Famine is ostensibly preventable through government action and yet some famines still kill. Minister of State for Health Saira Afzal Tarar has said that the federal government is looking to devise a five to ten-year plan to deal with the famine in the Thar region of Sindh. Clearly the State Minister has no idea about the urgency of the situation nor the expertise required to gauge it. She provided a roundabout account of the political and hypothetical world that surrounds the administration of famine relief and explained the nature of the debates about what was to be done to prevent famines in the future, completely ignoring what measures could be used to deal with the acute crisis right now. Though she outlined a passionate and balanced plan to include the UN Children’s Fund, the US Agency for International Development and the Ministry of National Health Services in future actions, she brought an old fashioned ‘elite politics’ style to bear on the proceedings. Governments may rationally fail to act against famines when the political costs of action are higher than the political costs of inaction. A famous observation goes: “Starvation is a characteristic of some people not having enough food to eat. It is not a characteristic of there being not enough food to eat.” It follows that food shortages are not a necessary condition for the outbreak of famines. What really matters are entitlements and control over food and non-food commodities, not food availability as such. Famines occur when groups of individuals experience entitlement collapse and are no longer able to buy sufficient amounts of food. At the time of this writing, a report by the District Health Department in Umerkot says 89 people have died in Umerkot out of whom 61 were infants. The total death toll in 2014 is reported at 472. Assuming unreported deaths — excluded from official total mortality data that is highly deficient — allows us to conclude that excess famine-related mortality cannot be deduced from this data, but also cannot be excluded as a possibility. The data shows the registered infant mortality rate as higher than normal and we find that mortality increased more in Tharparkar District (which was most affected by the drought), which provides some indirect and tentative evidence for excess famine-related mortality. Even if official mortality data is questionable and excess deaths must be figured on the basis of news reports and historical tendencies, one thing is clear: there is precious little evidence to support the irresponsible statement made by the Sindh Chief Minister (CM) Qaim Ali Shah about the Tharparkar famine that: “There is no proof of a single death from hunger.” I must say that I did not find the approach of the Sindh CM to be unsympathetic, inappropriate or otherwise uninterested. Instead, I felt disgusted and terrified by the Sindh CM’s skill in ignoring and covering up the problem. The latest deaths took the toll to alarmingly high proportions in Tharparkar. The famine has given us some of the most horrific images of ghoulish death that contemporary observers can remember. The loss of life captures well the problem of assessing whether the famine is a tragedy made worse by administrative blunders or by intentional evil masquerading as political economy. Either way, the Sindh political and administrative system should be in the dock. Viewing Tharparkar as a case of unsuccessful famine prevention by a responsive democratic government would be questionable in the light of the actual responses of the provincial and federal governments. Initially the Sindh government did not acknowledge the severity of the crisis and refused to provide assistance or declare a state of famine. Reports show that the response to the famine has been far from straightforward. Instead of doing everything they could to reduce the famine’s impact, politicians and the bureaucracy used the crisis to gain advantages. The famine has become politicised and this is obstructing rather than helping any immediate famine response, as politicians remain caught up in politics rather than concentrating on famine relief. The federal government for example should not be reluctant to redistribute domestic resources to famine victims just because the affected population represents a minority of the electorate and is not decisive in general elections. This calamity draws focus primarily on the Sindh administration, which appears cruel by almost any standards. While the risk of increases in fatalities is rapidly rising, the priorities of the Sindh government and PPP leadership are political and their assistance is superficial. Consider a country in which a drought or a flood leads to the provincial government being sacked as a consequence of severe negligence and incompetence. If this was the case then all provincial governments would act against all threats of famine at all times. CM Qaim Ali Shah appears to have a ruthless interest in preserving the role of the elite in Sindhi politics. If certain politicians were solely to blame for the calamity it could very easily be argued that this is a group of politicians that we neglect at our peril. This would be a mistake because in a sense the PPP’s approach perfectly mirrors the way in which it is governing the province. Whilst people were dying in remote parts of Tharparkar or on the streets and in crowded hospitals in Mithi, most of the important discussions on the issue took place in London. None of this is to say that the federal government did nothing in Tharparkar, but there is greater similarity in the flippant public policy of the federal and provincial administrations than some critics have noted. The government’s job is to facilitate relief. This does not mean absolute non-intervention but involvement required by moral considerations. This is why there is no escaping the harshness of what was done and what was not done. Only saving lives and providing adequate relief immediately and consistent development assistance that offer alternative means of livelihood and social security can rectify what will otherwise prove to be an intractable and consistent series of crises. The writer is a professor of Psychiatry and consultant Forensic Psychiatrist in the UK. He can be contacted at fawad_shifa@yahoo.com