution of emergency supplies.One Year After the Floods — Turning Towards a Brighter Future • 23

Funding against requirementsResourcemobiliZationUNICEF requirements:US$251.1 millionUNICEF has received a total ofUS$201.6 million from donorsUNICEF National Committees$81,132,802 (39%)Other Sources$11,426,022 (6%)Governments$109,080,368 (55%)The massive scale of the 2010 floods resulted in aneed for immediate, large-scale resource mobilization,which the government approved in thePakistan Flood Emergency Response Plan on 11 August2010. To ensure maximum visibility, in the first monthsof the response, UNICEF Executive Director AnthonyLake, UNICEF Regional Director Dan Toole, and UNICEFEmergency Operations Director Louis-Georges Arsenaultvisited flood-affected areas and reinforced theappeal for support. As the large-scale impact of thefloods became clear, the appeal was revised and thePakistan Flood Relief and Early Recovery ResponsePlan (PFRERRP) was launched in November, totalingUS$1.93 billion - the largest-ever humanitarian appealin response to a natural disaster. Within the PFRERRP,UNICEF requested US$251.1 million to support reliefand early recovery activities through the end of July2011. This timeframe has been extended to the endof December 2011 after a mid-year review, includingcapacity gap assessments and a project prioritizationexercise undertaken by the Early Recovery WorkingGroups; however, the overall resource mobilizationtargets remain the same.UNICEF sincerely thanks all public and private sectordonors for the contributions and pledges that have beenreceived so far. Without these timely contributions, thecurrent response would not have been possible. Thanksto the generosity of governments, UNICEF NationalCommittees, inter-organizational arrangements, intergovernmentalorganizations, non-governmental organizationsand other UNICEF Country Offices, as of 6July 2011, UNICEF had received US$201.6 million, withTop Ten DonorsContributions received by typeof donorDonorAmount in US$United States 21,203,152Australia 15,111,570United Kingdom 14,035,950Japan 13,800,000Norway 12,244,890German Committee for UNICEF 10,843,471UK Committee for UNICEF 9,710,752Netherlands 9,230,768US Fund for UNICEF 8,843,968CERF 7,964,55424 • Children in Pakistan

Funds Received To Date and Gaps (in US$)Sector Health Nutrition WASH Education Protection Grand TotalFunds Required 50,826,100 27,555,748 123,817,223 36,395,000 12,513,700 251,107,771Funds Received 45,900,058 27,538,801 87,550,045 28,250,004 12,400,286 201,639,193Utilization 40,330,347 24,382,835 65,425,362 14,799,828 12,343,567 157,281,939Funding Gap 4,926,042 16,947 36,267,178 8,144,996 113,414 49,468,578* Note: Amounts reported are on an interim basis as of 6 July 2011. Figures reported include costs for cross-cutting issues, operations, coordination, administration,and communications. Requirements are based upon the revised PFRERRP as of November 2010. Figures reported for funding received are at the programmablelevel, including recovery costs of US$13.6 million, and reflect funds available for in-country programming. Utilization amounts include expenditures and commitments(commitments represent planned expenditures charged against programme budget allotments before actual payment and for which an obligating documenthas been issued, in accordance with UNICEF’s Financial Regulations and Rules) and include recovery costs.the funding gap remaining US$49.5 million. Out of thefunding received so far, 55 per cent has been receivedfrom government donors, while UNICEF’s National Committeeshave provided 39 per cent of the funding. Theremaining 6 per cent has been received from other fundingsources including the United Nations Central EmergencyResponse Fund (CERF), the United Arab EmiratesRed Crescent, Agfund, the OPEC Fund and country officefundraising from UNICEF country offices worldwide.UNICEF would especially like to acknowledge governmentsand National Committees that provided immediateand timely provision of funding for rapid earlyresponse, and donors who have contributed “unearmarked”humanitarian funding, affording essential flexibilityto UNICEF to direct resources and rapidly ensuredelivery of critical supplies and interventions where theyare needed most, in an evolving