Pakistan Context Report

Pakistan, a federal parliamentary republic located in southern Asia (Figure 1), is uniquely positioned geographically, making it a key transit corridor, but also vulnerable to cross-border instability in the region. With a population exceeding 241 million and livelihoods heavily dependent on the Indus River system and agriculture, the country faces pressure from weather shocks, economic instability, rapid population growth, and persistent poverty, particularly in rural areas.

The country is characterized by a diverse natural geography that shapes livelihoods. The Indus River system is a strategic resource to the country’s agriculture, supporting about 90 percent of production in Pakistan, but is also a source of tension with India due to water sharing disagreements. The climate is arid to semi-arid, with rainfall shaped by the South Asian monsoon. Rural livelihoods are primarily agriculture-based, with wheat as the main staple crop and sugarcane and cotton as key cash crops. Households rely on own production and markets for food, and income mainly comes from labor, agriculture, and remittances. Food accounts for the largest share of household spending, and livelihoods are highly vulnerable to weather and economic shocks.

Pakistan’s economy remains structurally fragile after years of large current account and fiscal deficits. However, recent indicators point to improvement: GDP surpassed 400 billion USD in 2025 and remittances reached a record 38.3 billion USD in FY 2024/25. The country’s food supply system is sustained by its domestic production, which meets its national requirements in most years. 

In recent years, Pakistan’s food security has been affected by recurrent shocks, including the impacts of the COVID-19 pandemic, floods, droughts, economic shocks, crop and livestock disease outbreaks, and localized insecurity. High dependence on the Indus irrigation system makes Pakistan vulnerable to weather shocks and disputes over water allocation. Pakistan Bureau of Statistics (PBS) data showed that the proportion of the population reporting food insecurity-related experiences, per the Food Insecurity Experience Scale (FIES), has increased from 15.9 percent in 2018-2019 to 24.4 percent in 2024-2025. The main areas of concern are Balochistan, southern Khyber Pakhtunkhwa (KP), and southern Punjab and Sindh. Pakistan has been facing persistently high prevalence of acute malnutrition over the past decades, mainly driven by poor health and water, sanitation, and hygiene (WASH) practices and food insecurity (dietary intake and diversity). Although some district-level improvements have been observed over time, overall trends indicate continued acute malnutrition inherent to structural challenges, including poverty and recurrent weather and macroeconomic shocks.

Pakistan is a key transit corridor, sitting at the crossroads of South Asia, Central Asia, and the Middle East, sharing borders with India, Afghanistan, Iran, and China. Pakistan is a federal parliamentary republic, where executive power is shared between the President (head of state) and the Prime Minister (head of government). It contains a bicameral legislature comprising a 100-member Senate and a 342-member National Assembly, including 60 seats reserved for women and 10 for religious minorities. Pakistan is divided into four provinces (Punjab, Sindh, KP, and Balochistan), two administrative territories (Azad Jammu & Kashmir and Gilgit-Baltistan), and the Islamabad Capital Territory. The capital city, Islamabad, serves as Pakistan’s political and administrative center. Provinces are subdivided into 37 divisions and 164 districts. Each district is broken down into a varying number of tehsils and union councils.

While Pakistan’s unique geographic positioning makes it a vital transit corridor, it also exposes the country to cross-border instability. The border shared with Afghanistan is frequently disrupted by closures and insecurity due to militant groups, such as the Islamic State-Khorasan Province (IS-KP) and Tehrik-i-Taliban Pakistan (TTP), which Pakistan has accused of receiving support from the Afghan Taliban. Its relationship with India remains strained, as the unresolved Kashmir dispute persists, with bilateral trade shut down since 2019. Conversely, Pakistan’s relationship with China has seen greater cooperation, as the China-Pakistan Economic Corridor (CPEC) is a significant driver of investment, particularly in Balochistan and northern regions. CPEC aims to improve connectivity between the two countries, with investments into the construction/modernization of highways, railways, air travel, and energy transportation.

