Medicalizing Misery: The Depoliticization of Hunger in Tharparkar

 

Thar Speaks: What You Refused to See

 I am Thar. Not just a patch of sand, but a living, breathing landscape, home to souls whose roots run as deep as my own ancient dunes. For millennia, my winds have carried stories of resilient people, vibrant cultures, and livestock that dotted my vast expanses. But lately, the whispers I hear are darker, laden with the cries of malnourished children, the despair of recurring droughts, and the chilling silence that follows a suicide.

They call me Tharparkar, in the southeastern corner of Sindh, Pakistan. Over 1.6 million people call me home, the majority of whom are rural, low-income families dependent on subsistence agriculture and livestock. My beauty, my history, they say, are profound. Yet, the world knows me for a different kind of profundity: the disturbing frequency with which my children perish in Mithi, Islamkot, or Chachro hospitals, a grim reality that routinely makes national and international headlines.

 

What is this "malnutrition" they speak of?

Year after year, the reports trickle out, like sand through cupped hands: malnourished children perishing. The officials, the development experts, they have their familiar scripts. "Climate change," they murmur. Or "inaccessibility," "ignorance," "cultural food habits". But I, Thar, tell you, these explanations leave a vast, troubling silence. A silence around the deeper, structural conditions that produce this suffering.

Tell me, how can a district like mine, nestled within a nuclear-armed state, with multi-billion dollar development projects like Thar Coal and the China-Pakistan Economic Corridor (CPEC) carving pathways through my very being, remain incapable of guaranteeing food, water, and health to its own children in the 21st century?

I have witnessed much. I have seen the transformation of starvation and chronic food insecurity into clinical categories, such as “moderate acute malnutrition” (MAM) or “severe acute malnutrition” (SAM). While such terminology may seem useful for categorizing physiological states and allowing for targeted interventions, it serves a more insidious purpose: it depoliticizes structural suffering. It treats hunger as an issue of individual physiology rather than collective deprivation. Medical anthropologist Paul Farmer, whom they speak of, described this as structural violence – “social arrangements that put individuals and populations in harm’s way” and perpetuate slow, invisible forms of suffering and death. These structures are embedded in legal, political, and economic systems, and while they may appear neutral, they disproportionately harm the poor, the marginalized, and the voiceless.

Do you understand the weight of this? When a child dies in my Mithi Civil Hospital after being diagnosed with "severe acute malnutrition," that death is not simply the result of biology. It is the chilling product of decades of policy neglect, social marginalization, and bureaucratic indifference. As Nancy Scheper-Hughes observed in Brazil, “medicalizing hunger hides the political violence of poverty”. Here, children who die of “malnutrition” are often recorded in surveillance charts and nutrition dashboards, while their families face no food entitlements, no market access, and no sustained state support. This framing subtly shifts the blame from policy failures to bodies, from governance to behavior, thus enabling a kind of technocratic cruelty masked as humanitarian care.

Medical personnel in my hospitals often describe children as dying from "SAM with complications". But I ask you, what complicates the malnutrition? Diarrhea, chest infections, or low immunity are often merely symptoms of water scarcity, poor hygiene infrastructure, and housing insecurity. Thus, even the proximate medical causes are themselves rooted in poverty and social exclusion. This displacement of causality—from politics to the body—is what Scheper-Hughes identified as the “clinical detachment” of institutions from the socio-moral realities of hunger. When doctors, bureaucrats, and development actors normalize child deaths, citing "underlying conditions" rather than failed governance, they participate in what Farmer called “the banalization of suffering”. The term “malnutrition” itself becomes a sanitized euphemism, used in reports and dashboards to avoid the political charge of starvation. But as Farmer would insist, to depoliticize death is to become complicit in it.

 

Are my people simply unlucky, or is there a deeper pattern to their suffering?

