Thirty-three million people have been affected by the recent floods in Pakistan. The disaster has left more than 1,300 people – including more than 400 children – dead, displaced millions and put one-third of the country under water.

The floods were brought on by a severe heatwave which caused glaciers in the mountains to melt and heavier-than-normal monsoon rains.

United Nations Secretary-General Antonio Guterres described the flooding as a “monsoon on steroids” and a “climate catastrophe”. South Asia is one of the world’s climate crisis “hotspots” where people are 15 times more likely to die from climate effects, he warned. Although Pakistan contributes less than 1 percent to global carbon emissions, its share of the catastrophic effects of climate change is colossal.

As initial floodwaters ravaged towns and villages, drowning posed an immediate danger, and many people lost their lives this way. But as water continues to destroy crops and the roads along which food is transported, malnutrition becomes a very real threat. As is the case with many natural disasters, the most vulnerable will be the worst affected.

As well as being a humanitarian disaster, the floods also threaten the very fragile health infrastructure that was in place in Pakistan, bringing with them a new set of worrying health challenges.

Even before the current floods, there was a significant disparity in access to health services between rural and urban areas. Accessing these rural areas has been difficult. The World Health Organization (WHO) said that more than 1,400 health facilities had been fully or partially damaged and that access to “health facilities, healthcare workers, and essential medicines and medical supplies” remained the main healthcare challenge.

Waterborne diseases

Another key concern is the likely rise in waterborne diseases. People who have fled the devastation are living in makeshift camps with little or no access to clean water. According to charity Wateraid, half of all water, sanitation and hygiene facilities in some of the hardest-hit areas of Pakistan have suffered substantial damage, and there are already reports of thousands of people suffering from dysentery.

This highly infectious disease is an intestinal infection that causes severe diarrhoea with blood, fevers, abdominal cramps and life-threatening dehydration. The bacteria and parasites that cause dysentery, shigella E coli and amebiasis thrive in poorly sanitised water. Children and the elderly will be at most at risk of the complications that accompany dehydration.

The spread of cholera is also a concern according to the WHO and the UN. Cholera is an infectious disease caused by the bacteria Vibrio cholerae. It is spread through contaminated water supplies. If not managed properly, it can cause hypovolemic shock due to loss of fluid, kidney failure, and death. People who contract cholera can shed the bacteria in their stools for up to 10 days, adding to the risk of it spreading.

Before the floods, Pakistan was experiencing a rise in cholera cases, particularly across the Khyber Pakhtunkhwa, Sindh, Punjab, and Balochistan regions, and oral cholera vaccines and surveillance programmes were being set up, but many of these will have been pushed back as the floods hit.

As flood waters become stagnant, we are also going to see a rise in mosquito populations, which will use the waters as a breeding ground. Mosquitos bring with them vector-borne diseases, the most worrying being malaria and dengue fever.

With malaria, mosquitoes carry the Plasmodium parasite which is released into the bloodstream when an affected mosquito bites a human. The parasite travels to the liver where it grows; once fully formed it leaves the liver and enters red blood cells and begins to multiply. When the numbers inside of a red blood cell reach critical levels, they bust open, destroying the cell and the cycle begins again with the new parasites. Symptoms typically include fever, sweats, anaemia, and vomiting. There is a risk of coma and death if not treated with appropriate medication.

Dengue fever is transmitted via the bite of a mosquito harbouring the dengue virus. Symptoms include high fever, headaches, rashes, swollen glands as well as vomiting and bloody diarrhoea. A small percentage of people who have dengue fever can develop a more serious form of the disease known as dengue haemorrhagic fever. This can cause severe bleeding and death.

Skin diseases caused by people living in wet conditions are already being widely reported. Dermatological fungal infections grow best on wet or damp skin. As people make their way through floods, they expose large parts of their skin to the microbes that live within the water. Unable to wash clean afterwards, these bacteria and fungi thrive in skin folds under breasts, in the groin area and between toes causing intense itching, pain and skin breakdown, which in turn increases the risk of further infections.

Disrupted care

There is also a concern that the floods will cause disruption to much-needed immunisation programmes that were being rolled out across Pakistan.

Before the floods, Pakistan had reported more than 4,500 cases of measles and 15 cases of wild poliovirus in 2022, according to the WHO. Children will now be put at increased risk of vaccine-preventable diseases as much of the infrastructure needed to access and provide these life-saving vaccines was washed away.

Additionally, children face an education crisis as the floods have also fully or partially destroyed nearly 19,000 schools. This lack of education coupled with the trauma of living through a natural disaster of such magnitude is going to have far-reaching consequences for the children affected.

Among the millions of severely affected people are at least 650,000 pregnant women and girls, 73,000 of whom are expected to deliver in the next month. The United Nations Population Fund (UNFPA) says many of these women lack access to the healthcare facilities and support they need to deliver their children safely. With healthcare facilities and homes destroyed, many simply do not know where or how they will give birth.

Even before the floods, Pakistan had high maternal mortality rates – a result of lack of access to healthcare facilities and education, malnutrition, poverty and a high prevalence of violence against women. This was most pronounced in rural areas – the very areas that have been worst affected by the flooding. And it is not only pregnant women and girls who will be affected, but also those seeking access to contraception and other reproductive health services.

In addition to this, menstruating women are unlikely to have access to sanitary products and risk serious infection by using pieces of cloth to soak up menstrual blood and then washing it in contaminated water supplies, only to reuse it again.

Any relief effort must recognise that women and girls are disproportionally impacted by any natural disaster and must plan for female-specific support.

There has been criticism over the sluggish response to aid provision, particularly as the disaster has come at a time when many in the West are grappling with rising food and energy bills of their own. But turning our backs on those living through climate catastrophes largely caused by other countries is a mistake.

The global plan must recognise the immediate crisis facing the people of Pakistan but also the steps needed to tackle the wider issue of climate change because if nothing is done, it will inevitably affect us all.