| W |
ith over 42 per cent of households relying on tap water for drinking, Peshawar has been identified as the most vulnerable district to climate-induced water-borne diseases in Khyber Pakhtunkhwa Health Department’s climate Health and Vulnerability Assessment.
Peshawar lacks a proper sewage system. Wastewater is discharged into drains and rivers without treatment. The historic city and provincial capital, Peshawar, recorded the highest number of acute diarrhea and typhoid fever cases across all districts in 2024. This raises serious concerns about the nexus between health and climate change.
Harrowing memories
Mohammad Shahid, a daily wage labourer, who migrated from North Waziristan looking for a better life, settled in the low-lying Muslimabad area of Peshawar. In May 2024, tragedy struck his family in the most painful way; Shahid lost his four-year-old son, Hamza, to cholera, a deadly waterborne disease.
Like many other families in the area, the Shahids had relied entirely on tap water for drinking and daily use, unaware of the risks it carried. “Heavy rains in the last weeks of April 2024 caused severe flooding in Muslimabad,” Shahid recalls. “Streets and homes were submerged in dirty, contaminated water for nearly a week.”
In the first week of May, just days after the floodwaters receded, both of Shahid’s young sons — four-year-old Hamza and six-year-old Bilal —fell ill with severe diarrhea, vomiting and high fever.“I was at work when it happened,” Shahid says. “My wife and I thought it was a minor infection. We had no idea it could be fatal.”
By the time he returned home in the evening, both boys were nearly unconscious. “It was evening when I returned home. Both my children were lying there, barely moving,” he says, his voice trembling. In a desperate rush, he took them to Haji Camp Hospital, where doctors confirmed both boys had contracted cholera. Despite their efforts, little Hamza did not survive.
“I held my son in my arms as he took his last breath,” Shahid says. “He was so weak, so pale.”
When asked why they did not visit the hospital sooner, Shahid replied with sorrow, “I am a daily wage worker. I only come home in the evening. My wife and I did not know it could be this serious.”
While mourning the devastating loss of Hamza, the family had no time to grieve. Their elder son, Bilal, was still fighting for his life. “He was critically ill for two weeks. Too weak to stand, too tired to eat,” Shahid says. “We spent endless days by his bedside in the scorching heat, praying for his recovery.”
“For weeks, I had to buy mineral water to help for my son’s recovery,” says Mohammad Shahid, “Later, when his health improved somewhat, I would carry a large container to a filtration point near my workplace and bring clean water home,” he says.
The rising tally
Peshawar continues to face a worsening health crisis as climate-induced water contamination leads to widespread disease. Not only in 2024, but even in early 2025, Peshawar recorded the highest number of suspected cases of acute diarrhea and typhoid fever across all districts, according to the Integrated Disease Surveillance and Response System.
Moulvi Ameer Shah Memorial Hospital, a specialised healthcare centre for women and children in Peshawar, has reported that water-borne diseases were the most common among patients visiting the Out-Patient Department, according to its annual data.
In 2024 alone, the hospital recorded 68,456 cases of diarrhea and dysentery in children aged five and under. In addition, 13,547 cases of enteric (typhoid) fever and 6,767 cases of worm infestation were reported.
Dr Sufyan Khalil, a medical officer at the pediatric unit of Moulvi Ameer Shah Memorial Hospital, explained the growing concern: “Children are susceptible to waterborne diseases like diarrhea, cholera, dysentery, typhoid fever, as well as vector-borne diseases such as malaria and dengue fever.”
“What’s horrifying,” he added, “is that we are now treating dengue fever cases even during the winter. Rising temperatures are creating a favourable environment for mosquitoes year-round.”
Dr Khalil noted that summer was traditionally the peak season for waterborne illnesses, with hospital wards overflowing from March to September. “However, this year, our isolation unit—which is designated for patients with dysentery, cholera and diarrhea—has been unusually crowded since January. That had never happened before. This unit used to remain mostly empty in the winter months, as such diseases were rare at that time.”
“We are witnessing firsthand how climate change is having serious, negative impacts on children’s health,” he noted.
Climate change
Peshawar valley, once the heart of the ancient Gandharacivilisation, is grappling with growing concerns over water contamination and poor waste management. A region where clean water was once taken for granted has now become emblematic of a worsening water crisis.
The heavy rains in late April were largely unexpected. These are a direct consequence of shifting weather patterns attributed to climate change. These downpours not only caused widespread damage to homes and standing crops across the province but also laid bare the vulnerability of the city’s already strained urban infrastructure.
According to Regional Meteorological Department, what used to be light but consistent winter rainfall now occurs in short, intense bursts. These sudden downpours result in frequent urban flooding, overwhelming the city’s fragile water systems, which are ill-equipped to store or manage the excess water.
The Climate and Health Vulnerability Assessment is a scientific assessment plan to develop an adaptation plan called Climate and Health Adaptation Plan.
Not only in 2024, but even in early 2025, Peshawar recorded the highest number of suspected cases of acute diarrhea and typhoid fever across all districts, according to the Integrated Disease Surveillance and Response System.
The assessment by Health Department with assistance from the Evidence for Health Programme and funded by the Foreign, Commonwealth & Development Office, has been formally launched.
“The assessment has revealed that climate change not only exacerbates existing health issues but also degrades health services, water and food security and social protection framework, placing an additional burden on already overstretched health services,” said DR Rehman, a senior official of the Evidence for Health Programme in Peshawar.
