When Floodwaters Rise, Pakistan’s Sanitation Crisis Follows

Flooding is an increasing threat in Pakistan, occurring more frequently than ever before and causing numerous deaths, mass displacement, and billions of dollars in infrastructure damage, with poor sanitation serving as one key driver of this devastation. Sanitation is affected by flooding, which puts pressure on the sewage system, leading to sewage overflows, drainage canal overflows, and pit latrine collapses. As a result, wastewater discharges into rivers, wells, and drinking water reservoirs, all of which supply the water communities depend on for daily use. This destruction requires billions of dollars to repair and improve the system. Furthermore, this costs thousands of lives as the contaminated drinking water leads to waterborne diseases, including cholera, diarrhea, hepatitis, and dysentery. Despite the efforts of the Pakistani government and external organizations such as the UN and the Red Cross, addressing these issues has proven extremely challenging. 

Pakistan has witnessed 28 super riverine floods in its 75-year history, reflecting its vulnerability to monsoons and glacial floods due to its location. The country experiences monsoon rainfall due to the seasonal reversal of winds in South Asia. Rainfall intensity can vary widely, often resulting in excess water and flooding. While monsoons have long posed a threat to South Asia, global warming and climate change have exacerbated this threat. Asia is warming at rates nearly twice the global average, resulting in increasingly intense rainfall. Thus, warmer temperatures increase the air’s moisture content and create greater atmospheric temperature variation, producing a larger temperature gradient that leads to heavier rainfall. Additionally, the mountains of northern Pakistan are experiencing rapid glacial melt, causing nearly 7,000 glacial lakes to swell and increasing the risk of flooding—a threat that will intensify as global warming accelerates melt and places growing strain on Pakistan’s infrastructure.

Before the catastrophic 2022 floods, which killed nearly 2,000 people, caused about $40 billion USD in damage, and captured global attention, Pakistan’s National Flood Protection Plan (NFPP) had been updated following the 2010 floods and approved in 2017. Covering a ten-year period (2015-2025), the plan encouraged institutional reforms and included implementation mechanisms such as a two-phase funding program. In theory, it was meant to create a strong national flood response. However, although this ten-year framework represented a key step in flood management, worsening flood conditions and weak institutional performance ultimately necessitated further revisions.

During the 2022 floods, the Government of Pakistan, the UN, and other humanitarian partners mobilized relief efforts, with sanitation emerging as a central priority. This included the National Disaster Management Authority (NDMA) and the Provincial Disaster Management Authorities (PDMA) distributing 10,045 hygiene kits and 31,864 jerry cans, as well as providing mosquito nets. Such resources were necessary due to the inherent link between malaria and poor sanitation practices. Flooding creates stagnant water that acts as a breeding ground for mosquitoes, increasing the risk of malaria transmission. However, a key limitation of this response was its reliance on external funding, and only 57 per cent of sanitation targets were met in 2022. This shortfall resulted in continued gaps in care and sanitation-based assistance.

Higher rates of waterborne and sanitation-related illness resulted from these gaps. In 2022, the British Red Cross reported more than 90,000 cases of diarrhea in Pakistan’s southeastern Sindh province in a single day, with similar patterns observed in other heavily affected areas. According to the World Health Organization (WHO), Pakistan also saw at least a fourfold increase in the reported number of malaria cases after the floods.

In response to the impacts of the 2022 floods, Pakistan’s Ministry of Climate Change & Environmental Coordination and United Nations Development Programme (UNDP) released the Resilient Recovery, Rehabilitation, and Reconstruction Framework and Pakistan’s National Adaptation Plan in 2023, in preparation for future floods. Unlike past strategies, these frameworks prioritize post-disaster housing, livelihood restoration, and the improvement of sanitation and Water, Sanitation, and Hygiene (WASH) infrastructure across all communities through targeted aid delivery and increased private-sector investment.

During the 2025 floods, the UNDP delivered emergency relief items in the province of Khyber Pakhtunkhwa (KP), including in the districts of Swat, Buner, and Shangla, while also supporting infrastructure improvements and structural recovery across the province. In Punjab, Pakistan’s most populous province, emergency food assistance targeted 160 flood-affected families. Furthermore, the International Federation of Red Cross and Red Crescent Societies (IFRC) launched a 17 million Swiss-franc recovery action plan.

National and provincial governments also provided post-flood cash transfers and food assistance. Nonetheless, many individuals continued to struggle to access basic care and services. Although the government committed to repairing and improving infrastructure as part of long-term recovery efforts, these measures, like the 2022 response plans, remained heavily dependent on increased funding rather than deeper structural reform.

As a result, after the 2025 floods, the British Red Cross reported a pattern similar to 2022, with persistently high rates of diarrheal diseases and malaria. 

Despite current challenges, Pakistan has been taking action to improve WASH, with the 2025 Islamabad conference marking an important step forward. The conference brought together over 100 professionals from five continents. There were three main takeaways from this conference: the importance of constructing effective and sustainable infrastructure to avoid more costly issues in the long run; the need for strong, accountable institutions to achieve real progress; and the launch of the Pakistan WASH platform. The most important takeaway was the platform, which aims to coordinate efforts among development partners and NGOs. This differs from the previous fragmented sanitation efforts that led to large gaps and limited improvements in sanitation in Pakistan, and would permit a stronger response, allowing fewer sanitation-related illnesses to affect individuals. 

The Pakistani government’s efforts, along with those of international organizations, have not at present been sufficient to address deeper infrastructure issues. Without stronger, coordinated initiatives like the Pakistan WASH Platform, Pakistan will continue to experience devastation with every flood unless meaningful action is taken.

Ultimately, international organizations must work with local actors to improve overall sanitation and access to sanitation as climate change only gets worse. While recovery efforts improve, they enact only observational change, which masks the country’s urgent need for structural change to achieve real improvements.

Edited by Adele Torrington 

Featured Image: Severe flooding in Punjab, Pakistan, during the 2025 monsoon season displaced thousands and damaged homes, farmland, and critical infrastructure. “Responding to severe floods with relief support” by World Central Kitchen is licensed under CC BY 4.0.