Heatwaves and water scarcity in Pakistan: a climate-health emergency demanding global attention

Summary.

• Record-breaking heatwaves and acute water scarcity are two climatic challenges that Pakistan is confronting, which are having a significant negative impact on public health and placing a strain on the healthcare system, especially in Sindh and Punjab.

• The burden of heatstroke, dehydration and waterborne infections has increased due to the combined effects of high temperatures and water shortages, disproportionately affecting the elderly, the impoverished and outdoor labourers.

• Pre-existing disparities are made worse by climate stress, which exposes marginalised communities and casual workers more and restricts their access to essential cooling and hydration. This catastrophe requires immediate, concerted action, including equitable water governance, climate-resilient health systems and global public health policy that acknowledges the connection between health and climate change.

Introduction

Extreme heat and water scarcity are causing a growing environmental and public health crisis in Pakistan. The summer heatwaves of 2024 caused widespread power outages, record-breaking temperatures and a large number of hospital admissions, especially in Sindh and Punjab. These incidents highlight the growing connection between health and climate change that requires immediate attention from the global community.

Escalating heatwaves and their impact on health systems

Southern Pakistan experienced an unprecedented heatwave in June 2024, with temperatures in Hyderabad, Karachi and Nawabshah surpassing 49°C and reaching 52°C in some places. A Karachi seasonal surveillance study found that over 6000 cases of heatstroke¹ and nearly 8000 hospital admissions for heat-related illnesses were documented. The vulnerability of Pakistan’s healthcare system in the face of increasing climate stress was revealed by the catastrophic overcrowding in emergency rooms, the overcrowding in mortuaries and the extended power outages that further taxed vital health infrastructure.

Water insecurity and unequal access

Pakistan is experiencing extreme water scarcity in addition to heat. The amount of water available per person has fallen below 1000 m³, surpassing the threshold for complete water scarcity.² The dependability of water supplies has been further diminished by glacial melt, rapid urbanisation and inadequate water governance. Residents of megacities like Karachi and Lahore are forced to rely on expensive or dangerous alternative sources due to frequent pipeline disruptions.²

Deadly interplay between heat and water shortage

When water scarcity and heatwaves coexist, deadly conditions are produced. Lack of access to clean water and electricity makes it difficult to stay hydrated, maintain hygiene and cool down, which increases the risk of heatstroke, acute kidney injury and waterborne illnesses like cholera, dengue and gastroenteritis, particularly as higher ambient temperatures are significantly associated with increased mortality in South Asia.^{3 4} While frontline healthcare providers face increased operational and psychological stress, the elderly, children and people with chronic conditions are especially at risk.

Vulnerable groups and inequities exacerbated by climate stress

Construction workers, agricultural labourers and sanitation staff who work outdoors also have an increased exposure risk due to spending time in the sun, a lack of shaded rest spots and lack of protection. Workers who are indoors in factories and other health structures are also exposed to the same as especially in low-resource countries where there are few cooling systems.⁵ These hazards are highlighted by global evidence: as recent research shows, work-related heat exposure is a major contributor to the occurrence of heat-related diseases and low productivity in various locations.^{6 7}

Global ignorance about the health impacts in climate-vulnerable nations

Pakistan is often listed in the first decile of the countries which have been the most adversely hit by the calamities of climate change.⁸ The medical consequences of these incidences, however, especially water insecurity, are not widely recorded in the global discourse.

Therefore, global health systems need to be subject to substantive change, as what is happening in Pakistan is not a one-off crisis but the prelude to a series of similar misfortunes that is bound to engage an ever-expanding number of low- and middle-income nations in South Asia, the Middle East and Africa.⁹

Pathways to resilience and systemic change

To reduce the concurrent risks of extreme heat and water shortage requires a twofold approach, combining both an immediate emergency response and a long-term, systemic and infrastructural investment.

Immediate and emergency measures cannot be done without saving human life during the circumstances of crisis. Such interventions include the use of emergency water tankers, issuing hydration kits and implementation of work-hour limits based on empirically proven heat indexes. The rapid implementation of pre-developed heat-health action plans too is a critical short-term mitigation measure.¹⁰

Simultaneously, sustainable, enduring system-wide, system infrastructural investments are crucial in creating sustainable resilience. Reflective surface coating, urban greening proposed by the use of trees and setting up of cooling centres are some of the things that should be prioritised in the planning frameworks of an urban setting. Healthcare organisations should be retrofitted with climate-resistant water and energy systems, hence ensuring that the facilities can withstand climatic disturbances.

Finally, integrating water and health policy is vital at the governance level. Climate risk and health indicators should be incorporated into Integrated Water Resource Management by both national and provincial authorities. Strengthening surveillance systems for climate-sensitive diseases is also necessary, particularly in underserved and peri-urban areas.¹¹

Conclusion

The need for a revolutionary approach to global health is highlighted by the Pakistani crisis. Supported by specialised climate funding, climate adaptation must encompass resilience in health systems in addition to physical infrastructure. Linkages between climate change and health, particularly those involving waterborne illnesses, systemic vulnerabilities and occupational hazards, should be given top priority in research partnerships.

Water scarcity and heatwaves are related to public health emergencies rather than separate natural disasters. The experience of Pakistan serves as a sobering reminder and a global call to action. The climate-health emergency that is quickly becoming our shared reality will claim more lives if systemic change and global solidarity are not implemented.

Data availability statement

There are no data in this work.