The Indus River and its tributaries is the most important river system in Pakistan, though often a source of tension between Pakistan and India. The Indus Waters Treaty (1960) historically governed water sharing between India and Pakistan; however, India's unilateral suspension of the treaty in 2025, combined with upstream glacial retreat, rising temperatures, and other weather-related shocks, increasingly threatens long-term water availability for agriculture and livelihoods.

Gwadar port in Balochistan, developed under CPEC, provides strategic access to the Arabian Sea and has the potential to improve livelihoods and food security in surrounding communities; however, limited port activity due to security issues, high costs, connectivity issues, minimal road and rail infrastructure, and high production costs has constrained its operating capacity to date. Other major ports include Karachi and Port Qasim. Land border crossings and dry ports include Chaman, Torkham, and Ghulam Khan (Afghanistan trade), Taftan (Iran trade), and Khunjerab and Sost (China trade).

Pakistan’s geography is highly diverse and strongly influences its livelihood systems. Northern Pakistan is dominated by high mountain ranges, including the Himalayas, Karakoram, and Hindu Kush, with elevations exceeding 8,000 meters, while the central and southern regions consist largely of plains formed by the Indus River system. The Indus River and its tributaries — including the Jhelum, Ravi, Sutlaj, Chenab, and Swat rivers — represent Pakistan's most critical strategic water resource, supporting the world's largest contiguous irrigation system, covering approximately 19.36 million hectares, and underpinning approximately 90 percent of agricultural production. In contrast, the western province of Balochistan is largely arid plateau with sparse population and limited agricultural potential. Vegetation ranges from alpine pasture in the north to arid shrublands and irrigated cropland in the plains, shaping distinct livelihood systems across ecological zones.

Pakistan’s climate is generally arid to semi-arid, with strong seasonality driven by the South Asian monsoon. Average annual rainfall ranges from less than 100 millimeters (mm) in arid southwestern regions to over 1,000 mm in the northern regions. Temperatures also vary widely by region. Plains areas often exceed 40 degrees Celsius in summer, while northern highlands experience cold winters with snowfall. The country is divided into several agro-ecological zones (Figure 2), including irrigated plains, rainfed (barani) areas, arid deserts, and mountainous pastoral systems. Approximately 45 percent of Pakistan’s land area has potential for agricultural use, although only about one-third is cultivated due to water and soil constraints.

Seasonal livelihood patterns are largely shaped by the monsoon rainfall cycle, irrigation availability, and the two main cropping seasons (Kharif and Rabi). Rainfall occurs mainly during the monsoon period from July to September, bringing in the bulk of annual precipitation and supporting Kharif crop cultivation, from April to October, for mainly cotton, rice, maize, millet and sorghum. Planting of these crops typically happens between April and July, while the bulk of harvesting occurs from September to November (Figure 3).

The Rabi season follows during the cooler and drier months from October to April, with wheat and barley the dominant food crops grown. Wheat is generally planted between October and December, while most of harvesting occurs between April to mid-June. Sugarcane, another important cash crop along with cotton, has two sowing seasons: spring (February-March) and autumn season (September-October). Harvesting begins in October and continues until April-May. During these periods, demand for agricultural labor increases significantly, providing income opportunities for poor and landless households through activities such as land preparation, planting, weeding, and harvesting.

The dry season occurs from October to June, when rainfall is limited and crop production relies heavily on irrigation from canals and groundwater. Livestock production continues throughout the year, but fodder availability improves after the monsoon and crop harvest periods when residues become available for animal feed. The lean season for many rural households occurs before harvest periods (January to March), particularly before wheat harvest period in April and the start of the Kharif agricultural activities. 

In pastoral areas, seasonal migration of livestock to higher altitude pastures during summer, and lower valleys during winter, is common. Fishing activities along the Arabian Sea coast and Indus delta also follow seasonal patterns linked to monsoon winds and river flows. In flood-prone areas along the Indus River and its tributaries, seasonal flooding during the monsoon months can disrupt cropping activities, damage infrastructure, and temporarily reduce access to markets and labor opportunities.

