Climate Shocks as a Growing Pediatric Health Emergency in Pakistan: A Call to Action

Introduction

When floodwaters swallowed a third of Pakistan in 2022, the world’s attention briefly flickered toward washed-away bridges and decimated crops. But long after the headlines faded, the real tragedy began unfolding quietly and devastatingly, among the country’s youngest. In Sindh and Balochistan, the epicenters of the flood, rapid nutrition screenings conducted by WHO and UNICEF during the disaster reported a grim trend: 5.2% of children under 5 in flood-affected areas were suffering from severe acute malnutrition (SAM), with a further 10.5% experiencing moderate acute malnutrition (MAM). These rates translate to more than 1 in 9 children, significantly above national averages, requiring urgent therapeutic feeding and medical care.^1,2

Just a year later, the pendulum swung the other way. A brutal spring drought gripped southern Pakistan, pushing temperatures past 45 °C and decimating wheat fields that rural families rely on to survive the lean months. It wasn’t just a season of bad luck. It was part of a larger climate rhythm that keeps tightening around the country’s poorest families. ³

For children, the toll is now quantifiable. A global analysis of 580 000 children across 53 low-income countries found that even modest droughts (Standard Precipitation Evapotranspiration Index <−0.4) reduce children’s height-for-age Z-scores (HAZ), which is a proxy for long-term growth and brain development. ⁴ In places where governance is weak and irrigation is scarce, like Pakistan’s arid districts, the losses are steeper still. Another study focusing on South Asia showed that extreme rainfall in the first year of life depresses HAZ scores further by an average of −0.24. ⁵ This proves that today’s infants are being shaped by both extremes – droughts that parch, and floods that drown.

But hunger is only the beginning. Malnutrition strips away a child’s natural defenses, leaving the immune system fragile, as waterborne pathogens and disease-carrying mosquitoes move in.

After the catastrophic floods of 2022, Pakistan experienced an unprecedented surge in malaria cases. Between January and August of that year, over 3.4 million suspected malaria cases were reported. This was up from 2.6 million in the same period of 2021, with laboratory confirmation accompanying 170 000 new cases, primarily in Sindh and Balochistan where floodwaters lingered longest.^6,7 The World Health Organization cautioned that this spike represented the worst malaria outbreak since 1973, with floods overwhelming existing control efforts and exposing malnourished, displaced children, especially in flood-stricken zones, to a heightened risk of severe disease.

Along with malaria, dengue too followed the floodwaters. In Lahore, modeling studies found that for each mm increase in rainfall, dengue cases increased by ~14.7 cases. Each degree increase in temperature was associated with ~371 additional dengue cases. Between 2007 and 2012, 44.6% of dengue variance was explained by temperature and rain alone. ⁸ In Islamabad, a case-control study found that living near stagnant water had 4.86 times the odds of developing dengue fever. ⁹

The pattern is deadly and predictable. Floods create vast breeding grounds for mosquitoes, while droughts push families to store water in open containers, both of which help Aedes and Anopheles mosquitoes thrive. The net result? Children are caught in the crossfire, weakened by undernutrition and struck down by malaria, dengue, or both. A 2022 review by Agabiirwe et al confirmed that monsoon floods increase the risk of childhood stunting, wasting, and underweight. ¹⁰ A 2023 article about flood-affected districts sealed the connection: dengue and malaria outbreaks often rise together after climate disasters. ¹¹

The trend is unmistakable: hydrologic volatility first strips children of nutritional reserves, then seeds the perfect vector habitat, producing a double burden of wasting and fever that overwhelms fragile health systems. More than a decade ago, Environmental Health Perspectives warned that the biggest child health burden of climate change would come from “the tight feedback loop between infection and malnutrition.”^12,13 Pakistan’s data is now living proof of that prophecy.

What’s happening is not a series of isolated disasters. It is the emergence of a new pediatric emergency, one driven not only by climate change, but also by inaction. And unless climate response strategies are rapidly recalibrated to center children, the next flood or drought will carve deeper scars into Pakistan’s youngest generation.

To protect children from the worsening impacts of climate change, Pakistan must begin treating climate shocks as pediatric mass-casualty events. This shift in perspective demands actionable, child-specific policies across climate, health, and disaster management sectors. Firstly, existing early warning systems, such as rainfall and temperature dashboards used to guide irrigation and agricultural planning, must also be used to trigger health and nutrition interventions for vulnerable children. Evidence shows that climate extremes can predictably precede outbreaks of malnutrition and vector-borne diseases. These dashboards justify transforming weather alerts into public health triggers: when forecasts signal imminent floods or droughts, district-level teams could pre-deploy ready-to-use therapeutic foods (RUTF) and pediatric antimalarial medicines to clinics and mobile units. This anticipatory approach is gaining traction. For example, the World Health Organization’s 2022 pilot program in Somalia, supported by the UN’s Central Emergency Response Fund (CERF), successfully pre-positioned nutrition and medical supplies ahead of an anticipated drought. This intervention reached over 244 250 individuals, including children with severe acute malnutrition and malaria, and helped avert large-scale outbreaks of diarrheal and epidemic diseases. ¹⁴ Such evidence supports expanding this model to Pakistan, where climate-driven malnutrition and malaria threaten millions of young lives.

