Invisible Deaths: As Climate Disasters Kill in Pakistan, the True Scale Is Unknown

Climate change deaths are largely underreported as the crisis impacts millions and strains an already overburdened healthcare system, according to a new Amnesty International report.

When torrential rain in 2022 flooded Abdul Latif’s village in Badin, Pakistan, his roof caved in and he and his six children were forced to live on a road for a month without shelter, clean water or other basic necessities. 

Soon, his 3-year-old son fell sick with vomiting, diarrhea and a swollen abdomen. A government hospital in the nearest city said it didn’t have the resources to take him, so Latif brought him to a private clinic and paid for temporary treatment. A few days later, at a nonprofit facility, the toddler died of acute gastroenteritis.

Latif and his family were among the more than 8 million people in Pakistan displaced by that year’s catastrophic floods, and he was one of 210 people interviewed by human rights nonprofit Amnesty International for a report released Monday that outlines how insufficient health care, disaster response and data collection exacerbate the devastating risks of climate death and disease in a country on the frontlines of the global crisis.

“We asked the government to please provide us at least a tent so we can save our families,” Latif said, according to the report. “I had only one son, and he died.” 

Climate disasters—including floods and extreme heat—have killed thousands in Pakistan in the last several years. This year, temperatures of more than 120 degrees Fahrenheit came early and threaten to break spring heat records. 

By the government’s own estimation, more than 95 percent of all deaths in Pakistan go unregistered. This means that the already severe, documented impacts of climate change are likely just scratching the surface of the true scale of harm. 

“It’s really important [to understand] how little we see of the real impacts of the climate crisis in Pakistan,” said Laura Mills, a crisis response researcher at Amnesty International and one of the report’s authors. “We’re only seeing part of the story.”

Rising floods and extreme heat in Pakistan are straining an already under-resourced health care system, with elders and children most vulnerable to growing dangers of disease and death, the report says. 

Despite being the fifth-largest country in the world, Pakistan contributes only about 1 percent of total global greenhouse gas emissions. The nonprofit Germanwatch named Pakistan as the most affected country in the world by climate change in 2022.

Around the world, those least culpable for climate change are often suffering its worst consequences. Meanwhile, wealthy countries like the U.S.—the world’s largest economy, the highest historic emitter of greenhouse gases and the current second-highest emitter after China—are backing out of global emissions reduction initiatives, loss and damage fund efforts, foreign aid and crucial data and research on climate and global health. 

Monday’s report, which includes research from Amnesty International and the Indus Hospital & Health Network, a nonprofit health care network in Pakistan, emphasizes this global imbalance. It calls on wealthy and high-emitting countries like the United States to step up, while also saying Pakistan’s own government must fulfill its human rights obligations to protect its citizens’ health.

Tracking the Human Cost of Climate Change

The Indus Hospital & Health Network analyzed deaths in three of its rural hospitals in areas affected by floods or heat waves in 2022: the Badin district in southern Sindh and Muzaffargarh and Bhong in the Punjab province. The Badin district was heavily impacted by flooding, while Punjab has been hit hard by flooding and climate change-fueled heat waves.

Amnesty International conducted interviews with relatives of people who died in 2022 and 2024 floods and heat waves, both in the three IHHN facilities and in Karachi, the country’s most populated city. The group also interviewed health care workers, humanitarian response workers and government officials.

The 2022 floods—spurred by rain made 75 percent worse by climate change—put one-third of the country underwater, impacting 33 million people and displacing 8 million. The official death count was 1,739, likely a massive undercount. 

The World Health Organization found that 2,000 health facilities in Pakistan were destroyed or damaged in the 2022 floods, accounting for 13 percent of the country’s facilities. Roads and infrastructure in flooded areas were also decimated for weeks or months afterward, preventing many from accessing health care for chronic conditions or emergencies. In 2024, extreme flooding hit Pakistan again, displacing more than 140,000 people, many of whom had also lost their homes just two years prior.

Death certificates are not automatically issued in Pakistan, even when a person dies in a hospital, as Latif’s son did. A family has to apply specifically and pay for a death certificate to ensure that their relative’s death is counted in official tallies. According to the report, many families don’t obtain a death certificate unless the deceased owned property or land that needed to be passed down, which means that the deaths of women and children are less likely to be reported.

One of the estimated 95 percent of unreported deaths was that of Latif’s son. Latif, like many of Amnesty International’s interviewees, did not apply for a certificate. 

Even if that death had been recorded, it likely would not have been counted as a flood death, Amnesty International said. Official flood death counts in Pakistan only account for immediate deaths—like drownings. But the majority of deaths from floods come in the aftermath. Displaced communities living without resources, in often unsanitary conditions, are cut off from health care. Usually treatable health conditions as well as diseases exacerbated by flood conditions can easily become fatal.