Pakistan is the world's fifth most populous country, with a total population of 241.49 million, as recorded in the 2023 digital census, and an annual growth rate of 2.55 percent. The population is young, with 50 percent under the age of 20, nearly 80 percent below the age of 40, and a median age of approximately 20.8 years. The urban-rural distribution stands at 38.8 percent urban and 61.2 percent rural. Urbanization is accelerating, with the urban population nearly quadrupling between 1981 and 2023, though growth in urban areas remains uneven across provinces. In Sindh, 54 percent of the population resides in urban areas, while the populations of Balochistan and KP predominantly reside in rural areas. Karachi, with approximately 18.8 million residents, and Lahore, with approximately 13 million, are the largest urban centers.

According to the United Nations High Commissioner for Refugees (UNHCR), Pakistan hosts approximately 1.88 million Afghan refugees and undocumented Afghans as of March 2026, concentrated primarily in KP and Balochistan provinces. Following Pakistan's 2023 expulsion orders, approximately 1 million Afghans returned to Afghanistan, including 155,000 deported during 2025, though large populations remain. 

Pakistan is classified as a lower-middle-income country by the World Bank. The national poverty rate declined from 50.1 percent in 2005-2006 to 21.9 percent in 2018-2019 but is estimated to have risen to approximately 28.9 percent by 2024-2025, driven by the COVID-19 pandemic, the 2022 floods, drought in Sindh and Balochistan, and a broader macroeconomic crisis. Poverty is concentrated predominantly in rural areas, where incidence is approximately double that of urban areas. Balochistan records the highest provincial poverty rate at 47 percent, followed by KP at 35.3 percent, Sindh at 32.6 percent, and Punjab at 23.3 percent in 2024-2025, with geographic concentration most pronounced in southern Sindh flood-affected districts, Balochistan, and southern Punjab.

Agriculture is the backbone of Pakistan’s rural economy, employing 35 percent of the labor force and contributing roughly 23 percent of GDP. The country’s agricultural systems are dominated by irrigated farming in the Indus Basin, where major crops such as wheat, rice, cotton, maize, and sugarcane are grown. Wheat is the main staple crop grown across all provinces during the Rabi season, while rice production is concentrated in Punjab and Sindh. Cotton production is particularly important in southern Punjab and Sindh, supporting both agricultural livelihoods and the national textile industry. Livestock is also a critical component of rural livelihoods, accounting for over 60 percent of agricultural value added, with cattle, buffalo, goats, and sheep widely raised for milk, meat, draft power and selling. In arid and mountainous regions, agropastoral and pastoral systems dominate, combining livestock grazing with small-scale crop cultivation. 

Urban livelihoods are diverse and include employment in manufacturing, services, trade, construction, and transport sectors. Informal employment is common, particularly among low-income households, and includes street vending, casual labor, and small home-based enterprises. Migration and remittances also play a major role in household livelihoods, which significantly contributes to household income in rural and urban economies. Pakistan also hosts one of the largest refugee populations in the world, primarily Afghan refugees, many of which rely on informal labor markets, small trade, and humanitarian assistance.

Households obtain food mainly through own production and market purchases. In rural areas, own crop production is the dominant source. Wheat from the Rabi harvest is the primary staple and is consumed throughout the year, while rice and other crops contribute on a seasonal basis. Overall, staple foods such as wheat, maize, and rice make up a large share of diets, with independent research indicating that cereals account for nearly 60 percent of total caloric intake. Meat and milk from own livestock production also contribute to diets, particularly in rural areas; however, urban households tend to have more diverse diets overall, reflecting differences in food availability and consumption patterns across Pakistan. The Household Integrated Economic Survey (HIES) indicates that purchases play a central role in food access, especially for poorer rural households and urban populations that rely heavily on markets. In addition, community support mechanisms and formal social transfers provide a small but important share of food for low-income households.

Income sources vary significantly between rural and urban areas (Figure 4). Nationally, income from wages and salaries constitutes about 42 percent of total income, although the contribution is more than 50 percent in urban areas and about 34 percent in rural areas. Other non-agricultural activities, such as self-employment, firewood sales, construction, and transportation, collectively constitute the next most important sources of income. Crop and livestock sales also contribute significantly to total annual income for farming households in rural areas. In addition, social insurance benefits, including payments from the Benazir Income Support Programme (BISP), are an important income source for lower-income households. Foreign and local remittances are important supplementary sources of income for both rural and urban households, while gifts/community support mechanisms such as zakat provide smaller contributions.

