Pakistan Faces Post-Flood Health Crisis – Cholera, Dengue & Malaria Outbreaks Threaten Millions (October 2025)

Watch: Field report — Floods, camps and rising disease risk

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Part 1 — Situation overview: floods, displacement and immediate needs

The 2025 monsoon season brought record rainfall to wide areas of Pakistan. Rivers overflowed, low-lying agricultural lands turned into lakes, and entire settlements were inundated. Millions were affected: houses destroyed, livestock lost, and transport links severed. Large numbers of people moved into temporary shelters — schools, mosques, community halls and makeshift tent camps. In many of these sites, access to safe water, sanitation and basic health services is extremely limited.

In the immediate aftermath, humanitarian priorities were clear: life-saving rescue operations, emergency food and shelter, and medical first aid. But within days and weeks, the environmental changes created by the floods laid the groundwork for infectious disease transmission — a predictable but often devastating secondary crisis.

This report synthesises field observations, public health principles and recommended actions for families, health workers and decision-makers.

Part 2 — Which diseases are rising now?

Three categories of disease typically increase following large floods:

1. Waterborne diseases: cholera, acute watery diarrhoea, typhoid, hepatitis A and other gastrointestinal infections caused by contaminated water and food.
2. Vectorborne diseases: dengue and malaria, transmitted by mosquitoes that breed in standing water.
3. Respiratory, skin and wound infections: increased by overcrowding, poor hygiene and exposure to contaminated water and soil.

Cholera & acute watery diarrhoea

Cholera causes profuse watery diarrhoea and can lead to fatal dehydration within hours. Floodwaters often mix sewage and animal waste into drinking sources. In crowded camps, a single contaminated source or food handler can seed a large outbreak. Early detection and rapid rehydration are lifesaving.

Dengue & malaria

Standing pools and debris create ideal mosquito breeding sites. Dengue, spread by Aedes mosquitoes, can cause high fever and potentially life-threatening complications. Malaria, transmitted by Anopheles mosquitoes, remains a persistent risk in many rural districts and can surge after floods.

Respiratory & skin infections

Overcrowding increases spread of respiratory infections (like influenza and pneumonia). Skin infections and wound contamination pose risks too — small cuts exposed to contaminated water can worsen without proper care.

Part 3 — The epidemiology: why outbreaks follow floods

Outbreaks after floods are the result of multiple interacting factors:

• Contaminated drinking water: latrine overflows and damaged sewage systems contaminate wells and pipelines.
• Standing water: breeding habitats for mosquitoes multiply rapidly.
• Overcrowded shelters: reduced ability to maintain hygiene and social distancing.
• Healthcare disruption: damaged clinics, broken cold chains and limited medicines reduce prevention and treatment capacity.
• Food insecurity & malnutrition: weakened immune systems increase severity and fatality of infections, especially among children.

Because these drivers interact, interventions must be coordinated: improving water quality alone is not enough if mosquito breeding and overcrowding persist.

Part 4 — Surveillance, WHO & government warnings

Health authorities and international agencies issue rapid situation reports after major floods. Warnings often highlight high risk of cholera, dengue and other outbreaks if WASH and health services are not scaled quickly. Surveillance — early detection of case clusters — is essential to trigger targeted responses such as oral cholera vaccination (when appropriate), intensified water treatment and vector control campaigns.

National and provincial health departments, supported by WHO, UNICEF and NGOs, typically prioritise rapid assessments, surveillance set-up, and surge deployment of mobile medical teams. However, logistics — road access, fuel, cold chains — frequently slow the response and create gaps in coverage.

Part 5 — Who is most at risk and why targeting matters

Not everyone is affected equally. Targeting the most vulnerable saves the most lives:

• Children under five: can dehydrate very quickly from diarrhoea and are at highest risk of death.
• Pregnant women: need continuity of antenatal care and safe delivery facilities; infection risks affect both mother and newborn.
• Older adults and chronically ill: interruptions in medication (for diabetes, hypertension) increase morbidity and mortality.
• Remote communities: face delayed aid and access to clinics.

Programs that prioritise child health services, vaccination catch-up, and medication continuity for chronic patients have the greatest impact on reducing excess mortality.

Part 6 — What health services and aid agencies are doing

Core response activities on the ground include:

• Mobile clinics: treating diarrhoea, respiratory illness, wound care and providing routine medicines.
• ORS & zinc distribution: for children with acute watery diarrhoea and caregiver education on dehydration signs.
• WASH interventions: water trucking, provision of water purification tablets, emergency latrines and hygiene promotion.
• Vector control: larval source reduction, targeted fogging and distribution of insecticide-treated nets (ITNs).
• Surveillance & lab testing: rapid diagnostic support for cholera and dengue confirmation and hotspot mapping.
• Vaccination campaigns: where feasible, oral cholera vaccine (OCV) can be used as a short-term protective tool in high-risk settings.

Coordination between government, UN agencies and NGOs is critical to avoid duplication, prioritise gaps and ensure efficient use of scarce resources. Rapid funding release and logistics planning (fuel, vehicles, cold chain) are often the difference between an effective and inadequate response.

