s Pakistan braces for another monsoon, public health warnings tend to focus on flooding, waterborne stomach illness and dengue. But there is a health crisis brewing at the street level that gets far less attention: what heavy rain, stagnant runoff and thick humidity do to skin. Every year, clinics across the country see the season turn streets into a breeding ground for skin infections—of which most people have no awareness.

The scale of the problem is well documented. Global data from the Centre for Research on the Epidemiology of Disasters recorded 223 major flood events worldwide in 2021 alone, more than any other type of disaster that year. Pakistan remains one of the most frequently flood-affected countries on that list. Locally, the country’s own disease surveillance system reports the same pattern. Following the 2010 floods, health authorities recorded 143,870 cases of skin infection in Sindh alone, a figure widely cited in Pakistani flood-health literature more than a decade later.

During the 2022 floods, health workers at clinics and relief camps across flood-hit districts logged every new case they saw—including skin infections, diarrhoea, malaria, respiratory illness—into a shared national reporting system run by National Institute of Health in partnership with the UK Health Security Agency. This real-time tracking, designed to catch disease outbreaks early during emergencies, allowed researchers to later analyse the data and build a clear national picture of the health toll. A study based on this record, published in Disaster Medicine and Public Health Preparedness, documented more than 1.5 million disease notifications out of which skin infections were consistently among the leading categories alongside malaria, diarrhoeal illness and respiratory infections. A separate study in the Annals of Medicine and Surgery recorded over 132,000 cases of respiratory illness and close to 143,000 skin disease cases nationally, and pointed to humidity and prolonged contact with contaminated water as the primary drivers.

Researchers studying Pakistan’s water crisis argue that the problem runs deeper than any single flood season. At a recent seminar on water quality and public health, researchers from the Pakistan Council of Research in Water Resources and the Pakistan Institute of Development Economics noted that unsafe water already contributes to nearly 40 percent of disease nationwide in an ordinary year. Only 47 percent of the population has access to safe drinking water. As per UNICEF data (cited at the same seminar), nearly 70 percent of households consume bacterially contaminated water. Only 38 percent of the country’s wastewater is treated before discharge. When monsoon rains overwhelm drainage systems, that untreated water mixes directly with the floodwater that ends up on streets, in homes and on skin.

Polluted water of this kind carries more than dirt. It carries bacteria, fungi and toxins directly responsible for several skin conditions. Prolonged contact produces persistent irritation, redness and itching behind painful skin infections. Sewage-contaminated water creates ideal breeding conditions for mites, triggering outbreaks of intensely itchy skin disease.

Mosquitoes and insects are far more active in wet weather, breeding rapidly in stagnant rainwater. Beyond the direct risk of dengue fever, insect bites this season often trigger more than a passing itch. Many children and adults develop small, intensely itchy raised bumps appearing in clusters on exposed skin as an allergic reaction to mosquito, flea or bedbug bites. These can persist for days, get scratched raw, and occasionally, become infected.

Insect repellents, full-sleeved clothing, well-maintained screens on doors and windows, mosquito nets all help prevent bites. If bumps appear anyway, avoid scratching, apply a cool compress and see a doctor if they spread, blister or show signs of infection.

Proactive monsoon planning keeps these issues at bay. Monitor weather updates every morning and plan the day around it. Avoid unnecessary outdoor visits during heavy rain or flooding. Plan errands and visits around the forecast rather than convenience. Every hour spent wading through flooded streets means more exposure to contaminated water. If caught in the rain or exposed to standing water, don’t wait, wash thoroughly with soap and water as soon as possible and change into dry clothes immediately.

To ensure a safe household water supply, follow water safety directives, especially during monsoon season. Clean domestic storage tank through a two-step treatment process utilising alum and chlorine. However, this measure is restricted to non-potable household water and should not be applied to water destined for direct human consumption or culinary use.

At the root of this recurring crisis lies something far more fixable: a basic lack of awareness about seasonal skin hygiene. Public awareness campaigns in schools, workplaces and community centres should begin before the rains arrive, not once clinics are already overwhelmed. Since malaria and dengue campaigns already run every monsoon season, incorporating simple skin-health messaging into them would cost very little while substantially alleviating a disease burden—the evidence has long shown to be neither small nor new.

The writer is a consultant dermatologist based in Karachi with over a decade of experience in clinical dermatology.