Household expenditure patterns are strongly dominated by spending on food and other basic survival needs. According to the Household Integrated Economic Survey, 2024-2025, food expenditure constitutes a significant share of household spending, with lower-income households reporting 45-50 percent of total expenditures on food. Upper-income households allocate a lower share, at about 28 percent of their total expenditure. Rural households spend about 41 percent of their total expenditure on food, while urban households spend about 31 percent. Nationally, households also allocate about 25 percent of total expenditure to housing, water, electricity, gas, and other fuels, although urban households allocate slightly more than rural households. The remaining expenditure is distributed across other essential categories, including clothing, health, education, transport, and communication.

The most common shocks include drought, erratic monsoon rainfall, flooding, livestock disease, crop pests, as well as macroeconomic shocks, including inflation and price volatilities. Large-scale flooding along the Indus River basin periodically affects millions of people and damages crops, livestock, and infrastructure. Drought conditions frequently affect arid areas of Balochistan and Sindh, reducing agricultural productivity and livestock health. In addition, economic shocks such as inflation and food price volatility can significantly affect food access. Conflict and displacement also affect livelihoods in parts of Balochistan and KP provinces. Livestock diseases such as Foot and Mouth Disease, peste des petits ruminants, and Black Quarter also periodically affect cattle and small ruminants, reducing livestock productivity and household income. 

During periods of shock, households employ various coping strategies, including selling livestock, reducing food intake, increasing participation in wage labor, borrowing money, increasing reliance on remittances, and seasonal migration to nearby towns or farming areas in search of work. Additional strategies include borrowing food or cash from shopkeepers or landlords, purchasing food on credit, selling productive assets, and cutting back on non-essential expenses.

Since Pakistan’s independence in 1947, the country has faced persistent internal security challenges, including separatist insurgencies, Islamist militancy, and regional instability. One of the longest-running conflicts is the separatist insurgency in Balochistan, which has been ongoing since the 1960s.

Baloch separatist groups frequently target security forces, critical national infrastructure, government offices, and Chinese-backed development projects, particularly in areas with significant Baloch populations. Since 2022, these attacks have increased in both frequency and sophistication, further contributing to a sustained and evolving security environment.

Pakistan’s involvement in the Soviet-Afghan war in the 1980s, fought with the extensive support of the U.S. and some Arab countries, fueled both militarization and radicalization in the country’s border regions, which eventually evolved into a domestic insurgency and terrorism by Islamist militant groups such as Tehrik-i-Taliban Pakistan (TTP) and the Islamic State of Pakistan (ISPK). These groups seek to overthrow the government and impose Islamic law, with strongholds in the former Federally Administered Tribal Areas, which have been merged into KP in 2018, as well as other parts of KP. The TTP insurgency has escalated since 2021, following the withdrawal of U.S. forces from Afghanistan and the Taliban’s return to power. This resurgence has been particularly pronounced in KP, where insurgent violence reached a 10-year high in 2025.

This has heightened tensions with Afghanistan’s Taliban-led government, which Pakistan accuses of providing safe haven to the TTP. In response, Pakistan closed its borders with Afghanistan and suspended cross-border trade in October 2025, when hostilities escalated following Pakistani airstrikes inside Afghanistan, including in Kabul, which prompted retaliatory attacks by the Afghan Taliban on Pakistani military outposts along the border. Although Qatar facilitated a ceasefire later that month, the agreement proved short-lived and collapsed in February 2026, when renewed fighting erupted in border regions.