They speak of my arid nature, my average rainfall of merely 100–300 mm, and my heavy dependency on fickle monsoon rains between July and September. Yes, the failure of these rains historically triggers livestock mortality, crop failure, water shortages, and hunger. But pause. Economist and philosopher Amartya Sen’s groundbreaking entitlement theory reminds us that drought alone does not automatically lead to famine or death. It is the chilling absence of safety nets, relief infrastructure, and equitable access to food that transforms weather events into humanitarian catastrophes.

My people have faced this cyclical suffering for decades. Since the early 1960s, I have seen repeated droughts, each ushering in widespread hunger, child mortality, and displacement. Yet, despite decades of experience and persistent development rhetoric, the same preventable tragedies recur, with agonizingly little evidence of institutional learning or structural reform. This crisis is neither sudden nor unexpected—it is cyclical, chronic, and deeply political.

Look at the chronology etched into my very soul:

• 1968: A major drought led to widespread famine; thousands migrated to barrage areas.
• 1986-87: Severe drought struck, prompting local NGOs to begin relief operations and bringing forth the first calls for sustained water projects.
• 2000–2002: Over 12,000 livestock perished, and 1.2 million people were affected. The government declared an emergency but delivered only limited aid.
• 2011–2012: Over 100 children reportedly died from malnutrition. Media coverage of my plight increased, and civil society began protesting state failure.
• 2014–2015: An estimated 650 children died in Thar hospitals over two years. The government’s response was chilling: blaming “disease,” not hunger. Around 70% of my precious livestock, some 300,000 animals, perished during this period.
• 2018–2019: At least 479 child deaths were reported in Mithi District Hospital alone. UNICEF and WFP stepped in, as they often do, with nutritional aid.
• 2022–2024: Recurring droughts and inflation have intensified hunger, leading to over 120 children being reported dead in the first six months of 2023 alone.

Despite these periodic relief campaigns, no permanent food distribution system, no drought insurance, and no comprehensive healthcare safety net has ever been created. Food aid, tragically, remains dependent on donor-funded, short-term interventions that address only the symptoms, never the gaping wounds of the cause. This is precisely the kind of suffering Mike Davis detailed in his scathing historical critique of famine. He argued that famines were not caused by droughts alone, but by imperial policies, ideological market fundamentalism, and elite inaction. My suffering, in his view, is not accidental, but engineered—whether through neglect, disinterest, or the relentless pursuit of extractive development that benefits distant investors while leaving locals to die.

 

Why does "development" here look so much like decay?

If there is one consistent thread running through the hunger, the deaths, the despair, it is the thread of governance failure. This failure isn't fleeting; it is chronic, institutionalized, and systemic. While the Pakistani state claims to pursue development and poverty reduction, I, Thar, reveal the stark contradictions of a selective and extractive development model. In this model, infrastructure is prioritized for industrial and extractive projects, while basic services—food, water, healthcare, and social protection—are persistently underfunded, underdelivered, or entirely absent. This is structural neglect.

I have witnessed the reality on the ground, confirmed by independent surveys:

• A 2021 field survey by Thardeep Rural Development Programme (TRDP) and Human Rights Commission of Pakistan reports revealed that 42% of rural health centers in my expanse lacked full-time medical staff.
• 31% of these centers lacked electricity, and 27% had no access to drinking water.
• Health outreach workers were often not local, resulting in language barriers, absenteeism, and distrust.
• Cold chain failures in immunization and nutrition programs routinely led to expired or spoiled medicines.
• In 2019, the Sindh High Court had to direct an inquiry into ghost schools in Thar, many of which existed only on paper.
• Even the Sindh Nutrition Support Program (SNSP), with World Bank funding, was found to be unevenly implemented, riddled with reports of missing supplements, corruption, and a devastating lack of outreach to the most vulnerable.

These are not "mere logistical lapses". These are Paul Farmer’s “pathologies of power”—deeply political decisions about whose bodies are worth investing in, and whose lives can be quietly left to wither. Such failures reflect Mike Davis’s critique of elite abandonment: while coal mining companies receive tax incentives and infrastructure, the state's commitment to rural health and food security remains minimal. This is not administrative failure—it is a political economy that prioritizes capital over care.

