Introduction
In 2022, Pakistan faced one of its worst natural disasters, as torrential rains and floods devastated vast regions, affecting millions of lives.Reference Nanditha, Kushwaha and Singh 1 Approximately 33 million people were displaced, with over 1,700 fatalities and extensive damage to infrastructure and livelihoods.Reference Nazeer, Qadir and Khan 2 The aftermath of these massive floods saw devastated infrastructure, washed away homes, and destroyed vast expanses of agricultural land, which ultimately led to widespread economic, social, and health crises. The immediate response involved a collective effort from various organizations, both government agencies and nongovernmental organizations (NGOs), including student-led initiatives, to provide urgent relief in the form of food, shelter, and medical care, ensuring basic necessities reached as many people as possible.Reference Krogh and Lo 3 However, as the floodwaters receded and the immediate crisis faded, media attention slowed, and the focus shifted from emergency relief to the far more complex and prolonged process of rehabilitation and recovery. This transition brought new challenges: rebuilding homes, restoring livelihoods, and addressing the psychological toll the disaster had taken on flood-affected communities.
This essay aims to shift attention from the well-documented immediate relief efforts to a closer examination of the affected communities’ long-term rehabilitation, an area that often receives insufficient attention once the crisis fades from the headlines. Rehabilitation involves much more than rebuilding infrastructure; it requires restoring economic stability, providing sustained health care, and ensuring educational continuity for displaced children.Reference Berke, Kartez and Wenger 4 Equally important is the provision of mental health support, as survivors continue to grapple with the trauma of losing loved ones, homes, and livelihoods.Reference Math, Nirmala and Moirangthem 5
This report presents findings from a mixed-methods study examining community rehabilitation needs and the operational role of the Humanity Initiative (HI), a student-led NGO, in post-flood recovery efforts across Sindh province. It contributes to the growing evidence base on the unique strengths and limitations of student-led organizations in disaster medicine and public health preparedness.
Methods
Study Design
This was a mixed-methods study combining qualitative semi-structured interviews with descriptive quantitative data derived from NGO operational records. The study followed the schematic of a qualitative research study, guided by thematic analysis of interview transcripts alongside review of field documentation.
Setting and Geospatial Context
The study was conducted in flood-affected districts of Sindh province, Pakistan, which bore the greatest burden of the 2022 floods. Sindh experienced unprecedented monsoon rainfall estimated at 784% above normal in some areas, leading to the inundation of approximately 6.4 million acres of agricultural land. The 4 primary study districts, Naushehro Feroze, Sukkur, Tando Allahyar, and Dadu, were selected based on flood severity and HI’s working relations with local community leaders and their documented underrepresentation in relief distribution networks. These districts are located in interior Sindh, characterized by sparse health care infrastructure and high baseline poverty rates. HI relief camps were additionally established in aforementioned districts, bringing the total geographic coverage to six districts across a corridor of approximately 600 km along the Indus River.
Participants
Community leaders (n = 6) were purposively sampled from the 4 primary study districts. Inclusion criteria required participants to have (i) resided in the affected district continuously for at least 6 months prior to the floods, (ii) held a formal or informal community leadership role, and (iii) been directly involved in coordinating or observing relief and recovery efforts. Participants included village elders and NGO field coordinators. Additionally, operational data were obtained from HI organizational records documenting volunteer deployment, patient encounters, and geographic reach across the 2-year period.
Data Collection
Semi-structured interviews were conducted by interviewers between October 2023 and March 2024 at participants’ preferred locations in their respective districts. Interviews lasted 15–30 minutes and were conducted in Urdu, then transcribed and translated into English for analysis. A thematic analysis framework was applied to identify recurring patterns across transcripts, with codes developed inductively from the data. Quantitative data on HI operations were extracted from camp registers, volunteer deployment logs, and field reports filed by team leads.
Ethical Considerations
This project was conducted as a non-interventional program evaluation and field assessment using aggregated operational records and qualitative key informant interviews. Per institutional and national research standards for low-risk field evaluations without sensitive personal health identifiers, formal Institutional Review Board (IRB) review was exempt. All community leader participants provided voluntary verbal informed consent prior to interviews, and confidentiality was maintained by fully anonymizing all data in accordance with the principles of the Declaration of Helsinki.
Results
Timeline of Humanity Initiative’s Flood Response Operations
HI mounted a phased operational response spanning 2 years following the 2022 floods. Table 1 summarizes the key phases and activities.
Timeline of Humanity Initiative flood response operations (2022–2024)
Table 1. Long description
Timeline of Humanity Initiative Flood Response Operations (2022–2024).