Disputes between Pakistan and India have also fueled cycles of cross-border conflict. These tensions are primarily driven by competing claims of the Kashmir region but also fueled by water disputes, ethno-religious rivalry, and accusations between both countries of subversive activity and support for militant groups. The countries have fought multiple wars, including in 1947, 1965, 1971, and 1999. Even during periods of relative peace, skirmishes between Pakistani and Indian forces, cross-border shelling, and activity from militant proxy groups perpetuates securitization and instability along Pakistan’s eastern border. In May 2025, a significant escalation occurred over four days of intensified fighting involving air strikes, drones, and cyber warfare before a U.S.-brokered ceasefire agreement was reached.

Pakistan’s macroeconomic environment has stabilized from the repeated external crises of the past decade, but the economy remains structurally fragile. After an International Monetary Fund program in 2019 helped stabilize the economy temporarily, following years of external imbalances driven by large current account and fiscal deficits, low reserves, and structural weaknesses in taxation and energy, pressures re-emerged sharply in 2022 when global commodity price spikes, high energy import costs, and catastrophic flooding triggered a renewed and more severe crisis. By early 2023, foreign exchange reserves had fallen to barely weeks of import cover, the Pakistani rupee (PKR) depreciated rapidly, and import restrictions were imposed, marking the peak of acute external stress and near-default risk. Following stabilization under a new 2023 International Monetary Fund program, which supported fiscal consolidation, tighter monetary policy, and structural reforms, economic growth improved modestly to around 3.1 percent in FY 2024/25, up from 2.6 percent in FY 2023/24. Growth was supported mainly by stronger industrial activity and services, while agricultural performance remained weaker due to adverse weather and pest pressures. Although GDP has surpassed 400 billion USD in recent estimates, macroeconomic constraints remain significant. Pakistan’s public debt remained elevated at around 70 percent of GDP in June 2025, limiting fiscal space for subsidies, public procurement, social protection, and shock response.

Remittances remain central to Pakistan’s macroeconomic stability and external balance. In FY 2024/25, remittance inflows increased by nearly 27 percent to 38.3 billion USD, up from 30.3 billion USD the previous year, providing strong support to foreign exchange availability and reserve accumulation. The main remittance corridors continue to be Saudi Arabia, the United Arab Emirates, the United Kingdom, and the U.S., consistent with long-standing labor migration patterns. In January 2026 alone, remittance inflows reached around 3.5 billion USD, about 15 percent higher than the same month in 2025. These inflows typically account for around 6 to 8 percent of GDP and remain a critical source of foreign exchange that helps cushion the economy against external financing pressures.

Pakistan operates a market-determined exchange rate regime, with the State Bank of Pakistan intervening primarily to limit excessive volatility rather than maintain a fixed peg. As of April 27, 2026, the official exchange rate stood at about 278.98 PKR/USD, while the January 2026 monthly average was around 280.15 PKR/USD. This level was broadly stable month-on-month, though still substantially weaker than the recent five-year average. Inflation has eased significantly from earlier peaks driven by the economic crises, currency depreciation, high fuel costs, and weather shocks, particularly the 2022 floods, though price pressures remain relevant. Headline Consumer Price Index (CPI) inflation rose to 10.9 percent year-on-year in April 2026, compared with 7.3 percent in March. The State Bank of Pakistan kept its policy interest rate unchanged at 10.5 percent in both January and March 2026 before raising it to 11.5 percent effective April 28, 2026, indicating that monetary conditions remained tight amid continued inflationary and external pressure. Foreign exchange reserves have improved relative to 2023, reaching nearly 20.6 billion USD in April 2026, bolstering external buffers even as vulnerabilities remain.

Pakistan’s trade position remains structurally constrained by import dependence, particularly for fuel, despite its large agricultural base. Imports of minerals, fuel, lubricants, and related materials remained substantial, reaching 321,789 million PKR in January 2026, underscoring the country’s exposure to international fuel price movements. This dependence is further concentrated geographically, with the United Arab Emirates, Qatar, Saudi Arabia, Oman, and Bahrain accounting for more than three-quarters of petroleum imports. As a result, Pakistan remains highly vulnerable to fuel supply disruptions and higher shipping and insurance costs originating in the Gulf. These fuel cost pressures pass through transport, irrigation, milling, and distribution, directly affecting food (production and access) costs and market supply.