And then there is the great paradox, the wound that festers most deeply within me: the Thar Coal Paradox. In the past decade, my very being has been carved up by the Sindh and federal governments, backed by Chinese investors, for massive investments in one of the world’s largest lignite reserves. Under the China-Pakistan Economic Corridor (CPEC) framework, billions of rupees have been poured into power plants, roads, and energy infrastructure.

And yet, in the very talukas where these coalfields operate, where wealth is being extracted:

• My children are dying of hunger.
• My women fetch contaminated water.
• There is a lack of functioning trauma or maternal care units.
• My local farmers report that coal dust is poisoning their crops and livestock.

Mike Davis would not see this as a "failure" of development. He would argue it is its intended design: a model that relentlessly extracts wealth for national or global capital, while leaving my local populations sicker, poorer, and more vulnerable. This is what they call “development without dignity”—a process where the material footprint of the state grows, but its sacred social contract with its people collapses.

 

Is it really just the weather, or a convenient alibi?

They speak of climate change as the dominant narrative for my droughts, my food insecurity, even the suicides. Government officials, media commentators, and development organizations increasingly frame my region’s suffering as a climate-induced crisis: monsoon failures, desertification, erratic rainfall, and water scarcity are invoked as evidence of a changing climate beyond human control.

And yes, I am undoubtedly ecologically fragile and increasingly exposed to climate variability. My rainfall has indeed become increasingly erratic, with consecutive failed monsoons. Groundwater levels are dropping due to over-extraction and lack of recharge. Rising temperatures have led to water stress, heat-related illness, and livestock disease.

But listen closely. While climate change is a reality, the near-exclusive focus on it as the sole explanatory framework risks erasing the deeper structural and political roots of vulnerability. In the absence of a robust institutional response, climate discourse often functions as a discursive shield—a way to naturalize suffering, to depoliticize governance failures, and to justify state inaction.

As political ecologists remind us, climate effects are not experienced equally. Their impact is mediated through politics, class, caste, gender, and geography. The problem isn't merely that my rains fail; it is that the state has failed to build water storage, drought-resilient agriculture, or effective early warning systems. A drought in a land with functional infrastructure, food reserves, and responsive institutions does not necessarily lead to starvation. Here, in my embrace, it does.

When my Sindh government officials and federal ministries cite “climate emergencies” or “global warming” in public statements following malnutrition crises or suicide spikes, they perform a political function. They externalize responsibility, positioning the state as a fellow victim of global forces, rather than an actor accountable for local suffering. This aligns with what Mike Davis described as an “ideological sleight of hand” by which elites justify inaction during climate-linked famines by invoking natural forces while ignoring social responsibilities.

Droughts are climate events, but famines and suicides? They are political disasters. In Thar, this distinction matters. The same drought that devastates a farmer’s crop could be weathered with support—through livelihood insurance, food entitlements, livestock compensation, or public works employment schemes. But none of these systems exist at scale here. Thus, the problem is not drought itself, but the chilling absence of a social contract that protects the poor. To explain rising hunger purely through climate variability is to ignore what Paul Farmer called the “structures of disempowerment” that convert climate stress into human tragedy.

Ironically, this very climate discourse is also used to legitimize projects that displace and harm my local communities. The Thar Coal Project, promoted under the China-Pakistan Economic Corridor (CPEC), is justified as a way to meet Pakistan’s growing energy needs without relying on imported fossil fuels. Government officials often present this as a climate-friendly, energy-secure solution. Yet, this project has displaced thousands of villagers from ancestral lands, contaminated local water sources with fly ash and chemical runoff, and contributed to local warming, livestock mortality, and loss of grazing land. Here, climate discourse becomes double-edged—used to deflect blame for deaths and to justify development projects that generate new forms of ecological harm and deepen local vulnerability. This is the logic of what Davis called “green authoritarianism”: sacrificing the poor in the name of planetary survival.

