In Pakistan, risk of snakebites mounts amid floods
Climate change could make the danger from venomous snakes worse and less predictable, experts warn.
- 9 April 2024
- 6 min read
- by Adeel Saeed
It was August 2023, heavy monsoon in Pakistan's Punjab province, and the river Sutlej had overflowed badly.
Shahid Javed, aged 25, was sitting with a cluster of villagers on a slope looking down over the murky floodwaters that had submerged dozens of villages, including Hatheji, his home, when he suddenly spotted his family's missing cow standing in a deluged sugarcane field.
He jumped into the water to wade to the animal. As he made his way through the torrent, he felt a pinching pain, like the piercing of a needle, in his left leg.
“The [property] damage wreaked by floods on poor denizens of Hatheji was no doubt colossal – but recoverable,” reflected Sajid. “The loss inflicted by snakebite is not only devastating but also unrecoverable.”
– Muhammad Sajid
Realising he had been bitten by a snake, he made frantic calls for help to his fellow villagers, who rushed over, intending to bring him to hospital for treatment.
"The snake was so venomous that within a few minutes Shahid Javed became unconscious, amid spewing of a thick layer of froth from his mouth," recalls Muhammad Sajid, his cousin. His friends hauled him onto an inner tube to float him to safety – but he died before they reached dry land.
Snakebite "epidemic"?
Shahid was not the only local resident to be fatally bitten by venomous snakes during the flood season of mid-last year. Some eight to ten dwellers of different villages including Hatheji, Ali Pure and Lodhran met the same fate within just about a fortnight, according to Sajid. Other locals confirmed his estimate.
"The [property] damage wreaked by floods on poor denizens of Hatheji was no doubt colossal – but recoverable," reflected Sajid. "The loss inflicted by snakebite is not only devastating but also unrecoverable."
Snakebites were also reported with uncommon frequency from deluged parts of Pakistan during 2022's disastrous floods.
In Khyber Pakhtunkhwa (KP) province, which saw the displacement of 600,000 people due to the climate change fuelled disaster, the Health Department warned the public of the presence of venomous snakes in the water on August 2022, just days after Pakistan declared a state of emergency. The warning was issued as a woman in the state's Nowshera district was reported to have died. 134 cases of venomous snakebite had been officially counted across the floodaffected zones of the province by that point.
It didn't end there. In one district of the severely impacted Sindh province, Dadu, around 262 cases of snakebite were reported in September and October of 2022, a concerned official told VaccinesWork.
Zainul Abideen, a resident of Dadu, told VaccinesWork that he experienced severe pain and vomiting after being bitten by a snake, but was fortunate enough to receive antivenin in time. During his three-day recuperation at Dadu district hospital, Abideen says he witnessed several snakebite victims arrive, seeking urgent care.
Baluchistan province, which also received unprecedented flooding due to record rainfall, has registered more than 3,000 cases of snakebite in 2022 to 2023, officials say .
"In rural localities, most of the cases go unreported due to traditional treatment by people and the actual number of cases are much more than officially registered," said a doctor who works in a rural part of Baluchistan, .
When a snakebite patient does make it to the hospital, hope often rests on accurate diagnosis, supportive care and availability of an appropriate antivenin. "For detecting severity of snake venom, the victim's physical reaction is checked, and treatment is prescribed as per symptoms," explains Dr Shahid Sukaira, a snake expert who volunteers for a Facebook advice group called Reptiles of Wild. The group has been approached for advice by more than 170 snakebite victims since the onset of the 2022 floods, admins report.
The clinical features of bite by neurotoxic snakes including kraits, mambas and cobras, is drowsiness, slurred speech, frothy saliva, severe stomach pain and respiratory failure in severe cases, Dr Sukaira elaborates.
The victims of haemotoxic snakes, meanwhile, which include vipers, experience swelling and blistering at the place of bite, weak pulse, nausea and vomiting, bleeding from gums, and severe kidney pain.
NIH triples anti-venin preparation to cope with increase in snakebite
"In order to contain the snakebite burden, especially during monsoon season, National Institute of Health (NIH), an institution involved in multi-disciplinary public health related activities, prepared a six-and-a-half-minute video advisory in July 2023 for public awareness about protection and treatment," said Amina Najam, Officer In Charge Sera Lab, NIH.
In the video NIH warns that in flood-hit areas and in those receiving heavy rain, the risk of snakebite increases. NIH also prepared pictorial displays for educating the public about better treatment of snakebite victims, Amina told VaccinesWork.
Have you read?
NIH has recently scaled up preparation of polyvalent snake antivenin – which treats envenomation from the "big four" poisonous snakes – from 20,000 to 60,000 vials. The big four include the Indian cobra, common krait, Russell's viper and the saw-scaled viper.
Snakebite threat amid floods and climate change a matter of serious concern
That flooding causes the risk from vector-borne health sicknesses like malaria, or waterborne illnesses like cholera, to rise is well known – but experts emphasise that snakebite deserves its spot on that list of climate-impacted public health threats.
"Among various health-related challenges in wake of climate disasters like floods and monsoon rains, risk of increase in snakebite incidents is emerging as a matter of serious concern," observed Dr Mehtab Alam, a biochemist who works on snake venom, noting that it also remains overlooked as a public health problem.
"The distribution and abundance of snakes is expected to change with global warming via their thermal tolerance, while rainfall and floods may affect the timing of key activities like feeding, reproduction and brumation," he added.
Pakistan is home to a diversity of herpetofauna, of which 40 species are considered especially venomous – that is, capable of inflicting a deadly bite to an adult human.
According to the World Health Organization (WHO), around 40,000 bites are reported annually in the country, with approximately 8,200 fatalities . But data on snakebites in South Asia is patchy – the national level figures for Pakistan have not been updated since 2007 – a fact that prompted WHO to add snakebite poisoning to its list of neglected tropical diseases in June 2017.
"Our knowledge of where venomous snakes live, and their impact on human populations is currently insufficient. Climate change will only exacerbate the issue by affecting where, when, and how snakes share space with people. This is because snakes will shift their distributions as temperatures rise and extreme events become more common," read a communique issued by the World Health Organization earlier this year.
"Climate change will impact both snakes and people. Negative impacts on snakes can lead to negative impacts on people by displacing snakes and forcing them into new environments where they will come into contact with people previously unexposed to them," warns the global organization.
Many deadly snake species are predicted to increase in abundance and come into contact with more people, WHO cautions.
Amid flooding, more than 50 patients of snakebite received on daily basis in Sindh hospitals
Dr Mehtab Alam told VaccinesWork that in areas including Umerkot, Kachho and Dadu, more than 50 patients of snakebite were received on a daily basis soon after the flooding began in Sindh province.
Dr Alam stresses the need to compile cumulative, national-level snake bite data for future planning in countering this potential threat. In the meantime, his own efforts to improve public awareness of best practices surrounding snake envenomation have included filming a short instructional video for the Muhammad Ali Jinnah University in Karachi, entitled "Counselling on snakebite for flood victims." The film is due to be translated into Sindhi to extend its reach.
