Intended for healthcare professionals


One year on—the persistent plight of the 2022 floods on health in Pakistan

BMJ 2023; 382 doi: (Published 07 August 2023) Cite this as: BMJ 2023;382:p1818
  1. Mohammad R Ali, PhD fellow1 2 3,
  2. Syed W Javed, health adviser4,
  3. Zafar Iqbal, associate medical director public health3 5,
  4. Muhammad Sartaj, senior public health adviser4
  1. 1Department of Cardiovascular Sciences, University of Leicester, UK
  2. 2Faculty of Public Health, Special Interest Group: Disasters and Humanitarian Response
  3. 3Faculty of Public Health, Special Interest Group: Pakistan
  4. 4UK Health Security Agency, International Health Regulations (IHR) Strengthening Project, Pakistan
  5. 5Midlands Partnership University NHS Foundation Trust, St Georges Hospital, Stafford, UK

A year after the floods that devastated Pakistan, action must be taken to prepare for and mitigate the health and environmental damage caused by climate change, write Mohammad Rizwan Ali and colleagues

People in Pakistan continue to suffer one year after the disastrous flooding of July 2022. Monsoon rains unleashed significant floods that wreaked havoc on the lives of 33 million people—more than one sixth of Pakistan’s population—and over 1000 lives were lost.1 The economic impact was estimated at $30bn, requiring $16bn for reconstruction alone.2 These challenges are compounded by Pakistan’s severe economic downturn, characterised by high inflation, limited mechanisms to mitigate the decline in citizens’ purchasing power, and low economic resilience.34 Climate related flooding has transformed land once arable for rice and wheat cultivation into floodplains, depriving many individuals of their livelihoods and exacerbating food scarcity.

Challenges in accessing clean water and food add to significant health concerns. The situation is dire for the millions of people who lack access to safe and clean water.5 This is exacerbated by summer temperatures of up to 51°C,6 some of the highest globally.7 Running water is scarce. Groundwater usually extracted through tube wells is now inaccessible because of flooding, and available water is at risk of contamination. Recent estimates have shown that 10.5 million people, particularly children, are facing food insecurity.8 The prevalence of malnutrition has necessitated immediate public health interventions and targeted education on breastfeeding and infant feeding,9 given that 44% of children in the country have stunted growth attributed to malnutrition.10

Comprehending the health emergency in Pakistan after the flooding required rapid implementation of robust data collection methods to assess the health situation. Efforts were made to quantify the extent of ill health in flooded areas in real time. This allowed health professions to identify outbreaks of acute diarrheal and respiratory illness, skin diseases, and malaria across different regions of the country.11

Varying healthcare provision across regions has led to significant disparities in the incidence and prevalence of communicable diseases such as cholera and malaria, which persist a year after the floods. Such discrepancies have disproportionately affected the Sindh region, which has inadequate healthcare infrastructure, primarily because of economic deprivation. Despite the use of data systems for targeting resources, the failing health infrastructure, weak coordination mechanism, and lack of funding severely hindered an effective response to the floods.

Numerous aid agencies attempted to organise an international response shortly after the floods. But lack of coordination between them and the state sectors in Pakistan meant this was suboptimal. The probability of future serious flooding in Pakistan is high—up to 72% in 202312—and recent monsoons have caused additional loss of life.13 Funding for healthcare is insufficient.8 Inadequate healthcare provision, particularly in rural areas and those with low incomes, exacerbates the effects of natural disasters in Pakistan. Identifying those at highest risk and increasing the resilience of local health systems are vital steps. This includes determining regions acutely at risk for further flooding by using climate disaster modelling.14 Mitigation strategies must prioritise upstream prevention, implement effective interventions, identify healthcare provisions, and ensure the rapid delivery of aid in disasters. A more coordinated and well funded response is urgently needed to recover after the 2022 floodings and prepare for future incidents. This means establishing a resilient healthcare infrastructure that can adapt to climate change, and includes local laboratories, primary care facilities, and transportation networks.

Pakistan is among the most water stressed countries in the world, but opportunities exist to stabilise water levels in the long term. Careful planning and climate resilient agriculture practices will help Pakistan adapt to the changing climate. These practices include educating farmers in water-stressed areas to use new technologies and acquire specialised training in cultivating crops1516 such as rice, wheat, and maize.1718 This should be combined with sustainable groundwater management, using floodings to replenish low groundwater levels15 Insights from other countries that have successfully implemented interventions will be valuable, particularly as monsoon seasons intensify. Examples include the Netherlands, which has created more capacity for rivers to accommodate floodwaters,19 Japan, where underground tunnels and reservoirs have been constructed,20 or the US, where “at risk” land has been purchased by the government and converted into natural floodplain areas.21

The need to strengthen healthcare and infrastructure in Pakistan is urgent, as is an adequate response to future crises and mitigation of the worst effects of climate disasters. In 2022, some rapid and successful efforts were made to quantify health issues in flood-affected regions. But the state of ill health in Pakistan has worsened because of climate change,10 driven by lack of trauma care resources22 and inadequate healthcare provision, particularly for children.23 Enhanced stakeholder coordination between the Pakistan government, aid agencies, and local and national healthcare providers and increased funding are essential for providing adequate healthcare and protecting vulnerable populations from crises driven by climate change. Concerns remain about future climate driven events, especially among those who have already experienced their consequences. With a high probability of recurrence, global communities must learn from these events and take proactive measures.


  • Competing interest statement: All authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years.

  • Provenance and peer review: not commissioned; not externally peer reviewed.