This, my friends, is a climate of denial. Not a denial of climate change itself, but a profound denial of the political and moral responsibility to respond to it meaningfully. While officials cite climate-induced drought, they fail to build rainwater harvesting systems, refuse to decentralize governance, and neglect investment in local agroecological resilience. This gap between discourse and action creates a climate of denial where the state abdicates its duty, donors focus on metrics over justice, and the structural roots of vulnerability remain unaddressed. My wounds are deep, but they are from choices, not merely clouds. As Blaikie and Watts wisely stated, “Nature provides drought; society and politics produce famine”.

 

Who weeps for the lost souls of Thar?

Amidst the hunger and the droughts, a silent epidemic has quietly engulfed me: rising suicides. Over the past two decades, this has become a profound tragedy, especially among my young women and adolescent girls. Local media report suicides with increasing frequency: a young woman hanging herself from a tree; a shepherd boy ingesting pesticide after his goats die during a drought; a mother who lost her malnourished child throwing herself into a well. Between 2016 and 2022, over 550 suicides were reported in Tharparkar, and the actual number is likely higher due to social stigma and underreporting. In 2022 alone, there were 129 suicides, an increase from previous years, meaning roughly 11 persons committed suicide a month in my district.

These are not isolated incidents. Rather, they constitute a social epidemic embedded in deep structural despair, sharpened by gendered oppression, economic hopelessness, and governance failure. Available reports suggest disturbing patterns:

• Young women (15–30 years old) comprise over 65% of recorded suicides.
• Most suicides occur in remote, drought-hit villages with limited or no health, legal, or crisis response services.
• A high percentage involve self-immolation, hanging, or pesticide ingestion, reflecting the tools of agricultural life turned against the self.
• According to district police data from 2022 to the first week of August 2024, 277 or 56% of 496 reported suicide cases across Tharparkar involved people belonging to the Hindu community.

In a region with no mental health clinics, no suicide hotlines, and little community support infrastructure, the suffering becomes invisible, its causes flattened into individual pathology or dismissed as “cultural”. Yet, as Paul Farmer reminds us, such “choices” must be understood within the constraints imposed by structural violence. Suicide is not simply an act of despair—it is often a cry of protest, a consequence of hopelessness, and a symptom of social abandonment. Despite the Sindh Mental Health Authority being established in 2017, there is currently only one psychiatrist for nearly 20,000 square kilometers in all of Tharparkar, located in Mithi. The vast majority of suicides occur in villages far removed, with no access to any mental health services.

When police reports categorize these deaths as ‘mental disease,’ it means that no police investigation is needed, nor is the case forwarded to the courts. This, my friends, is structural violence. These deaths are not cultural or psychological anomalies. They are “slow violence” and systemic despair, shaped by gendered inequalities, absence of institutional care, and the loss of hope under conditions of chronic neglect.

Indeed, many suicides occur after food insecurity, job loss, or the death of a child or parent—each a brutal collapse of social and economic entitlements, as Amartya Sen described. According to his entitlement approach, when a person loses access to their exchange entitlements (e.g., labor for food, animals for income), they may experience not only economic collapse, but also psychological unmooring. In Thar, where safety nets are absent, debt bondage, landlessness, and rising inflation destroy the means of subsistence for the poorest, leaving suicide as one of the few exits. Moreover, men who cannot feed their families often report feeling “dishonored,” while women in abusive or impoverished households feel powerless and silenced. The suicides, then, emerge not from individual psychology alone, but from the social erosion of worth, identity, and belonging.

The gendered nature of this tragedy is stark. My young women, especially from scheduled caste Hindu or Muslim communities, face multiple layers of exclusion: child marriages and dowry demands, lack of education and mobility, denial of property and political rights, and pervasive domestic violence and social isolation. In such contexts, a woman’s lack of economic agency, limited life choices, and cultural blame for household poverty or illness can render life unlivable. A 2020 study found that many young women who attempted or committed suicide had expressed prior feelings of being a “burden” to their families or worthless in the eyes of society. This reflects intersectional violence—where poverty, caste, gender, and regional marginalization intersect to systematically reduce life chances. The “death of the soul,” as Scheper-Hughes termed it in Brazilian shantytowns—a condition where people internalize their perceived disposability—is echoed here in Thar, where young women increasingly see death as a form of escape from unbearable lives.