Pakistan’s food supply is heavily shaped by domestic cereal production, particularly wheat, rice, and maize. Wheat remains Pakistan’s primary staple crop and the main pillar of domestic cereal supply, with domestic production generally covering most national requirements. In 2025/26, wheat production is projected at nearly 29 million metric tons (MMT), remaining above the five-year and 10-year averages, although slightly below last year’s level (Table 1). In 2025/26, maize production is projected at about 9.8 MMT, above both medium- and long-term averages. Despite this relatively strong cereal production base, Pakistan periodically imports wheat to help stabilize domestic supply in years when production falls below domestic consumption, although import needs are generally modest relative to overall requirements; for example, wheat imports are projected at around 500,000 MT in 2025/26. By contrast, rice production consistently exceeds domestic consumption by a wide margin, with production concentrated in Punjab and Sindh (Figure 5), making rice a structurally important export commodity; in 2025/26 rice exports are forecast at about 5.1 MMT.

Domestic food markets are influenced by both seasonal agricultural cycles and repeated disruptions from weather, insecurity, and policy shifts. Wheat flour saw substantial price declines between March 2024 and July 2025 due to strong harvests, earlier imports, and changes in procurement policy. However, this easing did not persist. By January 2026, prices had risen again to near-record levels in many markets due to lower production, flood-related stock losses (mainly in Punjab), supply constraints, higher distribution costs, and strong demand. Additional volatility has been associated with disruptions to cross-border trade, including the closure of major crossings along the Pakistan-Afghanistan border beginning in October 2025, as well as wider regional conflict dynamics that disrupted fuel and food supply conditions. Market integration is generally stronger across the irrigated grain belt in Punjab and Sindh.

Pakistan’s seasonal price dynamics are shaped primarily by the wheat cycle, given wheat’s central role in domestic food consumption. Market supplies typically increase after the April-June harvest, and prices typically ease during the post-harvest period. Seasonal price movements are typically most pronounced during the pre-harvest period, when household dependence on market purchases tends to be higher, and stocks are tighter. Pakistan’s seasonal market dynamics are also influenced by the rice harvest cycle, which is more export oriented. Rice is produced during the summer season, with the rice marketing year beginning in November, meaning the main harvests and market arrivals typically occur around October-November.

According to PBS data, the proportion of the population reporting various food insecurity related experiences, per the Food Insecurity Experience Scale (FIES), has increased from 15.9 percent in 2018-2019 to 24.4 percent in 2024-2025, with the highest rates recorded in Balochistan (up from 15.2 percent to 30.3 percent) and Sindh (19.5 percent to 29.4 percent), followed by Punjab (14.4 percent to 22.6 percent) and KP (16.7 percent to 21.5 percent). Both FIES data, which is one food consumption outcome indicator within the IPC acute food insecurity reference table, and additional information on the food security context across Pakistan, suggest that the risk of acute food insecurity is greatest in remote rural areas of Sindh, KP, and Balochistan. In these areas, poor households face floods, drought, price volatility, crop and livestock diseases, limited employment opportunities, and localized insecurity.

Pakistan's food security has been shaped over the past decade by structural vulnerabilities and recurrent shocks. Near-total dependence on the Indus irrigation system, which delivers approximately 90 percent of agricultural water, creates systemic exposure to water flow disruptions, whether from disputes over water allocation, infrastructure failure, or climatic variability, which can in turn translate into the loss of food and income sources, including agricultural production. Smallholder dominance and limited agricultural productivity gains mean that even modest weather shocks reduce household food availability and income. Chronic energy challenges raise costs across irrigation pumping, cold chain logistics, milling, and production, while weak rural infrastructure, including roads and storage facilities, erodes food availability and farmer incomes.

The 2022 floods represent the most significant food security shock of the past decade, affecting approximately one-third of the country's land area across 94 districts. The floods damaged or destroyed approximately 1.78 million hectares of agricultural land, killed over 800,000 livestock, and displaced approximately 8 million people, with total damages and losses estimated at 30.1 billion USD. The agriculture, food, livestock, and fisheries sector sustained the greatest losses, with total damage and losses estimated at 12.9 billion USD. Sindh and Balochistan, already among the most food-insecure provinces, sustained the greatest agricultural losses, and recovery has been prolonged, with soil salinity, damaged irrigation infrastructure, and loss of productive assets continuing to suppress livelihoods and food access well into the present day.

