Last summer, temperatures as high as 45 degrees Celsius led to more than a thousand heat-related deaths in Karachi. This year, as it prepares for the peak of summer heat, the city has opened 179 heatstroke centres to try to hold down the death toll.

Officials have also trained scores of new ambulance drivers and are working with utility companies to try to keep electricity and water flowing as the city's 24 million people battle summer heat during the month-long Islamic fast of Ramadan, when drinking water and eating is forbidden during daylight hours.

Imams have said those whose life is at risk from the fast need not keep to it in extreme conditions.

‘If a doctor says that your life is threatened due to the scorching heat, or you have a medical condition and it is going to get worse due to the fasting, then you can skip the daily fast,’ Muhammad Tahir Ashrafi, chairman of the Pakistan Ulema Council, an organisation of scholars and religious clerics, told the Thomson Reuters Foundation in an interview.

If any area of Pakistan is hit by extreme heat during Ramadan, which began June 7, the council will remind followers of that flexibility in public service media announcements, he said.

As climate change brings ever hotter summer temperatures to some of the world's already sizzling spots, finding ways to reduce the risks is crucial, medical and climate change experts say.

In Pakistan's southern Sindh province, temperatures have already hit 52 degrees (125 degrees Farenheit) in Larkana, with Jacobabad and Moenjodaro just slightly cooler, according to the Pakistan Meteorological Department.

In the port city of Karachi, where temperatures so far remain below 40 degrees Celsius, heat relief centres are open, providing drinking water to passersby.

Last summer, more than 1,270 people died in Karachi, and nearly 36,000 were hospitalised or hit by water and electricity shortages during 13 consecutive days of scorching temperatures in June and July.

Officials of the Pakistan Meteorological Department, the Provincial Disaster Management Authority-Sindh and the health department say they are better prepared to deal with extreme heat this year, but experts warn deaths are still a risk unless new measures work.

Ghulam Rasul, director general Pakistan Meteorological Department, said a new early warning centre set up in Karachi in April aims to release warnings to government bodies, media and other organisations three days in advance of expected heat waves this year.

‘We have already identified the most vulnerable areas in Karachi, with help of the district administration, to convey the warnings instantly and keep the people safe from sizzling temperatures,’ he said.

The Met Office is also in touch with K-Electric, the main provider of electricity to around 20 million people in Karachi, and with the Karachi Water and Sewerage Board to try to head off unscheduled water and power blackouts during heat waves.

Such blackouts have already prompted near daily protests, including in slum areas, where the shortages are worst.

In March and April, over 400 volunteers and ambulance drivers were trained to give first aid to heatstroke victims and get them to hospitals, said Ajay Kumar Sewani, assistant director for administration at the Provincial Disaster Management Authority-Sindh.

He said that heat wave emergency first aid centres have been set up in almost all major cities of the province including Karachi, Hyderabad, Larkana, Mirpur and Sukkur. The centres offer oral rehydration solution, some medicines and ambulance services to nearby hospitals.

The provincial disaster management authority has distributed a half million brochures and 6,000 banners in cities across Sindh in an effort to raise awareness about heat risks, he said. A radio and television advertisement campaign also is planned.

The materials advise people to drink as much water as possible, avoid drinking dehydrating tea and coffee, try to stay inside or under a shade from 10 am to 4 pm and cover their heads with a cap during the daytime.

It also offers advice on recognising the symptoms of heatstroke and heat exhaustion, and has telephone numbers for relief centres.

‘Our aim is to ensure and guarantee zero deaths during the heat wave and we are prepared for it,’ Sewani said.

Local media reported two heat wave-related deaths in Karachi during the last week of April, but they have yet to be officially confirmed.

Some experts, however, say Sindh's plans are a good start but such measures need to be carried out effectively - and used throughout Pakistan.

Heat-related deaths are preventable if the Met Office releases its forecast well in advance and district administrations have a proper management plan, said Ali Tauqeer Sheikh, chief executive officer of Lead Pakistan, a non-profit organisation in Islamabad. But so far that is not the case countrywide, he said.

He said that a crucial component of an effective heat wave management plan is a comprehensive institutional communication and coordination plan. ‘This is important to prevent duplication of efforts and identify the most vulnerable areas,’ he said.

Early users of Karachi's heat relief centres said they are already hugely helpful to students, commuters and pedestrians who stop by to drink water, rinse their faces and just cool off when temperatures soar.

‘The district administration has made much better arrangements this time and we hope no one dies this Ramadan, unlike the last year,’ said Sumera Ambreen, 21, a medical student who stopped at a centre in North Nazimabad recently.