situation.Utilization of remaining resources in education andWASH will be concentrated on construction of 500 TSSand scaling up of sanitation coverage through the PakistanApproach to Total Sanitation (PATS). However, acontinuing concern is securing funding for early recovery.While donors generously funded initial life savingresponse activities, the strict demarcation of relief(now ended) and early recovery activities constitutesa challenge to advocating for donor funding for these:the issue is in communicating early recovery actionas still addressing critical needs within the emergencyresponse (PFRERRP), distinct from recovery or developmentaction. Given the urgent needs identified in theextended early recovery phase up until December 2011,including those revealed by the Flood Affected NutritionSurveys, continued donor support is essential tocontinue early recovery efforts. Without further funding,UNICEF will not be able to sustain its current responsescale - not only to meet the immediate needs of womenand children in nutrition, health, education, WASH andprotection, but also to build systems and ensure theconditions in which they can thrive.Sectoral Funding GapsOverall Gap = $49.5 million (20%)Nutrition,$16,947Health,$4,926,042Protection,$113,414WASH,$36,267,178Education,$8,144,996Sectoral Fund UtilizationOverall Utilization = $157.28 million(78% of $201.6 million received)Nutrition,$24,382,835Health,$40,330,347Child Protection,$12,343,567WASH,$65,425,362Education,$14,799,828One Year After the Floods — Turning Towards a Brighter Future • 25

LookingForwardAyear on from the floods, a sense of life-anddeathurgency remains. Millions of people arestill struggling to rebuild their livelihoods, infrastructureremains dilapidated and most social servicesstill require restoration. Enabling the survival of womenand children and establishing an environment in whichthey can thrive has been the impetus of UNICEF’s workthis past year and continues to be the focus moving forward.Substantial results have already been achievedand the NDMA has officially announced that the earlyrecovery phase has been extended until December2011, creating further opportunity to reach the affectedpopulation and turn tragedy into hope.Looking forward, there are clear priorities that mustbe addressed to enhance the well-being of the mostvulnerable children and women. Health, nutrition andWASH sectors require continued investment to ensurethat children survive and that their long-term developmentis not stunted. For nutrition, sustaining thenew Pakistan Integrated Nutrition Strategy is a criticalelement. Flood and militant action related displacementhas facilitated polio spread in 2010 and 2011, yeteliminating polio from Pakistan is a huge step towardsglobal polio eradication. Increasing education access -including for those previously unreached - is critical forchildren to reach their developmental potential. Protectivesystems must be strengthened to prevent permanentschool dropout, child labour and child marriage, toensure that child survival goals and the MDGs are met.A vital opportunity exists for UNICEF, the governmentand partners to address the challenges illuminated bythe disaster. In line with longer term planning,Girls attend class in a village of Nowshera district, Khyber Pakhtunkhwa province, which was heavily affected by the floods. The school, whichwas also damaged, was rehabilitated with the support of UNICEF.©UNICEF/PAK/2010/Ramoneda26 • Children in Pakistan

UNICEF’s strategy will be to strengthen communityand local government capacities, including for disasterrisk reduction, emergency preparedness and response.Contingency plans have been made and emergencypreparedness actions taken for the 2011 monsoon season.The floods stretched existing community copingmechanisms to the breaking point, yet affected familieswere quick to access and capitalize on even a minimalpackage of care to strengthen their resilience againstshock. UNICEF has worked to buttress communityresilience: as UNICEF provided Lady Health Workerswith supplies and helped establish 24/7 EmergencyObstetric Centres, people quickly gathered to accessthese services; similarly, as UNICEF has constructedTransitional School Structures, these have been quicklyfilled with more