The CHVA also revealed that waterborne diseases were also highly prevalent in the northern districts of Dir and Swat, the northeastern district of Haripur, the western district of Kurram and the southern district of Tank.
Rehman added that if the government failed to create resilience to climate change in its health services, the province could experience 10-20 percent increase in water borne diseases, 30-40 percent increase in dengue fever and malaria and a 20 percent rise in respiratory illness. 16-18 million additional people may face injuries and sickness or be killed in disasters.
Water and sanitation infrastructure
With a population exceeding 2.4 million and a growth rate of 2.86 percent, Peshawar faces mounting pressure on its already fragile water and sanitation infrastructure. Despite its growing urban sprawl, the city lacks proper sewage treatment facilities, putting public health and the environment at serious risk.
Shaida Muhammad, project director of the Water Quality Central Lab at the Public Health Engineering Department, says that Peshawar does not have a functioning sewage system. Wastewater is discharged directly into drains and rivers without treatment, including in upscale areas such as Hayatabad. “Both residents and the administration rely solely on open drainage systems to dispose of sewage water, with no treatment plants in place,” he states.
He explains the difference between the two systems: “A drainage system is designed to carry excess rainwater to reservoirs, seas or designated outlets. A sewage system is responsible for carrying wastewater and solid waste for proper treatment and disposal. The absence of a sewage system in Peshawar not only creates environmental hazards but also increases the risk of contamination in tap water channels that run close to these open drains.”
Two sewage treatment plants were originally planned for Peshawar — one in Hayatabad and the other on Warsak Road near Askari Colony, he adds. However, both have remained non-operational for years.
Shaida Muhammad says that in Hayatabad, the land allocated for the treatment plant was repurposed by the BRT authorities for the construction of The Mall of Hayatabad. Meanwhile, the provincial government’s 23-acre site on Warsak Road has seen no progress, leaving the city without a single operational sewage treatment facility.
“Recent lab tests conducted at approximately 140 locations across rural Peshawar revealed alarming results. More than 45 percent of the water samples were found unfit for drinking,” Shaida Muhammad says.
Drinking water distribution
The distribution and delivery of clean water in Peshawar have long been problematic. The interventions aimed at addressing the issue continue to face significant challenges.
The water and sanitation services in Peshawar are managed by two entities across the city’s 93 union councils. The Water and Sanitation Services Peshawar oversees 42 union councils. The remaining councils fall under the Rural Development Department. This division complicates service delivery, coordination and infrastructure development, affecting the efficiency of water and sanitation management.
Javed Ali, a spokesperson for the WSSP, says that, in addition to conducting 100 water quality tests on tube wells and pipelines, WSSP teams respond to public complaints. He says the WSSP has installed a Supervisory Control and Data Acquisition system at 134 tube wells, enabling automatic operation and real-time monitoring of water quality data.
According to the 2023 census, out of the 690,976 households in Peshawar, 670,248 have access to improved drinking water. Of these, 294,991 households rely on tap water. The rest depend on dug wells (45,682), bottled water (683) and filtration plant water (683).
Peshawar’s population is entirely dependent on groundwater for domestic use, as there is no major surface water supply. This over-reliance has caused a significant decline in groundwater levels, exacerbated by climate change, extreme heatwaves, reduced rainfall and inadequate recharge facilities. Recent WSSP data shows a 20-foot average drop in groundwater levels, with some areas experiencing a decline of up to 35 feet.
The situation is dire, with tube well development data (2016-2022) and electrical resistivity tests (2023-2024) underscoring the urgency for intervention. Authorities warn that if this trend continues, water quality and availability will be severely impacted, threatening Peshawar’s ability to meet the growing demand for safe drinking water.
Inadequate coordination
Despite being passed over three years ago, the KP Water Act 2020 remains unimplemented, leaving critical water management and regulation issues unresolved. The Act mandates the creation of a Water Resources Commission and a regulatory body to oversee water and sewerage services. However, the commission has yet to be established. This is delaying vital reforms in water supply, sewerage and drainage systems for both domestic and commercial sectors.
Dr Rehman emphasises the importance of the World Health Organisation’s concept of Health in All Policies in addressing waterborne diseases.
He says effective coordination between the Public Health Engineering Department and the Health Department in KP is crucial for controlling these diseases. Dr Rehman says that an intervention by the Provincial Health Engineering Department could prevent up to 30 percent of waterborne diseases.
“A cost-effective approach will not only improve public health but also significantly reduce the burden on government hospitals by alleviating pressures on hospital beds and reducing the need for medicines,” he says.
According to Chief Minister’s Advisor for Health Ihtehsam Ali, there is a lack of sustained coordination between the Health Department and the Public Health Engineering Department. Most coordination occurs instead with the district administration or local authorities.
“Whenever there is an outbreak of a water-borne disease in the province, it is the Health Department that steps in first” he says. He adds that recent outbreaks of water-borne diseases in Malakand and Landi Kotal were identified based on cases reported through OPDs. The department responded by setting up tent hospitals and medical camps to manage the situation on the ground.
He says that once an outbreak is confirmed, the Health Department contacts the Public Health Engineering Department to clean and disinfect the water channels in the affected areas to prevent further spread.
“This is the current extent of coordination between the two departments,” the advisor says. “Under the CHAP initiative, the Health Department is taking action to combat water-borne diseases,” Ali says.
The contributor is aPeshawar-basedjournalist with aninterest in environment, climate change and health. He tweets kjaved834