International Rescue Committee (IRC) conducted the Early Needs Identification (ENI) study focusing on Afghan refugees dwelling in the flood-affected six districts of Balochistan and Khyber Pakhtunkhwa (KP) provinces of Pakistan. These refugee-concentrated districts were Pishin, Killa Abdullah, Chaman, and Chaghi in Balochistan, while Nowshera and Lower Dir were in KP province. The primary data was collected to provide a quick overview of the humanitarian situation caused by heavy rains and floods by identifying the immediate and evolving basic needs of the vulnerable refugee population in these areas. In addition, the ENI provides a base for developing a response plan for addressing the people's needs identified on the ground. For primary data collection, 92 Key Informant Interviews (KIIs) were conducted with the local women and men, key informant representatives of NGOs/INGOs/UN agencies and government departments. The data thus generated from the primary sources were analyzed to identify priority needs, availability, and access to the basic needs of the target refugee population.

The ENI data informed that 36 refugees died in this crisis, around 372 were severely injured, and 18 were missing in these districts. In addition, approximately 570 houses were fully and 1730 partially damaged, and about 2,130 families were displaced. Similarly, around 4,830 livestock died, and 85% of the dwellings/shelters were without electricity. In addition, 20 health facilities in the vicinity of refugee concentration areas were fully damaged, 32 partially damaged, and 64 schools were fully and 134 partially damaged. Moreover, 574 water supply sources/schemes were also damaged. The IRC Pakistan has been responding to the emergency needs of the people at the ground level since the onset of the emergency, and this ENI will help to inform the IRC flood emergency response plan with a particular focus on refugees. The key findings of this ENI are as follows:

Access to Information: Currently, 63% of the refugee population (58% in Pishin, 22% in Killa Abdullah, 85% Chaman, 85% Chaghi, 63% Nowshera and 59% in Lower Dir) does not have access to information due to multiple reasons.

Safety: Around 58% of the sampled refugee respondents reported that in the current situation, members of their community are not feeling safe, 35% ranked it relatively safe, and only 6% were of the view that the community is feeling very safe.

Availability of Basic Services: On average, only 33% of the refugee population reported having access to essential services after the flood. People's access to the shelter was 59%, food and livelihood was 49%, health services were 36%, mobile networks were 35%, and education was 35%. Similarly, their access to WASH services was 33%, while a few reported accessesto information services and hygiene supplies. However, legal assistance, hygiene supplies, women, and child protection services and MHPSS were the least accessible services to the population (reported by less than 30%).

Priority Needs: Shelter, health, cash, and food were reported as the topmost priority needs, followed by water and sanitation services, livelihoods, education, Non-food items, including Menstrual Hygiene Management items, mental health psychosocial support, access to information, medical assistance and aid for livestock and protection service as well.

Vulnerable Groups: According to the ENI, refugee women and adolescent girls are highly vulnerable, as reported by 83% of respondents, followed by pregnant & lactating women (81%), persons with disabilities (69%), persons with chronic illness (50%), children of age 5 to 17 years (42%), and persons with a critical condition (29%). Shelter: 50% of the refugee community respondents from the target districts reported the problem of not having an adequate place to live, with the highest count of 75% in the Pishin and Nowshera districts. Regarding the most immediate shelter needs prevailing in their community, tents were highlighted by an overall 29% of the key informants, followed by cash assistance counted for 20% response rate, plastic sheeting (19%), GI sheet 17%) and Tarpaulin and Shelter repair highlighted by 14% of the respondents.

Food and Livelihood: 73% of the respondents (highest in Lower Dir, Chaghi and Pishin) reported the accessibility of refugees to the markets. Similarly, 66% of respondents from communities said that markets are functional. Respondents who reported dysfunctional markets were further probed for the reasons; 8% of respondents shared that markets are submerged under water, while the remaining 15% said its disconnection from the central market. According to key informants from Government and NGO staff, 64% of markets are accessible to refugees, while the remaining 36% are not accessible in the given context. In total, 62% of respondents reported that markets have sufficient supplies of essential commodities. Besides this, 87% of the refugee respondents shared that food items are not affordable. 71% of the respondents highlighted cash as their immediate need, and 11% went with food, drinking water, health and NFIs.

