Pakistani Prime Minister Imran Khan on May 15 urged provinces to loosen travel restrictions imposed by the COVID-19 lockdown saying more than 150 million people in his country have “suffered economically.” Khan and other policymakers point to a relatively low death rate from the coronavirus to make the case for loosening the lockdown.

The argument being made by the federal government, as well as some provincial governments, is that “the lives-versus-livelihood tradeoff is actually very real,” said Umair Javed, an assistant professor at Lahore University of Management Sciences in Lahore, during an online discussion hosted by the U.S. Institute of Peace’s Islamabad office.  

According to Javed, there is “a consistent refrain in the policy conversation that somehow Pakistan is not as badly affected by the virus as other countries have been.” As of May 18, Pakistan had 42,125 confirmed cases of COVID-19 and 903 deaths. But it may very well be that the lower death rate in Pakistan is a consequence of inadequate testing.

Javed said the Pakistani government has tried to make the case that it does not have the capacity to clamp down on all economic activity, and even if it did the risk to livelihoods will have long-term consequences.

Khan was initially reluctant to impose a lockdown, instead, he urged citizens to self-quarantine. In a March 22 televised address, Khan said, “Twenty-five percent of Pakistanis are below the poverty line ... today if I impose a complete lockdown then … my country’s rickshaw drivers, pushcart vendors, taxi drivers, small shopkeepers, daily wage earners, all of them will be shut in their homes.”

Numerous datasets show “restrictions placed on economic activity pose real livelihood and mortality risks to people, especially those who work within the informal sector,” said Javed.

The informal sector accounts for a large part of the economy in Pakistan. In the southwestern Balochistan Province, which abuts Afghanistan and Iran, the local economy depends on the borders remaining open. The services sector has been badly hit as the borders are closed because of the pandemic, said Rafiullah Kakar, director of the Strategic Planning and Reforms Cell in Balochistan’s provincial government. He predicted the lockdown will inflict a loss of “somewhere between 60 billion to 90 billion rupees” on the province.

The 18th Amendment

Pakistan has seen periodic swings between civilian and military rule since its founding in 1947. In 2010, then President Asif Ali Zardari enacted constitutional reforms that sought to undo provisions created by the country’s past military rulers to tighten their grip on power and legitimize their coups. The resulting 18th Amendment took away from the president the authority to unilaterally dissolve parliament and impose emergency rule, transferring these powers to a civilian government.

The amendment also transferred certain powers from the center to the provinces. As a result, “the provinces are at the forefront of responding to COVID-19,” said Adnan Rafiq, USIP’s Pakistan country representative.

The Pakistani government says the 18th Amendment has limited its authority to craft a national strategy to deal with the pandemic. Khan’s Tehrik-e-Insaf party (PTI) has sought a review to fix what it says are flaws in the amendment. Critics see an attempt to undermine democracy.

The Provincial Response: A Mixed Record

The dissolution of powers by the 18th Amendment has underscored the differences in the provinces’ capacities to deliver critical services.

In Khyber Pakhtunkhwa, the border province where Pakistan’s first COVID-19 deaths were reported, the provincial government was quick to declare a health emergency in February.

Sindh, too, was quick to lock down even as the federal government “still appeared to be muddling over a decision over whether or not the lockdown should be countrywide,” said Nausheen H. Anwar, a professor of city and regional planning at the Institute of Business Administration in Karachi. With a population of close to 15 million, Karachi, the capital of Sindh Province, is Pakistan’s largest city.   

In Punjab, the fact that the PTI is in power in the province has facilitated greater coordination with the federal government and “a greater degree of coherence in terms of some of the decision-making,” said Javed.

But while the Punjab government has come up with a plan to respond to the pandemic, its implementation has left much to be desired, said Javed. “There are significant concerns about the capacity of the government to impose even what they are calling a smart lockdown,” he said.

In Balochistan, the implementation of the lockdown has “not been at its best,” said Kakar. But when it comes to provinces’ capacity to deliver services, Kakar said they are doing a good job despite limitations. “Balochistan is probably the weakest in terms of capacity, but even Balochistan is doing a better job than the federal government,” he said.

Anwar emphasized the importance of accurate data and the role of the local government in addressing the pandemic. “If we keep on insisting that the buck stops at the level of the province when it comes to handling these crises, I think we are missing out on a much, much bigger picture,” she said.

‘How Do you Quarantine 30 People?’

Hard as they are to implement, social distancing and quarantines are even more difficult in countries where low-income populations are crammed into squalid slums and where even the better off have a culture of living in joint families comprising multiple generations.

Kakar, who is recovering after being stricken by the coronavirus, shares his home in Quetta with more than two dozen family members. Besides sharing rooms, “we all eat together, we dine together, we sit together, we drink together,” said Kakar.

“In a joint family system, it is almost impossible to arrange quarantine facilities,” said Kakar. “How do you quarantine 30 people?”

And so the virus spread insidiously through Kakar’s household infecting nearly everyone.

Living in close quarters has also heightened the risk of gender-based violence (GBV).

While Pakistan’s Ministry of Human Rights has set up a helpline for GBV, more than half of the calls have been people asking for financial help, said Fasi Zaka, an independent public policy consultant in Khyber Pakhtunkhwa. “People are feeling the pinch,” he said.

Confinement, Anwar explained, exacerbates cases of domestic violence against women as well as children. While acknowledging that GBV cuts across class lines, she said that in communities where people are confined to small spaces “being inside actually becomes more dangerous than being able to come outside.”

The Messaging Problem

In Pakistan, “our real problem is the mixed messaging that kept coming out from the federal government who at one point saw health and the economy as a binary,” said Zaka. “Even though there was a lockdown [mandated by the federal government] there was some talking it down. …  Even right before the extension of the lockdown it seemed … like a case was being made to lift it. Then there was an announcement of an extension for a week to 10 days.”

The response to the coronavirus could also have serious political consequences.

Zaka said if the worst-case predictions come true—riots, people denied medical care, hospitals packed to capacity, and a perception of state failure—“then this public health crisis will become a crisis of public order; it will become one of state legitimacy.”