children than were attending schoolpre-flood. In addition to assistance provision, UNICEFwill strengthen resilience through expanding access tonew information and knowledge, including on simpledisaster risk reduction methods, hygiene and sanitationeducation and nutrition and IYCF information.Ensuring progression from recovery to longer-termnational development and child rights goals, floodresponse programmes will be integrated into UNICEF’sregular country programme up to 2013 - as part of theOne UN system to Deliver as One - as well as dovetailingwith the ongoing IDP crisis response in the northwest.This will ensure continued humanitarian support forvulnerable women and children, linking to longer-termdevelopment through increased equity. Transitioningto stronger coordination by government ministries anddepartments is crucial, as the long-term duty-bearer forMDG achievement and child rights promotion. UNICEFis also well placed - through its multiple field offices, allwith devolved authority - to capitalize on the Government’sdecision to shift responsibility for social servicedelivery to the provincial governments as of July 2011;this will enable UNICEF to leverage partnerships andsynergy to achieve more for children and women.Funding remains a constraint and the organization stillrequires US$49.5 million to maintain its assistanceto the affected population, as well as an additionalUS$6.2 million for nutrition interventions due to thecontinued humanitarian crisis. Yet UNICEF is committedto nurturing the seeds of hope already planted. Withcontinued financial and human resource support, andcooperation, UNICEF can continue to provide assistanceto those in need, reach the previously unreached,strengthen systems and capacities for the provision ofbasic social services and build a hopeful future for thewomen and children in Pakistan.Some key lessonsKey lessons emerged from the humanitarian responseto the floods in Pakistan - grounded in thecontext of the extraordinary magnitude of this disasterand its huge impact on national capacities.An essential lesson is the importance of undertakingcapacity analysis of partners - which actors can work,where - before an emergency and developing thiscapacity as necessary, to be able to respond rapidlyat scale. Another important lesson has been the needto rapidly adjust operational targets and strategies toreach the affected population amidst complex patternsof displacement and return, including through the flexibleuse of partnerships, strong human resource andsupply/logistics management; quick establishment ofsecure offices; and tight financial and supply oversightin a large-scale, high-risk environment. There weresignificant lessons for UNICEF on meeting its interagencyand Cluster Lead Agency responsibilities:• Early challenges in determining coordination capacityand the enormous geographic scope of needs ledto delays in getting staff on the ground, but over theyear, the deployment of adequate numbers (73 staff)of dedicated staff for coordination and informationmanagement at national and local levels was criticalto fulfilling UNICEFs accountability and achievingeffective response coordination.• Dan Toole, UNICEF Regional Director for SouthAsia, was appointed as Special Representative inSeptember 2010 for the UNICEF flood response.This enabled the UNICEF Representative, MartinMogwanja, already acting as Humanitarian Coordinatorfor Pakistan at the onset of the floods, tocontinue this in a dedicated role, strengtheningboth UNICEF and inter-agency strategic response.• A consistent challenge in most emergencies isensuring strategic multi-sectoral coordination. InPakistan, the official ‘Inter-Agency Survival Strategy’helped to formalize cross-cluster collaborationfor synergistic, life-saving responses. Staff from theCLAs of Health (WHO), Food (WFP), and Nutritionand WASH (UNICEF) came together to develop andimplement strategic inter-cluster plans, the successof which has been in reaching the most vulnerablein a massive emergency, saving lives and avoidingepidemics.One Year After the Floods — Turning Towards a Brighter Future • 27

