‘Fear haunts us’: Pakistan’s floods leave mental scars long after waters recede

Shock, panic, guilt and grief grip survivors as mental health experts warn of chronic trauma from repeated exposure to natural disasters

For a 10-year-old, the loss is proving hard to grasp. “It has been four days since I last saw my home,” says Ahsan. He has not yet understood that the floods completely swept away his house in Dogoro Basha village in Shigar, Pakistan.

His confusion is part of the devastating aftermath of long months of rain and floods that have devastated thousands of families in the country’s northern provinces and left more than 860 people dead so far.

For Muhammad Shareef, 19, a university student living away from home in Islamabad, the distance does not help. His home in Dogoro Basha was also destroyed, and his family is now displaced. “My house and land are gone. My mother is now living in a tent. The only thing I have left standing is my father’s grave [marker],” he says.

Since the end of June, and throughout July and August, torrential rains and flash floods have battered Pakistan, mostly the regions of Khyber Pakhtunkhwa and Gilgit-Baltistan. According to the country’s National Disaster Management Authority (NDMA), more than 800 people have died and more than 1,100 have been injured.

More than half of the deaths happened when people were caught by flash floods, with others crushed by collapsing houses.

“This is not only a physical disaster but a mental health crisis,” says Shan-e-Zainab, a Karachi-based clinical psychologist and mental health trainer. “After a flood, people frequently suffer acute stress reactions, helplessness, shock and terror.

“Many develop survivor’s guilt, sleep problems, intrusive memories or overwhelming sadness after losing homes, jobs or loved ones,” she says. “Without proper support, these reactions often deepen into depression, prolonged grief or post-traumatic stress disorder.”

The destruction has been immense. The NDMA reports that across the country more than 9,000 houses have been damaged and more than 2,000 completely destroyed. Displacement is widespread: at least 25,927 people are living in 308 relief camps across Khyber Pakhtunkhwa, and 3,140 people are sheltering in 11 camps in Gilgit-Baltistan.

“Many people died because of the thunderstorm,” says Sher Nawab, 38, a farmer from Buner in Khyber Pakhtunkhwa. “Those who were outside tried to save their lives, but the people inside their houses could not survive.”

For him, survival is now shadowed by a sense of dread. “We lost our corn crops and livestock,” he says. “But what haunts us is the fear, God forbid, if it rains again.

“Our high school is two hours away; one of the students was swept away by the flood on his way there. The schools are closed now; children are sitting idle at home, and some have lost their books in the water,” Nawab says.

Sajjad Ali Khan, a village elder in Gilgit-Baltistan’s Kunduz valley, describes a similar reality. “In my village, there were about 150 houses. More than half have been affected by the floods,” he says. “People are not able to live in the village. They have left and gone to tents.”

Life in displacement, he adds, is marked by uncertainty. “The children’s school has also been destroyed. The only dispensary in our area was swept away. Our children’s future is at stake.”

In videos shown to the Guardian by a villager from Gilgit-Baltistan, boys explain how the floods have disrupted their lives. “Our schools are closed; we can’t go to class any more,” says one. Another says: “We don’t have clean drinking water.” A third adds simply: “We are living in tents now.”

Emergency officials witness this misery first-hand. “Fear and panic are always the first reaction,” says Muhammad Sohail, a media coordinator for Rescue 1122, a government disaster emergency service in Buner.

“Many victims are in shock, unable to comprehend what has happened. Those who have lost family members go through intense grief; others show helplessness, especially when they have lost their homes or means of livelihood,” he says.

He adds that rescue workers also carry invisible scars. “Rescuers are human. We see death, destruction and grieving families constantly. The emotional burden of not being able to save everyone is very heavy.”

For climate experts, the floods are not anomalies but warnings. “This is not just climate change, it is a climate emergency,” says Yasir Darya, founder of the Climate Action Centre in Karachi.

“Because of global warming, the weather patterns have shifted. The Earth’s systems are permanently damaged,” Darya says.

He points to the catastrophic floods in 2022, which killed at least 1,700 people, as a turning point. According to the World Bank’s post-disaster assessment, they displaced more than 8 million people and led to economic losses of $30bn (£26bn), making it the most devastating disaster in Pakistan’s recorded history.

“Families lost their homes, land, livestock and everything they had worked for,” says Darya. “In many valleys, people were cut off for weeks, like islands in a vast lake, with no food or medicine reaching them. That is collective psychological torture.”

Zainab says trauma manifests itself differently in different age groups. “Adults often show increased anxiety, anger, insomnia and withdrawal, while children may struggle in school, have recurring nightmares, or revert to earlier behaviours such as bed-wetting or clinginess.”

Where mental health support is lacking, she says, trauma becomes chronic. “It can lead to substance abuse, long-term anxiety or depression in adults, and serious emotional regulation problems in children. Trauma can even be passed from generation to generation.”

Repeated exposure to disasters magnifies the impact. “The disturbance of safety and healing brings an ongoing sense of powerlessness and hypervigilance,” Zainab says. “The risk of developing PTSD, depression and learned helplessness, where people feel unable to cope with ongoing crises, rises with every new flood.

“The most important is psychological first aid, ensuring safety, meeting basic needs, offering emotional support without pressuring survivors to relive details, providing clear information, and helping people reconnect with family and community,” she says. “Early interventions like these significantly reduce the likelihood of chronic psychiatric problems.”

Fewer than 500 psychiatrists serve 240 million people in Pakistan, however, and most of them are based in the major cities.

“Our mental health system lacks the tools to address climate-linked trauma,” says Zainab. “There are too few professionals, not enough community-based services, and stigma remains strong.

“What we need are disaster-response policies that integrate mental health, training for volunteers and health workers in psychological support, mobile mental health services in vulnerable areas, and nationwide awareness campaigns to fight stigma.”

In the northern provinces, survivors are all too aware that the floods will return and things may never go back to normal. “We can rebuild homes,” says Nawab, “but fear stays in the heart.”

For Shareef, in Islamabad, worry is now a constant companion when he travels to his village. “We might survive the day,” he says, “During the day, I might feel safe. But at night, I am worried. I’m not sure what to do.”

Cover photo:  Heavy monsoon rains have caused flooding in Peshawar, Khyber Pakhtunkhwa. Photograph: Bilawal Arbab/EPA