Part 7 — Practical, life-saving steps families and communities can take now

While system-level aid scales up, households can implement simple actions that dramatically reduce risk. These are evidence-based, low cost and replicable:

Water safety

1. Boil drinking water for at least 1 minute (3 minutes at high altitudes) or use chlorine tablets / household bleach in correct doses. Store water in clean, covered containers.
2. Avoid drinking untreated water from streams, puddles or open wells — always treat before use.

Preventing dehydration

• Keep ORS sachets at home and know how to mix them. For infants, continue breastfeeding and give ORS as needed.
• Recognise danger signs (reduced urine output, sunken eyes, extreme lethargy) and seek immediate clinical care.

Hygiene & food safety

• Wash hands with soap after latrine use and before preparing food; if water is limited, use alcohol-based sanitizer.
• Avoid raw foods that may have been contaminated by floodwater; reheat cooked food until steam rises before eating.

Vector protection

• Use mosquito nets while sleeping, wear long-sleeved clothing at dusk and dawn, and cover or empty containers that collect water.
• Engage the community in removing debris and disposing of waste that can hold water (tyres, cans, bottles).

Wound care & respiratory safety

• Clean wounds promptly with boiled or treated water and apply antiseptic; seek medical attention for deep wounds.
• Keep sick people separated where possible and encourage cough etiquette; maintain airflow in enclosed shelters.

Community leaders: organise hygiene promotion, ORS distribution points, and simple latrine cleaning rosters — small local actions save lives.

Part 8 — Policy & system-level actions that must happen now

To prevent outbreaks from becoming large epidemics, national and provincial authorities — supported by donors and partners — must prioritise:

• Mass WASH scale-up: rapid provision of safe water (trucking, repaired mains), emergency latrines, desludging and waste management.
• OCV deployment: consider oral cholera vaccine in targeted high-risk areas as a stop-gap while WASH is improved.
• Strengthened surveillance: community case reporting and laboratory confirmation for early targeting of interventions.
• Health workforce surge: deploy mobile clinics, community health workers and mental health teams to affected areas.
• Vector control campaigns: coordinated larval source reduction, targeted fogging and ITN distribution where malaria risk is high.
• Secure logistics & funding: open humanitarian corridors, ensure fuel and cold chain supplies, and fast-track donor pledges.

Transparent data sharing and strong subnational coordination (district-to-province-to-national) improve response targeting and reduce duplication.

Part 9 — Field snapshots, case studies and human voices

On the ground, scenes are stark: long queues at mobile clinics; caregivers mixing ORS under the shade of a tent; volunteers teaching correct handwashing steps; children sleeping on thin mats under nets. Health workers describe days when dozens of children arrive with acute watery diarrhoea — many are treated successfully with ORS, but supplies are limited in some remote sites.

Case study: In one remote village, an emergency team set up a temporary water point and taught mothers how to treat water with chlorine. Within a week, reports of watery diarrhoea declined and fewer children required clinic visits. This demonstrates how rapid WASH interventions plus behaviour change can stop outbreaks locally.

Voices from affected families are consistent: safe water and functioning latrines are the two most demanded items. Where communities received both, morale and health outcomes improved measurably.

Part 10 — FAQs, common myths and an urgent checklist

Frequently Asked Questions

Q: How can I spot cholera early?
A: Sudden onset of profuse watery diarrhoea (sometimes described as “rice-water” stools), vomiting and rapid dehydration are warning signs. Seek immediate rehydration (ORS) and medical care.

Q: Should I give antibiotics for every diarrhoea case?
A: No. Most diarrhoea is viral or self-limiting; antibiotics are used selectively for confirmed bacterial infections. Unnecessary antibiotics fuel antimicrobial resistance.

Q: Will fogging alone stop dengue?
A: No. Fogging helps reduce adult mosquitoes briefly but must be combined with larval source removal and community actions to be effective.

Common myths

• Myth: Floodwater becomes safe after a day. Fact: Floodwater may remain contaminated for days or weeks; always treat before use.
• Myth: ORS is only for hospitals. Fact: ORS is safe and lifesaving at home; start early for diarrhoea.

Urgent action checklist (for households & community leaders)

1. Keep ORS sachets at home and learn mixing instructions.
2. Treat all drinking water — boil or use appropriate chlorination — and store it covered.
3. Set up simple handwashing stations (tippy taps) with soap near latrines and eating areas.
4. Use mosquito nets and cover water containers to prevent breeding.
5. Protect and maintain medicine supplies for those on chronic treatments.
6. Report sudden clusters of fever or watery diarrhoea to local health authorities immediately.
7. Coordinate local sanitation efforts — latrine maintenance, waste removal and debris clearance.

Final note: Timely, coordinated public health action combined with simple household measures prevents most deaths after floods. If you are in an affected area and need urgent help, contact your provincial health department, nearest medical facility or a verified humanitarian organisation.

Related coverage & resources

Pakistan Floods — Timeline & Aid | How to Help: Verified Relief & Donations | All Health Coverage

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