UNICEF Partners and CounterpartsGovernmentFederal level: Federal InvestigationAgency, Ministry of Education, Ministryof Environment, Ministry of Health,Ministry of Social Welfare and SpecialEducation, National Database andRegistration Authority, National DisasterManagement Authority. Provinciallevel: Departments of Education,Departments of Health, Departments ofLocal Government, Departments of RuralDevelopment, Departments of SocialWelfare, Planning and DevelopmentDepartments, Provincial DisasterManagement Authorities, Public HealthEngineering Departments.United Nations SystemFood and Agriculture Organization (FAO),International Organisation for Migration(IOM), Office for the Coordination ofHumanitarian Affairs (OCHA), Officeof the High Commissioner for HumanRights, (OHCHR), Office of the HighCommissioner on Refugees (UNHCR),United Nations Department of Safetyand Security (UNDSS), United NationsDevelopment Operations CoordinationOffice (UNDOCO), United NationsDevelopment Programme (UNDP),United Nations Environment Programme(UNEP), United Nations Educational,Scientific and Cultural Organization(UNESCO), United Nations JointProgramme on HIV/AIDS (UNAIDS),United Nations Development Fund forWomen (UNIFEM), United Nations Officefor Project Services (UNOPS), UnitedNations Population Fund (UNFPA),World Food Programme (WFP), WorldHealth Organization (WHO), WorldMeteorological Organization (WMO).NGOs and Civil SocietyACTED, Action Against Hunger, ActionAidPakistan, AJK Rural Support Programme,Association for Better CommunityDevelopment, Aurat Foundation, BasicEducation and Employable Skill Training,Blue Veins, Bunyad Literacy CommunityCouncil, Center of Excellence for RuralDevelopment (CERD), Children First,Community Motivation & DevelopmentOrganization, Catholic Organisationfor Relief and Development Aid, DostWelfare Foundation, EnvironmentalProtection Society, Friends Foundation,FM107, Focus Humanitarian Assistance,Frontier Primary Health Care, Foundationfor Rural Development, GOAL,Global Peace Pioneers, Global VisionOrganization, Goth Seengar Foundation,Health & Nutrition DevelopmentSociety, Health Education and LiteracyProgramme, Hayat Foundation,Handicap International, Health OrientedPreventive Education, Human ResourceDevelopment Network, Human ResourceDevelopment Society, InternationalCatholic Migration Commission,International Rescue Committee, JobsCreating Development Society, JustPeace International, Jahandad Societyfor Community Development, KhwendoKor, Kashmore Communication,Khushal Awareness and DevelopmentOrganization, Lodhran Pilot Project,Muslim Aid Pakistan, Mercy Corps,Merlin, NGO’s Development Society,National Rural Support Programme,OXFAM, Poverty Alleviation Organization,Plan International, ParticipatoryIntegrative Development Society, PakistanPaediatrician Association, PakistanVillage Development Programme,Partner Aid International, PremiereUrgence, Qatar Charity, Research &Awareness for Human DevelopmentBenefits and Rights, Relief International,Relief Pakistan, Root Work Foundation,Rural Development Initiative, RuralSupport Programmes Network, Save theChildren, Sindh Agricultural & ForestryWorkers Coordination Organization,Sahara Voluntary Social WelfareAgency, Sorath Citizen CommunityBoards, Society for CommunityDevelopment, Society for Conservationand Protection of Environment, SindhDevelopment Society, StrengtheningParticipatory Organization, SindhRural Support Organization, SachalSatellite Communication (Pvt) Ltd,Society for Sustainable Development,Solidarités, Sudhaar, SustainablePeace and Development Organization,The Blessing Foundation, TakhleeqFoundation, Thardeep Rural DevelopmentProgramme, Trust for VoluntaryOrganizations, World Vision.Surge Capacity Standby PartnersCANADEM, Danish Refugee Council,Icelandic Crisis Response Unit, iMMAP,Oxfam GB, Norwegian Refugee Council,RedR Australia.DonorsUNICEF National CommitteesAndorran Committee for UNICEF,Australian Committee for UNICEF,Austrian Committee for UNICEF, BelgianCommittee for UNICEF, CanadianCommittee for UNICEF, Danish Committeefor UNICEF, Finnish Committee forUNICEF, French Committee for UNICEF,German Committee for UNICEF, HongKong Committee for UNICEF, IcelandCommittee for UNICEF, Irish Committeefor UNICEF, Italian Committee forUNICEF, Japan Committee for UNICEF,Korean Committee for UNICEF,Luxembourg Committee for UNICEF,Netherlands Committee for UNICEF,New Zealand Committee for