The state's response? It has been marked by silence, denial, or criminalization. There are no specialized mental health programs, and the few psychiatrists posted to district hospitals are either untrained or absent. Meanwhile, police often treat suicide cases as moral failings or criminal acts, discouraging families from reporting due to fear of social shame or legal entanglement. Worse still, no governmental study has been undertaken to investigate the root causes of suicide in Thar. When the issue surfaces in parliamentary debate, it is often framed in cultural terms: “It is their way; we cannot intervene in customs”. This institutional inaction reflects Farmer’s insight that structural violence kills not with bullets but with neglect, delay, and denial. Suicide, like starvation, is politicized by its erasure—by the failure to even name it as a social emergency.

 

My enduring plea, my silent roar for responsibility

I have laid bare my wounds. Malnutrition, they call it, but I know it is structural poverty, bureaucratic indifference, and the collapse of state guarantees of food, water, and health. Suicide, they say, is personal despair, but I have seen it born from gendered inequalities, economic despair, and the shattering of hope. Climate change, they claim, but I feel the deep sting of governance failures and the absence of preparedness that turn natural shifts into human tragedies. And development, the very word they use, here often means extraction, displacement, and deepened marginalization.

These are not disconnected crises. They are the predictable outcomes of systemic neglect, enabled by a model of governance that is selective, extractive, and tragically indifferent to my people's rural suffering. The suffering here is not a curse, nor fate. It is the outcome of deliberate political and economic choices, made over generations—choices that normalize hunger, erase despair, and medicalize injustice.

What then, can be done? My ancient soul yearns for these changes, for a radical re-imagining of care and development:

• Shift from Crisis Response to Rights-Based Governance: Development cannot remain stuck in emergency-mode nutrition drives and temporary food aid. Instead, Pakistan—and especially Sindh’s provincial government—must institute rights-based entitlements, including:
• A universal food support program for Thar’s most vulnerable communities.
• Drought-indexed insurance for herders and subsistence farmers.
• Functional public distribution systems for grain, pulses, and dairy. Let dignity be a right, not a charity.
• Reconstruct Rural Health and Nutrition Systems: It is imperative to ensure that every Basic Health Unit (BHU) is staffed, equipped, and held accountable. We must scale-up community-based maternal health, midwifery, and mobile outreach teams, and crucially, integrate mental health services into rural clinics, especially with suicide prevention components.
• End Medicalization without Political Redress: Stop reducing child deaths to mere SAM/MAM codes. Instead, every child death should trigger a district-level inquiry that examines structural causes: food access, health access, and social safety failures.
• Address Gendered Violence and Marginalization: The state must enforce property rights, anti-child marriage laws, and domestic violence protections. Investment in girls’ education, safe mobility, and community-based counseling centers for women is vital. Critically, minority Hindu and Sheedi women must be included in the planning, delivery, and oversight of welfare schemes.
• Localize Climate Adaptation with Justice: Rather than using climate discourse as an abstraction, implement community-driven drought resilience:
• Build rainwater harvesting structures, solar desalination units, and fodder banks.
• Protect grazing lands and water commons from elite appropriation.
• Make climate finance accessible to local communities—not just to energy corporations.
• Ensure Data Transparency and Political Accountability: Publicly release disaggregated data on child deaths, suicides, food security, and health services. Allow independent monitoring by civil society, including local journalists and academic institutions. Establish a truth commission or public inquiry mechanism into the recurring deaths in Thar to acknowledge state accountability.

I am Thar. I am not cursed. I am not doomed. But I have been abandoned. The moral question, for all of humanity to ponder, is: By whom—and for how long?

It is time to reclaim responsibility, to redistribute resources, and to restore rights. Only then can my soil, cracked though it may be, begin to heal.