7.4. Reasonableness to settle

Across Islamabad, Karachi and Lahore, available information indicates growing pressure on access to adequate food, mainly linked to rising prices, climate-related disruptions and pressure on local food supply. In all three cities, poorer households appear particularly exposed, although the degree and form of vulnerability differ.

In Islamabad, rising food prices reportedly affect slum residents in particular, limiting access to more nutritious foods such as meat and fruit; women were reported to be especially disadvantaged. At the same time, some mitigation efforts have been introduced, including measures to promote fortified flour and increase local food consumption.

In Karachi, food insecurity appears more widespread and structural. In Sindh province, almost one third of households were reportedly affected by moderate or severe food insecurity, linked to drought, water scarcity and flood-related crop damage, all of which contributed to reduced agricultural output and higher prices.

In Lahore, food access was also affected by supply pressures, including shrinking agricultural land and monsoon floods. Sharp price increases and shortages of key food items were reported, although government-supported Sahulat Bazaars provided some subsidised access to essential commodities.

Across Islamabad, Karachi and Lahore, formal housing coexists with significant informal settlement patterns, particularly affecting lower-income groups. In all three cities, residents of slums or informal settlements appear more exposed to overcrowding, unsafe structures and environmental risks. In Islamabad, marginalised communities in informal and peri-urban settlements face exposure to flash floods and heat waves. Most households reportedly have access to a washroom. In Karachi, housing vulnerability appears most acute, with around 60 % of residents living in informal settlements (katchi abadis) marked by overcrowding and unsafe buildings, including roof and building collapses. In Lahore, significant slum areas persisted, while property prices further increase low-income households’ reliance on informal housing.

Across Islamabad, Karachi and Lahore, available information points to significant shortcomings in access to water and sanitation, although the nature and severity of these problems differ between the three cities. In Islamabad, water quality is poor and supply insufficient, resulting in water rationing; dam construction is cited as a mitigation measure. In Karachi, access to the public water system appears uneven due to deficiencies in infrastructure and water theft, with many residents reportedly depending on private water tankers. Conditions in katchi abadis are described as particularly poor, with limited or no access to piped water and sanitation, increasing exposure to waterborne infections, though access varies across settlements and city areas. In Lahore, water shortages, flooding, sewage contamination and severe air pollution combine to create a particularly acute environmental situation.

Across Islamabad, Karachi and Lahore, access to healthcare infrastructure is generally good, particularly in central urban areas and both for basic and specialised services. At the same time, the quality and effective availability of care appear to vary depending on local capacity, type of facility and ability to rely on public or private provision.

In Islamabad, healthcare access is reported to be good overall, with all three levels of the health system described as easily accessible, namely primary care through BHUs and Rural Health Centres (RHCs), secondary care through Tehsil Headquarters (THQ) and District Headquarters (DHQ) facilities, and tertiary care through specialised hospitals.

In Karachi, healthcare facilities are also described as generally accessible for most residents, with the relative exception of the outer Malir District. However, public hospitals face significant capacity constraints, in particular a severe shortage of medical staff. At the same time, treatment is available for conditions including tuberculosis, HIV and hepatitis.

In Lahore, the healthcare situation appears comparatively strong, with the city ranking second out of 129 districts in the District Vulnerability Index of Pakistan and hosting a high concentration of specialised hospitals. Both public and private healthcare sectors are well developed, although recent changes suggest reduced insurance-based coverage in public hospitals and only limited continued coverage in registered private facilities.