UNICEF,Norwegian Committee for UNICEF,Portuguese Committee for UNICEF,Slovenian Committee for UNICEF,Spanish Committee for UNICEF, SwedishCommittee for UNICEF, Swiss Committeefor UNICEF, Turkish Committee forUNICEF, United Kingdom Committee forUNICEF, United States Fund for UNICEF,Finnish Committee for UNICEFGovernmentsAustralia, Austria, Belgium, Canada,European Commission, Finland, Ireland,Italy, Japan, Kuwait, Liechtenstein,Luxembourg, Netherlands, New Zealand,Norway, Republic of Korea, Russia,Spain, South Africa, Sweden, UnitedKingdom, United States.OthersUnited Nations Central EmergencyResponse Fund (CERF), AgFund, OPECFund, UAE Red Crescent, internationalonline donations, UNICEF Argentina,UNICEF Belgrade, UNICEF Bhutan,UNICEF China, UNICEF EAPRO, UNICEFGuyana, UNICEF India, UNICEF Malaysia,UNICEF Pakistan, UNICEF Philippines,UNICEF Russia, UNICEF Slovenia,UNICEF Thailand, UNICEF UAE.UNICEF values all of its partnershipsand works with a wide range ofdistrict authorities, community-basedorganisations, faith-based organisations,non-public actors and other groups andindividuals, and recognizes that many ofthose could not be mentioned here.28 • Children in Pakistan

AcronymsCCCsCERFCFSCLACMAMCPCECDEPRERWGFANSGAMGBVIDPsIYCFLHWsMcRAMMDGsMICSMNHCMAMMoECore Commitments to Childrenin Humanitarian ActionCentral Emergency ResponseFundChild Friendly SpacesCluster Lead AgencyCommunity Based Managementof Acute MalnutritionChild Protection CentreEarly Childhood DevelopmentEarly Recovery PlanEarly Recovery Working GroupFlood Affected Nutrition SurveysGlobal Acute MalnutritionGender Based ViolenceInternally Displaced PersonsInfant and Young Child FeedingLady Health WorkersMulti-Cluster Rapid AssessmentMechanismMillennium Development GoalsMultiple Indicator Cluster SurveysMaternal and Newborn HealthCareModerate Acute MalnutritionMinistry of EducationMoHNDMANGOOCHAPATSPFRERRPPINSPLHIVPLWPPTCTSAMTLCTSSTWGUNUNFPAUNICEFWFPWHOMinistry of HealthNational Disaster ManagementAuthorityNon-Governmental OrganizationOffice for the Coordination ofHumanitarian AffairsPakistan Approach to Total SanitationPakistan Flood Relief and EarlyRecovery Response PlanPakistan Integrated NutritionStrategyPeople Living with HIVPregnant and Lactating WomenPrevention of Parent to ChildTransmission (of HIV)Severe Acute MalnutritionTemporary Learning CentreTransitional School StructureThematic Working GroupUnited NationsUnited Nations Population FundUnited Nations Children’s FundWorld Food ProgrammeWorld Health OrganizationReferences1. Department of Health, Government of Sindh, Pakistan (2011) “Flood Affected Nutrition Survey.” UNICEF and ACF, p.1; Department of Health,Government of Punjab, Pakistan (2011) “Flood Affected Nutrition Survey.” p.15; UN Pakistan (2010) “The Human Cost of the Floods in Pakistan”.October 2010. (The Flood Impact on MDGs Analysis); WASH Cluster IM Team (2010) “Pakistan WASH Cluster, Pre-flood WASH indicators, 22ndOct. 2010”, p.4.2. Department of Health, Government of Sindh, Pakistan (2011) “Flood Affected Nutrition Survey.” UNICEF and ACF, p.1; Department of Health,Government of Punjab, Pakistan (2011) “Flood Affected Nutrition Survey.” p.15.3. UN Pakistan (2010) “The Human Cost of the Floods in Pakistan”. October 2010. (The Flood Impact on MDGs Analysis), p.61.4. UN Pakistan (2010) “The Human Cost of the Floods in Pakistan”. October 2010. (The Flood Impact on MDGs Analysis), p.33.5. UNGASS (2010) “PAKISTAN REPORT Progress report on the Declaration of Commitment on HIV/AIDS for the United Nations General AssemblySpecial Session on HIV/AIDS. “Prepared by National AIDS Control Program, Ministry of Health, Government of Pakistan, Islamabad, 2010 p.9.One Year After the Floods — Turning Towards a Brighter Future • 29

©UNICEF/PAK/2011/ZaidiFor more information, please contact:Dan Rohrmann, Representative, drohrmann@unicef.orgKaren Allen, Deputy Representative, kallen@unicef.orgAlhaji Bah, Chief of Field Operations, abah@unicef.orgKristen Elsby, Chief of Advocacy and Communication, kelsby@unicef.orgLoa Magnusdottir, Resource Mobilisation Specialist, lmagnusdottir@unicef.orgUnited Nations Children’s FundPakistan Country OfficeWebsite: www.unicef.org/pakistan© United Nations Children’s FundJuly 2011Cover photo credit:©UNICEF/PAK/2011/Noorani