Pakistan's macroeconomic crisis of 2022-2023, caused by weak economic governance, fiscal deficits, low economic growth, and high inflation, was compounded by flood impacts, as the PKR lost over 70 percent of its value between early 2022 and late 2023, driving food inflation above 35 percent at its peak before declining to below 10 percent in 2024-2025. Rising import costs for wheat, edible oil, and pulses placed further pressure on food access, while fiscal constraints limited the reach and adequacy of social protection. Remittance inflows, which represent approximately 10 percent of GDP and serve as a critical food security buffer for poor households, declined by approximately 12 percent in 2023 before rebounding to a record approximately 38.3 billion USD in 2024-2025.

Droughts are a recurrent driver of food insecurity in Balochistan and Sindh, particularly in Balochistan, which relies more heavily on rainfed agriculture and livestock than other provinces. Multi-season droughts during 2015, 2017, 2018, and 2022 resulted in depleted livestock holdings due to disease and mortality, eroding a primary asset and income source for many pastoral communities and reducing household resilience prior to the 2022 floods.

Balochistan, southern KP, and southern Punjab and Sindh represent the areas of highest concern, given recurrent weather shocks, poor infrastructure, and limited livelihood diversity. Areas of Balochistan bordering Afghanistan, Iran, and rural areas of southern KP, including former Federally Administered Tribal Areas districts, are also of concern due to insecurity and access constraints. Poor urban households in large cities, including Karachi, Lahore, Quetta, and Peshawar, are also often of concern, given the increased competition for income opportunities that comes with urbanization, and high exposure to food price inflation, amid reliance on informal wages and minimal savings or asset buffers.

Despite declines since the 1980s, Pakistan continues to face persistently elevated rates of acute malnutrition and structural constraints that undermine access to nutrition and WASH services. Nationally, wasting as measured by weight-for-height z-score (WHZ) and/or edema has shown fluctuations over the last four decades, ranging from 24.0 percent in the 1985-1987 National Nutrition Survey (NNS) to 12.5 percent in the 1990-1991 Demographic and Health Survey (DHS); 17.2 percent in the 1990-1994 National Health Survey; 14.1 percent in the 2001 NNS; 14.9 percent in the 2011 NNS; 10.5 percent in the 2012-2013 DHS; and reaching 7.1 percent (6.0–8.4 95% C.I.) in the 2017-2018 DHS. Findings from the 2018 NNS indicated a wasting prevalence of 17.7 percent, more than double the DHS estimate for the same period; however, it is not used in the Joint Malnutrition Estimates. 

These national averages mask large disparities across regions where, historically, Sindh and Balochistan have consistently reported the highest levels of acute malnutrition. In the 2018 DHS, wasting as measured by WHZ and/or oedema was 11.7 percent in Sindh and 18.3 percent in Balochistan, compared with 4.0 percent in Punjab and 7.5 percent in KP; among other administrative regions, global acute malnutrition (GAM) was estimated at 5.3 percent in Federally Administered Tribal Areas and 2.8 percent in Islamabad Capital Territory, against the national prevalence of 7.1 percent.

Recent SMART surveys demonstrate that nutritional vulnerabilities persist. In June 2023, the SMART survey in Naseerabad (Balochistan) conducted in the context of massive flooding in 2022, found Critical levels (15-29.9 percent) of acute malnutrition, with 19.8 percent GAM (15.3-25.2 95% C.I.) and 5.1 percent severe acute malnutrition (SAM) (2.8-9.2 95% C.I.) as measured by WHZ and/or oedema, alongside a crude death rate (CDR) of 0.14 (0.05-0.44 95% C.I.) per 10,000 people per day, and under‑five death rate (U5DR) of 0.10 among females and 0.19 among males, with all reported deaths attributable to illness. The 2023 SMART survey in Sindh’s Dadu and Jamshoro districts, conducted in the context of devastating 2022 floods, reported GAM WHZ of 12.7 percent and 11.7 percent, respectively, consistent with Serious levels (10-14.9 percent) of acute malnutrition. In East Balochistan, Médecins Sans Frontières’s 2022 nutrition survey reported a GAM WHZ above 20 percent and SAM exceeding 5 percent; notably, these levels had not deteriorated relative to pre‑flood conditions, underscoring long-term structural issues rather than acute shock-driven deterioration.

