When natural disasters such as flooding affect a region, ill-health tends to follow. This commentary reviews the epidemiological evidence and considers the implications of the rate and prevalence of mental disorder in the flood-affected regions of Pakistan. In particular, the risk of increasing disability is highlighted. Given the limited resources for psychiatric assessment and treatment available currently in Pakistan, the case is made for investment and aid to prevent the significant long-term mental health consequences that could arise from the recent natural disaster. Rainfall in Pakistan varies radically. The monsoon season (from July to early September) is marked by heavy downpour. This phenomenon, along with monsoon depressions arising from the Bay of Bengal, leads to extremely high flood peaks in rivers and generalized flooding. With an average of 579,732 people subjected to potential damage each year, Pakistan is ranked 9th out of 162 countries affected by flood.1 Last year the province of Khyber Pakhtunkhwa received the highest recorded rainfall in the last 80 years, killing more than 1600 people and affecting more than 14 million people.2 In the immediate aftermath, deployed aid and rescue teams combatted acute infectious diseases and the immediate after effects as best as they could. However, as the emergency situation stabilized and mental euphoria of surviving the flood began to wane, issues of post-traumatic stress disorder (PTSD), survivors' guilt and generalized depression were seen lurking in the background. In addition, the army predicted that rebuilding the infrastructure could take upto 6 months, during which those affected would remain displaced in relief camps across the country, creating not only a physical but also a cultural displacement from the conservative rural to liberal urban and peri-urban areas. Mental health issues often take a back seat to the more immediate effects of natural disasters obviously because complications related to mental health do not usually become apparent until much later. As experience shows, both financial and physical relief efforts reach a peak a few weeks after natural disasters and gradually begin to decline in the chronic phase where much effort is still required. Nevertheless, complications related to mental health following floods have been extensively described in various journals published internationally. In terms of long term morbidity, PTSD is arguably the most important of these. Over the past few years, there have been a number of publications that have focused on the prevalence of PTSD in regions affected by severe flooding.3-7 In 1993, Tobin and Ollenburger found that up to 71% of the questioned adults, with no symptoms of anxiety prior to the event, described symptoms of PTSD 3 months after extensive flooding in the American Midwest.8 More recently, Huang et al. carried out a survey amongst individuals affected by floods in China, 2 years after the event and found 9.2% of the subjects to be 'probable PTSD-positive'. 9 The incidence of psychiatric symptoms has been shown to be directly linked with the dissatisfaction of help received during the floods.10 Research has also shown that the risk of developing PTSD is dependent on age and gender. While analyzing mental health effects of floods in Bihar, Telles et al. found that, compared to younger individuals, prevalence of the condition was greater in survivors over 60 years. 11