A disaster in the disaster: a study on post-traumatic stress symptoms among flood relief workers in Pakistan

Pakistan’s 2025 monsoon floods created extreme humanitarian demands, exposing frontline relief workers to sustained trauma, hazardous conditions, and challenging safety resources. While post-traumatic stress among disaster survivors in Pakistan is documented, little evidence exists regarding responders. This study assessed post-traumatic stress symptoms among flood-relief workers and examined factors associated with elevated Impact of Event Scale–Revised (IES-R) scores. A cross-sectional analytical survey was conducted in September to October 2025 among verified frontline responders deployed by Alkhidmat Foundation in Punjab and Khyber Pakhtunkhwa. A structured bilingual questionnaire captured demographic, occupational, and exposure variables, followed by the 22-item IES-R. Purposive roster-based sampling yielded 239 respondents (62% response rate). Descriptive statistics summarized characteristics; Mann–Whitney U, Kruskal–Wallis, χ² tests, ordinal logistic regression, and multivariable linear regression assessed associations between exposure variables and IES-R outcomes. Mean IES-R score was 35.6 ± 18.9, indicating moderate distress; 52.7% scored ≥ 33, 52.7% scored at or above commonly used screening thresholds suggestive of probable PTSD. Direct contact with injured or deceased victims was strongly associated with higher total IES-R scores (p = 0.0028) and independently predicted greater severity (OR 1.87; 95% CI 1.22–2.85). Paid staff showed higher distress than volunteers (p = 0.019; OR 1.62; 95% CI 1.08–2.45). Limited personal protective equipment (PPE) availability correlated with increased severity (p = 0.0097; OR 0.71 across ordered levels of PPE availability; 95% CI 0.56–0.91). Debriefing exposure showed no significant effect. Subscale analyses confirmed similar patterns across Intrusion, Hyperarousal, and Avoidance domains. Responders deployed through a large humanitarian organization in KPK and Punjab demonstrated a high burden of post-traumatic stress symptoms, appears higher than some previously reported estimates among disaster responders, though differences in instruments and thresholds limit direct comparison. Direct trauma exposure, professional role, and inadequate protective resources were key contributors. Findings underscore the need to integrate responder-focused mental health and psychosocial support (MHPSS), adequate safety measures, and structured resilience strategies into Pakistan’s disaster-response systems.