By Dr. Ayesha Khan
In the shadow of Pakistan’s urban development narratives lies a widespread and concerning reality: a sanitation crisis that undermines public health, dignity, and economic potential. An issue of urban deprivation, the challenge is particularly visible in small towns and peri-urban settlements, where infrastructure has struggled to keep pace with population growth. The situation in Dhoke Hassu, a settlement of approximately 320,000 people, reflects the broader concern.
The statistics from Dhoke Hassu are concerning. Out of 45,713 households, roughly 22,857 to 27,428 homes, an estimated 50–60%, lack a proper sewerage system, discharging wastewater directly into open drains and gutters. This results in open sewage points becoming a common feature, with untreated wastewater frequently overflowing into narrow lanes. Any existing sewerage lines, described as being in a “poor and neglected condition,” lack critical components such as manholes, resulting in a system that is incomplete and ineffective.
These infrastructure challenges have a direct and serious impact on community health. Residents report a noticeable increase in sanitation-related illnesses, including typhoid, hepatitis, dysentery, and persistent skin conditions. These are not isolated incidents but predictable outcomes of systemic gaps. When household wastewater mixes with stormwater and pools in public spaces, it creates favorable conditions for pathogens, enabling the spread of waterborne diseases. Children, older adults, and economically disadvantaged populations bear a disproportionate share of this burden, facing recurring illness that affects many aspects of daily life.
The situation in Dhoke Hassu highlights an important truth: sanitation is not merely a community concern, but a foundational pillar of public health and socioeconomic development that requires stronger attention. The absence of a sealed, managed sewerage system represents a significant shortcoming in the first line of protection against disease. It also reinforces inequality, as wealthier households can afford filtered water and private solutions, while lower-income communities remain exposed, illustrating disparities in living conditions.
To respond to this challenge, organizations such as the Akhter Hameed Khan Foundation (AKHF) have raised important voices to build awareness of the issues; however, a standardized protocol is clearly needed at both national and provincial levels to support more coordinated actions. Efforts must move beyond short-term fixes towards a comprehensive, integrated water, sanitation, and hygiene (WASH) program, supported by sustainable funding, community-led management structures, and public awareness initiatives to address gaps and misconceptions.
AKHF is already contributing through ongoing community-based initiatives focused on improving water and sanitation practices, promoting hygiene awareness, and supporting access to education and primary health activities in underserved areas. These efforts demonstrate the value of locally grounded approaches in strengthening community resilience and service delivery.
Pakistan’s path to a healthier and more prosperous future is closely linked to its ability to address its sanitation deficit. Investing in comprehensive, well-designed sewerage and wastewater management programs is not merely an expense but a strategic investment in human capital—a necessary step to protect millions from preventable disease and to build a more resilient and equitable society.
Dr. Ayesha Khan is CEO, AHKF.
