Pastoralism in the Hindu Kush Himalayan region of Pakistan has undergone significant sociocultural, economic and ecological changes over the last three decades. The economic value of mountain pastoralism has been underestimated and ignored, leading to the loss of Indigenous ethnomedicinal knowledge and threatening food and livelihood security in the eastern Hindu Kush region. This study explores the changes and transformations in mountain pastoralism and their societal impacts, focusing on the loss of Indigenous ethnomedicinal knowledge, traditional skills, food security and livelihood sustainability. Primary data were collected through extensive field surveys conducted from 2010 to 2023. Secondary data were obtained from census reports, rural settlement records, the Food Department of Lower and Upper Chitral districts and the Regional Meteorological Centre (RMC) Peshawar. The study found significant changes and transformations in various aspects of mountain pastoralism, including a decrease in livestock population, alterations in grazing arrangements, the abandonment of high-pasturing practices and the loss of Indigenous ethnomedicinal knowledge and skills. Reduced livestock population causes shortage of meat, milk and other dairy products. Insufficient self-provision of livestock products has led to heavy dependence on external foodstuff on the market, which has raised the prices of food items to unaffordable levels, leading to food insecurity. Further, this is the first ever study to document ethnomedicinal Indigenous information about 61 plants species and one mineral and their therapeutic application. It is inferred that changes in mountain pastoralism underlay the swift erosion of traditional ethnomedicinal knowledge. Finally, this study provides nuanced insights for conservation of medicinal flora and establishes a foundational framework for further scientific investigations in phytochemistry and ethnopharmacology to evaluate novel active ingredients for potential drug discovery within the area. The findings will be useful for policymakers and practitioners in designing effective programmes and policies to decrease vulnerability and enhance food and livelihood security. This article was published open access under a CC BY-NC 4.0 licence: https://creativecommons.org/licenses/by-nc/4.0/ .
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