As average global temperatures rise, the stability of the monsoon rainfall, over the past century,  has been uncertain. It has long been expected in South Asian regions that heavy rain is going to cause an increasing amount of problems. The recent devastating and unprecedented rainfall during  July 2010 and early August 2010, hit all the four provinces; Sindh, Punjab, Khyber Pakhtunkhwa (formerly NWFP), Balochistan, and additionally Gilgit Biltistan, Kashmir and FATA in Pakistan. This triggered flash and riverine floods across the length of this country. According to the reports by national and international agencies as many as 1800 Pakistani individuals have lost their life and more than 20 million people have been displaced, losing their basic residence, fertile lands, jobs, and cattle.

According to the Pakistani Government, most of the crops and the agricultural fields have been destroyed. In addition, the major infrastructure such as roads, bridges, schools, and hospitals have been affected.

The flood stricken areas during this natural disaster were already the least developed parts of the country.  The situation in these areas has been further aggravated because the flood has disproportionately affected the already most deprived population of the country including farmers, labourers, and manual workers. Children, women, and elderly people constitute approximately 75% of the affected population in Pakistan, which are now at higher risk of flood related diseases.

Floods can significantly increase the transmission of waterborne (in early phase) and vector borne infections (in delayed phase). In the aftermath of this flood, many public health challenges have arisen and others are likely to appear shortly. In our opinion (on the basis of field work experience in affected areas), the initial challenges are to provide the basic necessities of life to the displaced parts of the population immediately. Shelter, food, clean water, and sanitation are still the biggest challenges ahead even after four weeks of this disastrous event. Huge numbers of cases of diarrhoea (204,040 till 14th of August), skin (263,356) and acute respiratory infections (204,647) are putting a strain on the already dysfunctional health system of the country. The primary need at present is the establishment of medical camps in areas where refugees are temporarily settled. There is still a shortage of medications, trained, or even junior level medical staffs, these gaps need to be filled immediately to halt the spread of infections. In addition, mobile ambulance crews would be a good approach to deal with scattered clusters of affected individuals.

As the next spell of rain comes and goes, and the water recedes, the current issues (infections, food shortage) will be compounded. However, health needs assessment on the basis of area, will provide further insight to deal with the existing problems. The situation after this massive flood is still unfolding and aggravating and the scale of disaster demands synchronised humanitarian efforts with the help of society, volunteer & non government organisations, national and international agencies, and the civil society.
 
Kashif Shafique is a lecturer in Dow University of Health Sciences, Karachi, Pakistan and currently following his PhD in Public Health in University of Glasgow.

Saira Saeed Mirza is a research associate in Dow University of Health Sciences, Karachi, Pakistan and has an interest in public health activities.

Muhammad Farooq Tareen is a medical graduate from Bolan Medical College Quetta and currently serving as Medical Officer in Department of Health, Balochistan, Pakistan.

Moin Islam Arain is a medical student in ISRA University, Hyderabad and involved in volunteer work for health improvement in socio-economically deprived groups of population.

These authors contributed equally to this work.