In total, more than 12,000 individuals were served across 6 districts; and more than 150 medical students and health care professionals were mobilized over the 6-month period.
Geospatial Distribution of Relief Efforts
HI’s medical camps were distributed across 6 districts in a north-to-south corridor along the Indus River floodplain (Figure 1). Khairpur Nathanshah and Naushehro Feroze, which recorded the highest flood inundation levels and the greatest displacement of populations, received the earliest and most intensive support (Phase 1). Sukkur and Dadu (Johi), located along major transport routes, were added during Phase 2 as floodwaters spread southward. Government-established relief camps were found to be concentrated near district headquarters, creating a geographic gap in service delivery that HI’s decentralized camp model was designed to address.
Geographic map showing flood-affected districts in Sindh Province, highlighting the Indus River corridor and deployment sites of Humanity Initiative mobile camps. Courtesy: Google Maps.
Figure 1 Long description
Geographic map showing flood-affected districts in Sindh province, highlighting the Indus River corridor and deployment sites of Humanity Initiative mobile camps (Courtesy Google Maps)
Organizational Structure and Volunteer Deployment
Humanity Initiative (HI) is an independent, voluntary, student-led nongovernmental organization that operates autonomously from official government disaster structures. Relying entirely on volunteer manpower and crowdsourced funding, HI’s voluntary interventions were designed to operate independently but complementarily, targeting remote areas underserved by official government relief efforts. HI operates through a hierarchical yet flexible structure comprising a Central Coordination Committee and Field Volunteers. For the flood response, a dedicated Flood Response Team was established in the early days of the disaster declaration. Table 2 describes the organizational tiers and their functions during the relief operations.
Organizational structure of HI flood response unit
Table 2. Long description
Organizational Structure of Humanity Initiative Flood Response Unit.
Volunteers underwent a structured pre-deployment orientation of 1–2 hours covering field safety, triage protocols, waterborne disease management, documentation practices, and basic psychological first aid. Medical students were paired with supervising physicians to ensure clinical oversight. Volunteers were rotated on weekly deployment cycles to prevent burnout and ensure a consistent workforce.
Community Health and Social Needs: Thematic Findings
Thematic analysis of the 6 community leader interviews identified 5 major domains of persistent need, consistent with quantitative indicators from NGO field records and prior literature on post-flood recovery in South AsiaReference Berke, Kartez and Wenger 4 , Reference Math, Nirmala and Moirangthem 5:
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1. Access to Clean Water and Waterborne Disease: All 6 community leaders cited contaminated water sources as a critical ongoing concern. Wells and hand pumps across the affected districts were either physically damaged or contaminated with floodwater. Community leaders reported sustained outbreaks of diarrhea, cholera, and malaria. As 1 community leader stated, “Access to clean drinking water is a major issue. The flood contaminated many wells, leading to waterborne diseases.” HI field registers documented that approximately 38% of patients presenting at medical camps had waterborne illnesses during Phases 1 and 2, declining afterwards following distribution of water purification tablets and community education campaigns.
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2. Housing and Displacement: Four of 6 participants reported that a significant proportion of their communities remained in temporary shelters or relief camps more than 18 months after the floods. As 1 community leader noted, “Many people are still homeless and living in temporary camps. The government made promises, but so far, very few people have received new homes.”
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3. Food Security and Economic Stagnation: Agricultural land across the study districts remained waterlogged or infertile well into 2023. Community leaders reported widespread food insecurity and economic stagnation. As 1 participant described, “If you go to the markets now, you will feel a sense of fear … shopkeepers sit idle with their hands folded.” Farmers reported an inability to access seeds, fertilizers, or credit to resume cultivation.
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4. Mental Health: Five of the 6 participants raised mental health as a significant unmet need, particularly among women, children, and the elderly. Community leaders reported increased incidences of anxiety, depression, and post-traumatic symptoms. The absence of a structured mental health referral system represents a critical service gap identified in this study.
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5. Educational Disruption: Many schools in rural areas were destroyed or repurposed as relief camps. Two years post-flood, community leaders reported that many children remained out of school, with girls disproportionately affected due to the compounded challenges of displacement, poverty, and deteriorating infrastructure.
Discussion
This mixed-methods study documents the sustained rehabilitation needs of flood-affected communities in Sindh province 2 years after the 2022 Pakistan floods, and describes the operational response of HI, a student-led NGO. Our findings build on prior reports of post-disaster recovery in PakistanReference Nazeer, Qadir and Khan 2 , Reference Abidi 6 by providing geospatially contextualized data on service distribution, volunteer deployment, and community-identified gaps.