Secondly, protecting the “food pipeline” is essential for food security during climate shocks. Drought-resistant wheat and flood-tolerant rice cultivars are proving to be important reforms in safeguarding Pakistan’s food security during climate shocks. For instance, flood-resistant rice varieties (like DR92 developed with FAO support) produce yields comparable to high-input hybrids and withstand prolonged submersion, saving valuable kilocalories during floods. ¹⁵ Meanwhile, climate simulations indicate that rising temperatures and reduced rainfall could slash wheat yields, especially in arid regions, making drought-tolerant wheat varieties essential for nutritional stability. ¹⁶ Such resilient crops can reduce caloric losses, directly preventing childhood malnutrition in vulnerable districts. According to Pakistan’s National Nutrition Survey 2018, 40.2% of children under 5 are stunted, with more than 60 districts showing stunting rates above 30%, signaling an urgent need for targeted agricultural subsidies. ¹⁷ Without scaling up climate-adapted agriculture, Pakistan risks exacerbating childhood wasting and micronutrient deficiencies in every future flood or drought cycle.

Thirdly, vector control must be embedded in disaster response as a non-negotiable component. The distribution of insecticide-treated mosquito nets (ITNs), larvicides for standing water, and vector repellents should be as routine as chlorine tablets in flood-affected regions. Post-disaster environments are ideal breeding grounds for vectors like Aedes and Anopheles, and studies show that dengue and malaria outbreaks closely follow flood events in Pakistan. Children, who already suffer from weaker immunity and malnutrition, are particularly susceptible to severe outcomes.

Fourth, a more integrated approach to child health is essential, especially in the wake of climate-related disasters. Malnutrition, unsafe water, and vector-borne infections such as malaria and dengue don’t occur in isolation. They form a vicious cycle, each one amplifying the others. For instance, undernourished children have weakened immune systems, making them more vulnerable to infections, which then further deplete their nutritional reserves. In Southeast Asia and sub-Saharan Africa, studies have shown that standalone programs focused solely on nutrition, water and sanitation (WASH), or vector control fall short. Instead, integrated multisectoral efforts that combine nutrition support with WASH improvements and infectious disease prevention have been far more effective in breaking this harmful feedback loop. The WHO-UNDP Climate and Health profile (2020) emphasizes that true resilience requires this kind of combined programming, noting that coordinated interventions yield health benefits greater than the sum of their parts, improving child growth and reducing disease simultaneously. ¹⁸ UNICEF’s WASH initiative further emphasized that transformative WASH programming, integrated with nutrition-sensitive interventions, can contribute to better child nutrition and development outcomes. ¹⁹ These examples demonstrate that isolated interventions cannot address systemic issues. Instead, a holistic strategy is required to truly protect children from the overlapping threats of hunger, infection, and environmental degradation.

Finally, there is a critical need for Pakistan to invest in pediatric-focused climate-health research. Despite children bearing the brunt of climate-related health risks, according to UNICEF’s Children’s Environmental Rights Initiative (CERI), just 2.4% of funding from key global multilateral climate funds, covering a span of 17 years through March 2023, can be classified as truly child-responsive, meaning it addresses the distinct vulnerabilities of children, strengthens essential services like health and education, and involves children in climate solutions. ²⁰ That means over 97% of global climate finance today overlooks the specific needs of children, even though they are among those most vulnerable to the health impacts of extreme weather, pollution, and ecosystem disruption.

Without redirecting even a small fraction of adaptation budgets toward child health, Pakistan risks losing a generation to preventable climate-related morbidity and developmental setbacks. For this purpose, dedicated funding streams must support longitudinal cohort studies that track child growth, infectious disease patterns, and mental health across seasonal cycles such as El Nino and La Nina. Such evidence is necessary, because by understanding how repeated climate shocks like floods, heatwaves, or drought affect children over time, health authorities can develop more effective pathogen surveillance, nutritional supplementation schedules, and mental health support plans tailored to Pakistan’s varied ecological zones. In the absence of this data, public health responses risk being reactive and one-size-fits-all, rather than proactive and precise. Investing in child-centered climate research today means safeguarding the physical, cognitive, and emotional futures of Pakistan’s next generation.

Unless pediatric resilience is systematically woven into Pakistan’s climate response strategy, the country’s youngest citizens will remain acutely vulnerable to preventable losses stemming from floods, droughts, malnutrition, and infectious disease. Children are not only disproportionately affected by climate shocks, but also represent the greatest potential for long-term national recovery and stability. Integrating child-focused planning into early warning systems, disaster response protocols, agricultural subsidies, and health surveillance is no longer optional. It is both, the right thing to do and essential for public health. The cost of inaction will be measured not just in stunted growth and rising disease, but in the irreversible loss of human potential.