Health: 34 HFs mainly used by refugee communities; are fully or partially damaged in the mentioned six districts (3 in Pishin, 12 Killa Abdullah, 7 in Chaman, 6 in Nowshera, and 5 in Lower Dir). Around 212 HFs are out of essential medical supplies in these districts. And in total, 175 HFs have not been functional due to floods. 57% of community respondents stated that the existing health facilities do not have the required services. The KIIs with government staff informed that 35% of health facilities do not have the necessary assistance. According to communities and health officials, the health services situation is worst in all the districts. According to KIIs with refugee communities and Government and NGO stakeholders, Diarrhea is the primary health concern, followed by Skin Infection, Malaria/Dengue, mother, and child health issues, and so on.

Regarding the availability of staff and medicines at health facilities in these areas, 58% of community respondents and 53% of Government and NGO respondents reported that these are inadequate. In addition, 31% of community and 42% of government key informants shared that only basic facilities are available. Furthermore, 74% of community and 90% of government key informants reported problems regarding general physical health in refugee communities. Regarding the availability of pregnancy and childbirth-related services, less than 10% of community and government/NGO key informants reported that these services are available. In addition, 48% of community respondents reported that the patient load on health facilities had increased after the floods. Furthermore, 38% said that the quality of services deteriorated, and only 29% considered the quality of health service was the same as before the disaster. In addition, 25% shared frequent stockouts of essential medicines and supplies.

WASH: 57% of the refugee population does not have access to clean drinking water in their communities. The situation was worst in Lower Dir, Pishin and Killa Abdullah. The government and NGOs key informants reported that the problem is worst in Lower Dir, Killa Abdullah and Nowshera districts. 70% refugee population do not have access to basic hygiene supplies, and 57% do not have access to sufficient water. Similarly, 61% of women and girls face difficulties accessing latrine facilities, while 49% of the population do not have access to toilet facilities. 93% of community Key Informants from all 06 districts reported no access for refugee women and girls to any menstrual hygiene supplies in the current disastrous situation. Similarly, the Key informants from Government and NGO staff reported no access to hygiene supplies for refugee women & girls in all four districts of Balochistan province. In contrast, 17% in Nowshera and 25% in Lower Dir reported access.

Protection: 62% of the respondents mentioned that people in their community feel distressed due to current crises in their area, which has contributed significantly to making them more vulnerable. Further, respondents were asked to share their reasons for distress. Most of them (91%) reported a lack of access to essential services, 88% reported property loss as the fundamental reason for distress among the community, followed by loss of livelihood sources (84%), loss of valuables (66%), lack of information (38%), the prevalence of violence (34%) and other reasons including safety issues, and harassment etc. The respondents identified several community protections issues, such as psychological trauma, stress and anxiety, no access to health services, no access to information due to communication barriers, marginalization, No access to other essential services, and so on. 90% of the refuge respondents quoted referrals to respective services as per need, 54% mentioned knowing about safe access to essential services, 48% counted shelter needs, 40% needed safe spaces for women and girls, and 35% highlighted the lack of hygiene supplies including menstrual hygiene items. Likewise, women and, girls, children are also a marginalized group and are exposed to protection-related issues. Therefore, respondents also shared protection issues relevant to children. These included child labor with the highest ratio of 96%, child forced marriage at 56%, Psychological trauma at 52%, no access to education for 31% and so on.

Education: Refugee community key informant reported averagely, eight schools in Pishin are non-functional due to floods, four schools registered from Nowshera, 4 in lower Dir, and 1 in Chaman district. In Nowshera and Lower Dir, there is no school facilitating particularly for the refugee community. Chaman has one government school; seven schools were in Chaghi, and UNHCR supported six schools in Pishin. 34% of the respondents reported their children's access to education facilities, while the remaining 66% reported no access to education facilities or reported not going to schools due to floods.

• https://reliefweb.int/report/pakistan/early-need-identification-eni-afghan-refugees-flood-affected-districts-balochistan-and-khyber-paktunkhwa-september-۲۰۲۲