Two years post-disaster, the situation in affected areas remains far from fully recovered. Significant gaps persist in access to clean water, housing reconstruction, economic recovery, mental health support, and educational continuity, findings consistent with broader literature on post-disaster rehabilitation in low-and-middle-income countries.Reference Berke, Kartez and Wenger 4 , Reference Math, Nirmala and Moirangthem 5
Student-led organizations such as HI demonstrated unique strengths in this context. Their flat organizational hierarchies enabled faster mobilization than larger institutions, and their geographic distribution across 6 districts allowed them to reach communities underserved by government relief infrastructure. The student-physician supervisory model adopted by HI represents a replicable model for integrating medical education with disaster response. Consistent with Krogh and Lo’s analysis of organized volunteers in emergency management,Reference Krogh and Lo 3 HI’s strong local engagement fostered community trust and facilitated more effective aid distribution.
However, important limitations must be acknowledged. Funding constraints, lack of formal recognition, and limited capacity building remained the primary barriers to sustaining HI’s operations beyond the acute phase. The absence of a structured mental health referral pathway, despite high reported need, reflects a critical gap that student-led organizations alone cannot address. Policymakers, larger NGOs, and community leaders must collaborate to create an enabling environment that amplifies the contributions of these organizations.
Geospatial findings reveal that government relief infrastructure was disproportionately concentrated near district headquarters, with rural sub-districts receiving significantly less support. Future disaster response planning should incorporate geographic equity assessments to ensure that the most isolated and vulnerable communities receive proportionate relief.
Conclusion
The 2022 Pakistan floods continue to have lasting consequences for affected communities in Sindh, with 5 major domains of unmet need: clean water access, housing, food security, mental health, and education. Student-led NGOs such as HI have played a vital complementary role in disaster recovery, reaching over 12,000 individuals across 6 underserved districts through a structured, phased, and geographically distributed response. An integrated disaster recovery model that incorporates geospatially informed planning, structured student volunteer deployment, and sustained mental health and economic recovery programming is essential for building community resilience. Collaborative frameworks between student-led organizations, larger NGOs, and government bodies remain a critical priority for future disaster preparedness in Pakistan and analogous settings.
Implications for Practice
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1. Community-Centered Health Care Provision: Our findings highlight the importance of incorporating student-led and NGO-driven models in disaster response. These entities are more agile, locally connected, and able to provide immediate and sustained health care access, especially in remote and underserved areas. The 2:1 student-to-physician model employed by HI offers a practical framework for future deployments.
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2. Mental Health Integration in Disaster Response: The psychological toll on flood-affected communities, particularly children and adolescents, underscores the need for integrated mental health support within disaster response and recovery. Practitioners should advocate for structured mental health referral pathways, not only awareness sessions, to ensure that identified cases receive appropriate follow-up care.
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3. Long-Term Rehabilitation and Preventative Measures: Health care providers and policymakers should focus not only on short-term emergency relief but also on long-term, sustainable recovery. Ensuring consistent access to clean water, medical supplies, and infrastructure repair can prevent the resurgence of waterborne and communicable diseases.
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4. Collaboration with Student-Led Organizations for Sustainable Impact: Student-led NGOs have demonstrated capacity to provide cost-effective and innovative health care solutions during disaster recovery. Formal integration of student-led relief activities into national disaster response frameworks, including pre-deployment training standards and certification, would strengthen their impact and accountability.
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5. Policy and Funding Support for Grassroots Efforts: Government agencies and international funders should recognize the essential role of student-led and local NGOs in long-term rehabilitation. Funding mechanisms that support phased, multi-year engagement (rather than acute-phase-only grants) are needed to sustain these organizations’ contributions beyond the initial emergency period.
Data availability statement
The original contributions presented in the study are included in the article/supplementary material; further inquiries can be directed to the corresponding author.
Acknowledgment
The authors are grateful to Humanity Initiative, the nongovernmental organization working in Pakistan, for conducting flood relief medical camps and supporting this research. Humanity Initiative is an NGO that relies solely on crowdsourcing and donations for its funding and does not receive financial support from governmental or corporate entities.
Author contribution
SMAA: Conceptualization, supervision, writing—original draft, writing—review and editing. SNFH: Project administration, supervision, validation, writing—original draft, writing—review and editing.
Funding statement
The authors declare that no financial support was received for the research, authorship, and/or publication of this article.
Competing interests
None.
Ethical statement
Following the nature of this article as a field report involving fieldwork experiences, formal ethical approval was not required. All participants provided verbal informed consent. Our work is based on published literature and observations from HI’s medical camps conducted in response to the 2022 flooding in Pakistan. Privacy and confidentiality of all individuals involved were ensured, adhering to the principles of the Declaration of Helsinki.
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