Globally, floods worsened by climate change are contributing to a rise in vector-borne diseases like cholera, typhoid, dengue and malaria and can cause deadly diarrhea. In 2016, when diarrhea caused 1.6 million deaths worldwide, more than half were in South Asia. After the 2022 floods, impacted areas of Pakistan saw spikes in malaria, dengue, diarrhea and other health complications.

The result of not tracking these deaths in connection to the floods is an “overall chasm of actual mortality data,” said Amnesty International’s Mills. 

“You’re only getting a tiny piece of the picture of who’s dying,” Mills said. “You don’t even actually know who are the most vulnerable if you’re not capturing disease.”

That’s also true with heat waves, increasingly ubiquitous and deadly in Pakistan and across South Asia. Extreme heat can cause heat exhaustion and heat stroke and can exacerbate chronic conditions like respiratory or cardiovascular disease, but deaths from heat are notoriously underreported. A 2022 heat wave across both Pakistan and India was made 30 times more likely because of climate change. 

Among Amnesty International’s interviewees was the brother of Ibrahim Sanif Abdul, a 55-year-old security guard who worked 12-hour shifts outdoors, seven days a week, until his death during a heat wave on June 26, 2024.

Abdul’s death was attributed to a heart attack. But it’s well documented that exposure to extreme heat puts strain on the cardiovascular system, and it’s likely that Abdul’s death was at least a partial result of the heat. His death, however—like many others—would not be counted as a “heat death,” Amnesty International said. 

Climate health risks are most acute for socially vulnerable groups, including the elderly, children, women and people with disabilities, the report found.

Both elders and young children are more biologically vulnerable to dehydration and heat-related illnesses, and face higher risks of the mosquito-borne, water-borne and respiratory diseases that global warming and subsequent flooding make more likely. 

Farah Waseem, a medical intern in a government hospital in Lahore, said she often sees pollution drive patients into the hospital with acute breathing problems and exacerbated chronic diseases. Air pollution is worsened by extreme heat and reached record highs last year in Pakistan. During peak smog season, Waseem was sometimes unable to see the car in front of her while she drove to work. 

“It gets worse, year by year,” said Waseem, who is also a climate activist and is working with Amnesty International to get the word out about the report.

Climate death and disease are an acute problem across South Asia. A mortality study set in India and published last week found that deaths from both extreme heat and cold are rising. The authors, with O. P. Jindal Global University, called for greater government support for outdoor and low-wage workers most exposed to extreme temperature dangers. 

Waseem’s hospital in Lahore is overburdened with needs that health care workers can’t keep up with, like overcrowding and lack of subsidized medications for patients experiencing poverty. Pakistan has roughly one physician for every 1,000 people—the U.S. has a rate more than three times that—and one nurse or midwife for every 2,000 people, one of the lowest rates in the world.

“Working as a doctor, this is the hardest thing that I have to do: … to say, ‘I’m sorry, we cannot accommodate you,’” Waseem said, fresh off a 31-hour shift. “It is the biggest human rights violation, in my own personal opinion, that I think that we can do as individuals, as doctors, as physicians, because we’re supposed to take care of other people.” 

Need for Global Support Amid Rollbacks

Pakistan has joined global calls for the loss and damage fund, an initiative that aims to provide financial assistance to countries most vulnerable to climate change. The fund has been called a necessity for equitably addressing the crisis, but it is severely underfunded. 

The 2022 floods caused about $30 billion in damages and economic losses, and much of the international support the country received was in the form of loans, not grants, adding to its serious financial challenges.

Amnesty International’s report called on Pakistan’s government to step up its disaster response, data collection and health care efforts, particularly for vulnerable populations, but also emphasized that the country on its own cannot address climate change and global resource gaps. 

The trend in the U.S. and elsewhere to move away from climate action and global health initiatives is worrying, Mills said.

“The U.S., the EU, these are sort of the big historic emitters who are very much the most to blame for the climate crisis,” Mills said. “And instead of more support, what we’re seeing is a real rollback in support.”

Mills said that USAID’s Demographic Health Surveys Program—a project launched in 1984 to provide comprehensive open-source data on global health—is one of the only data collection programs that government officials in Pakistan can use to track domestic health issues, including those related to climate. It’s currently “on pause,” frozen by the Trump administration along with foreign assistance programs addressing climate change and public health around the world.

Waseem hopes that Amnesty International’s report will raise global awareness that climate change is already a crisis in Pakistan and spark action from countries with the power to help.

“It’s not just that my own country needs to step up,” Waseem said. “Other countries also need to step up.” 

 

Cover photo:  People carry their belongings through a flooded area after heavy monsoon rainfall in Punjab, Pakistan on Aug. 25, 2022. Credit: Shahid Saeed Mirza/AFP via Getty Images