Strengthening Post-Flood Public Health and Nutrition Preparedness in Gilgit-Baltistan, Pakistan: An Integrated Assessment of Health Services, WASH Risks, Disease Surveillance, and Recovery Priorities Following the 2025 Floods

Abstract

Background: Floods are among the most frequent climate-related disasters affecting Pakistan and often result in population displacement, disruption of health services, deterioration of water, sanitation and hygiene (WASH) conditions, and increased risk of communicable disease outbreaks. Following the July–August 2025 floods in Gilgit-Baltistan, a comprehensive assessment was required to identify priority public health and nutrition needs and inform recovery planning. Objectives: To assess the post-flood public health situation in Gilgit-Baltistan, identify major health, WASH, disease surveillance, and nutrition-related risks, and develop an operational response framework to strengthen disaster preparedness and resilient recovery. Methods: This applied public health study used secondary programmatic data extracted from the Gilgit-Baltistan post-flood field assessment conducted between September and October 2025. Descriptive analyses were performed using frequencies, proportions, and operational indicators. Health service availability, disease surveillance, WASH conditions, outbreak risks, logistics, nutrition-related information, and data quality were systematically reviewed. A risk-prioritization approach was used to identify critical operational gaps and develop an integrated intervention package. Results: All ten districts of Gilgit-Baltistan were affected by the floods, with four districts remaining affected during the assessment period. Approximately 6,000 people were affected, including 2,910 internally displaced persons residing in six temporary camps. Acute watery diarrhea, acute respiratory infections, and skin diseases were the leading morbidities. A confirmed cholera outbreak was identified in Astore, while a suspected dengue outbreak was reported in Diamer. Eleven health facilities sustained flood damage, including four completely destroyed facilities. Of 588 functional health facilities, only 372 (63.3%) were reporting through the Integrated Disease Surveillance and Response System. Major operational concerns included incomplete WASH information, open defecation practices, limited vector-control activities, insufficient nutrition screening, and inadequate data on maternal and newborn health, mental health, returnee populations, and water quality. An Integrated Flood Health and WASH Surveillance and Response Package was developed to strengthen outbreak surveillance, mobile health and nutrition services, WASH interventions, cold-chain recovery, logistics management, and emergency preparedness. Conclusion: The 2025 floods exposed important vulnerabilities in health service continuity, disease surveillance, WASH infrastructure, and nutrition-related information systems in Gilgit-Baltistan. Integrating surveillance, WASH, nutrition, and primary healthcare within a coordinated recovery framework can strengthen resilience, improve emergency preparedness, and reduce the health consequences of future flood emergencies in disaster-prone settings.