- Healthcare and disaster response failing during floods and heatwaves
- Collaboration with Indus Hospital & Health Network reveals extent of problem
- Children and older people most likely to suffer; least likely to be counted
Pakistan’s healthcare and disaster response systems are failing to meet the needs of children and older people who are most at risk of death and disease amid extreme weather events related to climate change, Amnesty International said in a new report.
Uncounted: Invisible deaths of older people and children during climate disasters in Pakistan documents how increasingly frequent floods and heatwaves are overwhelming Pakistan’s underfunded healthcare system, leading to preventable deaths among young children and older adults in particular.
Pakistan, which contributes about 1% of global greenhouse gas emissions annually, is the world’s fifth-most vulnerable country to climate disasters. In collaboration with Indus Hospital & Health Network (IHHN), a charity hospital that provides free healthcare in Pakistan, Amnesty International investigated how spikes in deaths often followed extreme weather events.
“Rising temperatures drive ever more intense and unpredictable weather. Children and older people in Pakistan are suffering on the front line of the climate crisis, exposed to extreme heat or floods that lead to disproportionate levels of death and disease,” said Laura Mills, researcher with Amnesty International’s Crisis Response Programme.
“Pakistan’s healthcare system is woefully underfunded and overstretched, even in non-emergency times. The climate emergency creates an extra strain that is unbearable and the system is failing to deliver adequate care to those in need.”
Floods often foster the spread of water- and mosquito-borne diseases and respiratory illnesses, which pose a major threat to older people and young children. Similarly, extreme heat is most dangerous for older adults, particularly those with preexisting health conditions, as well as infants. Pakistan collects virtually no mortality data on these impacts, limiting its ability to respond adequately and save lives.
To understand the impact of extreme weather patterns on health, IHHN conducted a quantitative study, analysing deaths across three of its facilities in 2022: Badin (in Sindh province, most affected by floods), and Muzaffargarh and Bhong (in Punjab province, most affected by heatwaves). IHHN compared the relationship between mortality rates and climate indicators, including precipitation and temperature.
To build on IHHN’s quantitative investigation, Amnesty International conducted qualitative interviews to further understand the situation. Amnesty International visited Sindh and Punjab provinces four times between April 2024 and January 2025, and conducted remote interviews in Khyber Pakhtunkhwa and Balochistan. In total, the organization interviewed 210 people, including 90 relatives of people whose deaths could credibly be explained by heatwaves or flooding.
“On the day she died, I was beside her bed”
In 2022, Pakistan experienced record heatwaves, with temperatures reaching 50°C. This above-average temperature drove abnormally intense rains. The Indus River, which runs the length of the country, burst its banks and flooded a 75,000km2 area. At least 33 million people were affected, and an estimated eight million displaced.
In September, IHHN’s Badin hospital, in southern Sindh province at the mouth of the Indus, recorded deaths that were 71% higher than the monthly average for 2022. The main causes were related to maternal and neonatal health, and infectious diseases, with the greatest increases among children under five, particularly infants and neonates (babies under 28 days old), and adults over 50.
Amnesty International interviewed dozens of people affected by the 2022 floods, including those who had lost loved ones to mosquito or water-borne diseases. In many cases, they said the absence of timely evacuation measures and lack of adequate living conditions were the leading contributor to the illness of a child or older person.
Seeta, 32, and her three children were displaced to an elevated road near her village. The family tried to make a shelter using bed frames and tarp. She told Amnesty International: “We were completely wet and could not protect ourselves.”
Soon after, her one-year-old daughter Kareena developed a severe cough which lasted for weeks. Due to the floods, the family was unable to transport her to a doctor. Eventually, they brought her to IHHN’s Badin hospital. Despite receiving oxygen, intravenous drips and other medications, Kareena died on 27 August from acute respiratory distress.
Seeta said: “On the day she died, I was beside her bed. She was losing consciousness and closing her eyes. I screamed for my husband… I was [in] immense pain.”
Many people received no warning of the coming scale of the disaster. The lack of early warning cost lives, including those of many children who were sometimes left behind or lost during hurried evacuations.
In 2024, the same pattern occurred, with abnormal heat causing heavy rains and flooding. More than 1.5 million people were affected; many of them had also been displaced two years before. While early warnings had improved by 2024 in some areas, evacuation and shelter were often not provided to flood survivors, and virtually no preventive health measures were in place, leading again to widespread disease.
“His body was hot… he was not moving”
The punishing heatwaves of 2022 and 2024 marked new highs in temperature across much of Pakistan. Despite low official death tolls, Amnesty International interviewed many people whose health was adversely impacted by the heatwaves, as well as 24 relatives of people whose deaths could have been credibly caused by extreme heat in 2022 and 2024, but were not registered as heat-related. All those who died were over 50 years old, and many of them were forced to continue working during dangerous heat because they had no pension or other social assistance.
In Karachi, prolonged electricity blackouts, known as “load-shedding”, made densely-packed apartment blocks dangerously hot. While the government and NGOs set up some cooling centres, these were few and far between for a city of at least 20.3 million people. Most people Amnesty International interviewed were unaware of them. Primary health clinics were ill-equipped to treat patients suffering from heat-related illnesses. Many patients were funnelled towards a handful of major hospitals, which quickly overwhelmed capacity.
One man in Karachi said that his 65-year-old father had died amid prolonged electricity outages. On 25 June 2024, the man took his father to a nearby clinic after his condition deteriorated. He said: “His body was hot, his eyes were open – but he was breathing very heavily and he was not moving…. The clinic told us to move him to a major hospital, because his condition was too serious.”
There were no government ambulances available, and charities said they were too overwhelmed to send one. The man died before reaching hospital.
Inadequate data collection
In Pakistan, fewer than 5% of deaths are recorded in any way. Amnesty International found that official flooding death figures are invariably an undercount. For example, figures gathered by disaster management authorities generally only capture deaths
from drowning or electrocution, omitting anyone who subsequently died from infectious diseases. This makes older people and young children, who are most at risk from disease after a flood, statistically invisible.
Data about mortality during heatwaves is even less reliable. In 2022, when temperatures reached 50°C in many parts of Punjab province which is home to 120 million people, there were zero heat-related deaths officially recorded.
Deaths caused by extreme heat are challenging to record accurately in any context, as victims often have preexisting medical conditions that increase their susceptibility. Scientists often use “excess deaths” – or those above the expected number – to determine the relationship between extreme heat and mortality.
Despite the disproportionate impact of climate disasters on older people, there is virtually no data collected on their health. Official government data is currently not designed to capture the human toll of the climate crisis. Without a better understanding of the number of victims and who is at highest risk, neither the Pakistan government nor the international community can begin to address climate harms.
Recommendations
Under international human rights law, states must protect the rights to life and to health. While Pakistan has made some notable improvements in disaster responses since 2022, it still falls short of protecting these rights for many people.
“The tragic fact is that those who contribute least to the climate crisis are bearing the largest burden of its harmful consequences,” said Laura Mills.
“Climate change doesn’t stop at international borders. Responsibility for the preventable deaths in Pakistan lies not just in Islamabad, but also with those countries that continue to burn, produce and supply fossil fuels at unacceptably high rates.
“Pakistan must do more to improve its healthcare system and emergency responses to confront a changing climate, and the international community must also ensure that the most vulnerable in Pakistan’s society are protected. High-income, high-emitting countries must provide more financial and other support to help everyone in Pakistan adapt to the climate crisis and remediate climate harms.”