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 says in a new report.

Climate change is a pressing reality for Pakistan, directly impacting millions of lives. Ranked as the fifth most vulnerable country to climate change despite contributing just 0.88 per cent of global greenhouse gas emissions, Pakistan faces a dire crisis with severe implications.

The report, “Uncounted: Invisible deaths of older people and children during climate disasters in Pakistan”, made available on Tuesday, 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 1pc 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.

The Amnesty report shows how, even at the best of times, Pakistan’s healthcare system fails to meet the needs of its population, particularly very young children and older adults. “Climate disasters compound these existing structural issues, putting children and older people at even greater risk,” it added.

The report documents many cases in which very young children and older adults prematurely lost their lives in ways that were often preventable. Gaps in data collection stymie efforts to address many of these failures.

“Under international human rights law, states are obliged to respect the right to life and the right to health,” it noted. “While Pakistan has made some notable improvements in disaster responses since 2022, it still falls short of protecting these rights for many people, particularly the youngest and oldest, during heatwaves or flooding.”

However, the report says ultimately, Pakistan cannot do this alone; other countries that have historically emitted far more greenhouse gases bear responsibility for the harm they have caused.

“These states must understand that failing to phase out the extraction, production and use of fossil fuels — the primary driver of global warming — threatens the rights to life and health not just of their own populations, but of children and older people all around the world,” the report says.

“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,” it recommends.

It added that there is much that Pakistan can do to safeguard the right to life and health of those most affected by climate disasters. It should increase spending on the health sector and ensure that health workers at all levels are trained and equipped to deal with flood and heat-related illness.

“It should invest more in preventive measures such as cooling centres, and ensure that district disaster management authorities are properly operationalised with funding and human resources to ensure a quicker on-the-ground response during emergencies,” it points out.

“It can also remove requirements such as non-objection certificates for humanitarian organisations, given that these and other bureaucratic hurdles often prevent them from delivering timely aid to those in need.”

The report further recommended that Pakistan can also broaden social protection measures to ensure that they are responsive to climate shocks, including extreme heat.

“The government should introduce a universal social pension for older people in particular, to prevent them from being forced to work in dangerous conditions,” it says.

“Islamabad must know who is the most affected when a flood, heatwave, or other environmental disaster strikes. It can ensure more effective health responses by improving data collection and making it inclusive of all groups.”

According to the report, the government can replicate successes it has had in increasing birth registration by applying similar measures to death registration, including abolishing fees and improving data-sharing between health facilities and other government agencies.

“It can end the near-total exclusion of older people from health data collection, ensuring their inclusion and visibility,” the report adds.

The report notes that despite the disproportionate impact on their lives and health, young children and older people are often not adequately included in climate disaster responses.

“In Pakistan, that is true of children, who make up almost half the population, and it is particularly the case for adults over 60, whose population share is projected to increase from 6.7pc today to 13pc by 2050,” it says.

“While Pakistan has previously received support from international donors to conduct surveys on key child health indicators, such as infant mortality, data collection has largely excluded adults over 50 years old.”

According to the report, there is virtually no information on the health or well-being of older people in the country, and unlike the United Nations International Children’s Emergency Fund in the case of children, no international agencies are specifically dedicated to lobbying for the visibility and inclusion of older people.

In addition to flooding, 2022 and 2024 were marked by extreme temperatures in Pakistan. In 2022, temperatures reached 50C across much of the country. In 2024, the same occurred. This proved particularly deadly in urban areas like Karachi: there, temperatures reached over 40 centigrade, which when combined with over 70pc humidity created conditions at the limits of human tolerance. While less visible than flooding, heatwaves had a major impact on the health and livelihoods of those affected.

Pakistan’s healthcare system is underfunded and overstretched even in non-emergency times. But when a flood or heatwave strikes, that system comes under even greater strain, and typically fails to deliver adequate care to those in need. According to WHO, 2,000 health facilities in Pakistan — or 13pc of the total — were damaged or destroyed in the 2022 floods.

Flooding and heatwaves merely exacerbated the existing gaps in Pakistan’s healthcare system. According to most benchmarks, countries should spend 5 to 6pc of their GDP or 15pc of their budget on healthcare to ensure universal health coverage. Pakistan in 2021 spent just 1.11pc of its GDP and about 6pc of its budget on health.

This has led to insufficient staffing and beds, and also means there are not enough healthcare facilities, forcing people to travel long distances to access care. Many people in Pakistan also incur significant out-of-pocket healthcare costs. Families who were hit by climate disasters often described paying significant amounts to treat their loved ones, and several people described taking out loans in order to afford care.

Header image: A woman, who became flood victim, takes care of her ailing baby at a hospital, following rains and floods during the monsoon season in Jamshoro, on September 20, 2022. — Reuters