The floods that swept through Pakistan this monsoon have left behind a quieter but deadlier crisis. Dengue, malaria, cholera, and typhoid are spreading rapidly in communities already weakened by displacement and poverty. In Rawalpindi, 41 new dengue patients were admitted across hospitals in a single day, forcing institutions like Holy Family Hospital to create extra wards. Karachi, Lahore, and other urban centres are bracing for similar spikes. Across Sindh and Punjab, stagnant floodwater has become a breeding ground for mosquitoes while contaminated wells continue to spread waterborne diseases.
This pattern is entirely predictable. The Pakistan Meteorological Department has already warned of severe dengue outbreaks in at least ten major cities. UNICEF estimates that more than three million children in flood-affected districts remain acutely vulnerable to disease and malnutrition. The alerts come every year, but what does not arrive is a sustainable plan of action.
The roots of this failure are structural. Pakistan’s health spending has hovered between 0.4 and 0.7 per cent of GDP, among the lowest in the region. The World Health Organisation recommends six per cent for low-income countries. Bangladesh spends around 2.5 per cent of its GDP on health and has sustained dengue surveillance systems, allowing it to mount faster responses. Sri Lanka spends about 3.8 per cent and has achieved higher immunisation coverage and more effective malaria control. Pakistan, by contrast, devotes nearly four-fifths of its already meagre budget to curative treatment, leaving prevention starved of resources. The result is visible in broken mosquito control programmes, the collapse of sanitation systems, and chronic gaps in access to clean water.
The consequences extend beyond hospitals. Pakistan already records a childhood stunting rate of 40 per cent, one of the highest in the world. Severe acute malnutrition has doubled in some districts. Each infection further diminishes children’s physical growth and cognitive development, locking future generations into cycles of poor health and limited productivity. The World Bank estimates that poverty has climbed to 42.3 per cent this year, with 2.6 million more people pushed below the line. Epidemics, in other words, are not only public health failures but also drivers of economic regression.
Pakistan’s vulnerability to climate shocks is undeniable. It ranks among the top ten most climate-exposed countries while contributing less than one per cent of global emissions. Floods cannot be prevented. Epidemics that follow can. If Pakistan wishes to break this cycle, it must triple its health spending, prioritise prevention, and hold senior officials accountable for failure. At the end of the day, the sovereignty of any state is measured by whether citizens can drink safe water, whether children survive the monsoon season, and whether hospitals cope without collapsing. On those measures, Pakistan lags behind its neighbours.