Additional evidence from district-level assessments highlights notable risk factors. In Buner District (KP), which was badly hit by flash flooding during monsoon, a 2025 SMART survey (not published) found 16.8 percent (14.3-19.6 95% C.I.) GAM and 2.1 percent (1.2-3.6 95% C.I.) SAM as measured by WHZ and/or oedema, with high child morbidity, including 28.5 percent cough, 27.3 percent fever, and 9.8 percent diarrhea in the preceding two weeks. WASH conditions were poor, with 87 percent of households not treating drinking water and widespread unsafe waste disposal practices.

Contributing factors remain broadly focused on Infant and Young Child Feeding (IYCF) practices, illness, and food security. UNICEF’s database indicates suboptimal IYCF practices, including only 19.6 percent early initiation of breastfeeding, 47.8 percent exclusive breastfeeding, and 12.7 percent Minimum Acceptable Diet. Dietary quality remains low: Minimum Dietary Diversity is only 15 percent nationally, and complementary feeding practices are weak. National micronutrient deficiencies also contribute. For example, in Naseerabad, only 19.8 percent of children received vitamin A supplementation and 22.1 percent were dewormed.

Across regions, illness patterns reflect substantial disease burden. In recent SMART surveys referenced above, diarrhea, fever, malaria, and acute respiratory infections were frequently reported. Cholera outbreaks in 2023-2024 across Balochistan, Sindh, and parts of KP further increased the risks of malnutrition.

IPC Acute Malnutrition (AMN) analyses illustrate the geographic concentration and persistence of high GAM levels. Between April 2021 and February 2022, eight of nine assessed districts in Sindh, which faced drought conditions, were classified in Critical (IPC AMN Phase 4), with the remaining district in Serious (IPC AMN Phase 3). In the 2023-2024 Integrated Phase Classification Acute Malnutrition analysis covering 32 districts in Sindh, Balochistan, and KP, 23 districts were assessed to be in IPC AMN Phase 4, and 5 districts were assessed to be in IPC AMN Phase 3, driven by large-scale 2022 flooding, insufficient food intake, inadequate sanitation, elevated childhood illness, and poor health-seeking behavior. 

Findings from the 2025-2026 IPC AMN analysis further underscore the sustained acute malnutrition in parts of the country. Sindh remained the most affected province, followed by KP, driven by large-scale 2025 flooding, high malaria burden, and widespread diarrheal and respiratory diseases. Balochistan showed slight improvements relative to 2023-2024. These findings underscore a pattern of chronic crisis in the southern and western provinces. Underlying risk factors remain strongly interconnected. Poor household food consumption, drought conditions, and limited livelihood opportunities constrain dietary diversity. Disease prevalence, including diarrhea, acute respiratory infections, fever, malaria, measles, and cholera, continues to drive acute malnutrition, exacerbated by low health-seeking behavior and limited service availability. WASH system weaknesses contribute to high disease risk through unprotected water sources, inadequate sanitation, and unsafe waste disposal. Community-Based Management of Acute Malnutrition (CMAM) coverage remains insufficient, with only 133,422 children with wasting treated in 2025 across the 45 priority districts, representing just 26.6 percent coverage. 

Despite some district-level improvements over time, the overall pattern suggests that Pakistan’s acute malnutrition burden remains deeply rooted in long-standing structural challenges, including poverty and recurrent environmental shocks. High disease prevalence, inadequate diets, low IYCF indicators, insufficient service coverage, and climate-driven disruptions continue to interact, limiting progress in reducing acute malnutrition.