EVERY day, in homes across Pakistan, millions of children are quietly being left behind. Not by flood or famine, earthquake or epidemic, but by the slow, invisible erosion of chronic undernutrition. The crisis unfolding concerns the 40 per cent of Pakistani children under five who are stunted, the nearly 10m children affected by chronic growth failure and the millions more whose brain development is compromised during the most critical window of human life. This will push Pakistan’s already strained systems further under pressure.

Children affected by stunting can experience severe cognitive damage. They tend to have poorer memory, weaker attention and lower educational achievement. Some will develop disabilities requiring ongoing support. Many more will experience difficulties that limit their participation in school, work and society.

Not every undernourished child will develop a disability but when millions are exposed to this risk, the math becomes inescapable. Even a modest percentage translates into hundreds of thousands of children who will need early intervention, rehabilitation and inclusive education in the coming years. The wave is coming and Pakistan is not prepared.

Pakistan has over 5,500 Basic Health Units and 96,000 Lady Health Workers, yet routine developmental screening does not exist. A child can be seen repeatedly without being assessed for delays until those delays prevent school participation. Even birth registration remains critically low, with only 42pc of children under five registered. Without an identity, millions remain invisible to the systems meant to support them.

Is Pakistan prepared for the disability rights challenge ahead?

Access to rehabilitation services is limited to cities, with therapists and psychologists largely absent in remote areas. A family in rural Balochistan must choose between forgoing support or travelling at unaffordable cost. The window for early intervention closes, and the child enters school already behind.

Pakistan has taken steps towards inclusive education, but the system still relies heavily on segregated models. Research indicates that nearly 70pc of children with disabilities are not enrolled in school. Most mainstream schools lack assistive devices or accommodations for children with learning difficulties. In classrooms already stretched thin, they are the ones most likely to be left behind.

The 2023 Census reports 7.45m persons with disabilities but also identifies over 23m with functional limitations. This gap suggests many children with developmental delays remain outside formal recognition systems.

With over 5m births annually, even modest prevalence of developmental delay translates into enormous need each year. The workforce to respond does not exist, and the data systems meant to track children do not communicate with one another, making it difficult for the state to anticipate what lies ahead.

The children who are stunted today will be school-aged tomorrow. They will enter school with delays, and become adolescents navigating systems ill-equipped to support them. Those who leave school early will face labour markets that already exclude persons with disabilities at disproportionate rates. This is not a prediction but an identification of risk, and risk can be mitigated through action.

The necessary actions are known: institutionalise developmental screening, expand nutrition programmes, scale up rehabilitation services, move from pilot projects to real inclusive education, streamline disability certification and integrate data systems. They are investments that could prevent millions of children from being left behind.

The alternative is to continue on the current trajectory and hope that the children now at risk will somehow manage without support. Some will drop out of school, some will remain unemployed and some will require care that families cannot sustainably provide. The costs, both human and economic, will be immense.

This week, Pakistan sits before the Committee on the Rights of Persons with Disabilities in Geneva. The government will share its laws, policies and progress but the truest measure of accountability lies elsewhere: in whether a child in rural Balochistan, a girl in a Punjab village or a boy in a Karachi settlement receives the support they need to learn, participate and thrive.

The question is whether Pakistan will act on what it already knows. Whether it will treat early childhood undernutrition not merely as a health issue but as an emerging disability rights challenge. Whether it will invest now, early enough to make a difference. The choice, and the responsibility, belong to us all.

The writer is the chairperson of the National Commission for Human Rights.

Published in Dawn, March 11th, 2026