Monsoon Preparedness in Pakistan: A Call for Anticipatory Health Action

In Pakistan, the annual monsoon season brings predictable health threats, yet the response by government agencies remains largely reactive rather than proactive. This year's monsoon, which commenced in July 2025, has already raised concerns regarding public health, particularly in flood-affected regions of Sindh and southern Punjab. Health hazards such as acute watery diarrhoea, cholera, and vector-borne diseases like dengue and malaria are on the rise, exacerbated by inadequate infrastructure and lack of anticipatory measures.

According to Aisha Khan, Chief Executive of the Civil Society Coalition for Climate Change, 'The Met Department consistently issues warnings about the intensity of monsoons, but the government’s prioritization of health responses remains inconsistent.' This inconsistency is evident in the aftermath of the catastrophic 2022 floods, where health response teams mobilized only after outbreaks had already begun, highlighting the need for a shift towards anticipatory action.

The National Disaster Management Authority (NDMA) is mandated to coordinate health responses in collaboration with the Ministry of National Health Services and provincial health departments. However, the National Institute of Health (NIH) lacks real-time health risk analysis capabilities at the district level, which has led to insufficient preparedness. Dr. Sarah Johnson, a public health expert at Johns Hopkins University, states that 'integrating health risk assessments into disaster management plans is crucial for effective response.'

In contrast, neighboring Bangladesh has made significant strides with its anticipatory health protocols, which include pre-positioning health supplies and deploying early action plans based on flood forecasts. The country’s approach is supported by the International Federation of Red Cross, which has institutionalized anticipatory financing mechanisms at the national level. In Nepal, too, anticipatory health responses are being piloted, particularly focused on food security and disaster risk reduction (DRR).

The gaps in Pakistan's disaster health response are multifaceted, including fragmented governance, weak institutional mandates, and operational capacity issues. For instance, in provinces like Balochistan and Khyber Pakhtunkhwa, critical health infrastructure lacks the necessary cold chain storage for vaccines, leaving populations vulnerable during health emergencies. Furthermore, financial bottlenecks often delay necessary procurement of health supplies, even when forecasts provide ample warning.

Despite these challenges, there are signs of progress. The NDMA's recent joint simulation exercises with the NIH signify a step towards improving coordination among health and disaster management stakeholders. Additionally, the National Adaptation Plan now explicitly addresses climate-sensitive disease surveillance, reflecting a growing recognition of health risks associated with climate change.

However, these developments remain isolated and project-based, lacking the sustained commitment needed for long-term improvement. As Dr. Paul Adams, a climate change researcher at the World Bank, notes, 'Without a formal anticipatory health activation system, Pakistan’s health response will remain reactive, often leading to unnecessary morbidity and mortality.'

The implications of climate change, including rising temperatures and more intense monsoons, necessitate urgent action. Experts call for Pakistan to establish a comprehensive 'Climate and Health Resilience Policy' that integrates anticipatory health action into disaster risk management protocols. Such a policy would enhance inter-agency collaboration and ensure that health sector budgets support preparedness rather than relying solely on external funding.

In summary, the time for anticipatory action is now. As monsoon-related health threats loom larger, Pakistan must shift its focus from reactive responses to proactive measures, incorporating real-time data and multi-sectoral planning to safeguard public health in the face of climate challenges.