Rozina is a pseudonym used to protect her identity. She was interviewed for this story about her experience during the floods in southern Khyber Pakhtunkhwa. Some identifying details have been withheld to protect her privacy.

The water came at night, which is the detail Rozina returns to most often. Not the depth of it, not what it took, but the hour. It was dark, and she was bleeding, and the family had to move.

Her village sits in the flat country east of Bannu city, where the Kurram and the Tochi run down from the hills and spread out across farmland that is good precisely because the rivers have flooded it for centuries. In an ordinary year this is a blessing. In the monsoon years that have come one after another since 2022, the rivers arrive faster and higher than the old men remember, and the mud-brick compound walls that define a household's private world dissolve in a few hours.

What washed away first, in Rozina's compound, was the latrine.

The geometry of privacy

To understand what that means, you have to understand how a woman's day is built in this part of Khyber Pakhtunkhwa.

Rozina is thirty-one. She has four children. She has, in her adult life, almost never used a toilet that was not inside her own compound walls or the walls of a close relative's. This is not a preference. In a district where purdah is the organizing principle of public life, the compound wall is what makes it possible for her to exist as a body at all — to wash, to change, to squat, to be unobserved.

The latrine in the corner of the yard, a pit and a concrete slab and a curtain of sacking, was not plumbing. It was infrastructure for her dignity.

The flood took the sacking curtain, then the slab, then the walls.

For eleven days the family lived on the raised embankment of the road with perhaps sixty other households, under tarpaulins, the men on one side and the women on the other with a rope strung between and a sheet hung over it.

There was no latrine at all for the first four days. Then the district administration set up six for the whole encampment, for everyone, unsegregated, in the open, a hundred metres from the sleeping area, with no lock on any of the doors and no light.

Rozina's period started on the third day.

Three o'clock in the morning

She did what the women around her did, because there was nothing else to do. She stopped drinking water after midday, so that she would need the latrine less. She ate almost nothing.

And she waited until the camp was fully asleep — usually somewhere between two and four in the morning — before walking out with her sister-in-law holding a chador stretched between her hands as a screen.

“We went together. Never alone. Even for a minute, never alone.”

The cloth she used she had been using for years: strips torn from an old shalwar, washed, dried, folded, reused.

In normal conditions, the practice depends on three things: water to wash the cloth, soap, and a private place in the sun to dry it.

The flood removed all three simultaneously.

The water in the camp was for drinking and was rationed. Washing menstrual cloth with it, in front of people, was unthinkable. And drying was the hardest problem of all: a menstrual cloth could not be hung where men might see it.

So Rozina dried the cloth under her bedding, inside a folded quilt, in damp August heat, and put it back against her body before it had properly dried.

By the second month after the flood, she had developed a urinary tract infection and another vaginal infection she had no name for.

She did not tell anyone for a long time.

The medical camp that came through was staffed by a male doctor, and to describe the symptoms to him she would have had to say words she had never said aloud to a man.

What the relief truck brings

There is a standard shape to Pakistani flood relief and Rozina can recite it: flour, cooking oil, lentils, sugar, tea, tarpaulin, a water cooler, sometimes a mosquito net.

During the catastrophic 2022 floods, millions of people across Pakistan were displaced, and menstrual hygiene emerged as one of the less visible challenges facing women and girls living without secure sanitation, private washing facilities or reliable access to basic supplies.

In Rozina's area, significant menstrual hygiene distributions reached women through a local women-led organization rather than the state, and they arrived weeks late.

When packs did come, they came with two problems attached.

The first was that some women in the camp had never used disposable sanitary pads and did not know how to use them.

The second was that a pad, once used, had to be disposed of. In a camp with no effective waste system and almost no privacy, disposal could itself become a visible and embarrassing act.

Several women in Rozina's row took the packs, said thank you, and continued using cloth.

Nobody had asked them first.

That is the recurring failure, and it is not a complicated one.

The things Rozina says she actually needed, when asked, are unglamorous and cheap: a bolt on the inside of a latrine door. A latrine block for women only, close enough to reach at night. A solar lamp. Soap. A roofed, screened line to dry cloth.

A female health worker, even one, even part-time.

The part that doesn't wash away

Rozina's family rebuilt.

The walls went up again, mud and straw, the way they always have. The latrine was dug in the same corner, which her husband and brother-in-law both said was the sensible place, and which everyone in the household knows may flood again.

That is the piece of this that is properly about climate and not only about poverty.

Pakistan contributes only a small share of global greenhouse gas emissions yet remains highly exposed to climate-related disasters, including extreme rainfall, flooding and heat.

For families living in flood-prone parts of southern Khyber Pakhtunkhwa, repeated monsoon disasters increasingly raise a harder question: what does recovery mean when the same infrastructure may be destroyed again?

The eleven days on the embankment were not simply an aberration in Rozina's life.

They were a rehearsal.

She is aware of this in a way that is entirely unsentimental.

Asked what she will do next time, she was quiet for a moment and then said she had begun keeping a separate bundle — cloth, soap, a small plastic sheet, a spare chador — tied up and kept high, near the roof beam, where the water is less likely to reach.

Adaptation, in the most immediate sense of the word.

A woman in Bannu, planning around the disappearance of a toilet.

Why this is a policy question

Menstrual health can easily be pushed to the margins of disaster response, treated as something to address after food, water and shelter.

For women living through displacement, however, sanitation, privacy and menstrual health are inseparable from physical safety and health.

A woman who reduces her water intake during extreme heat because she is afraid to use an exposed latrine faces another health risk on top of the disaster that displaced her. A girl without access to a safe and private toilet may struggle to continue attending temporary learning spaces. An infection becomes harder to treat when women cannot comfortably speak to the available medical staff.

The fixes are known and comparatively simple: sex-segregated latrines with internal locks and lighting, placed close to shelters; female health workers embedded in mobile medical teams; menstrual materials selected after consulting the women expected to use them; private washing and drying spaces treated as core WASH infrastructure rather than an optional extra; and women involved in camp layout decisions before the layout is fixed.

None of that requires a technology that does not exist.

It requires that someone planning a camp think, at the planning stage, about a woman walking a hundred metres in the dark.

Rozina did the thinking already.

She has been doing it, by herself, at three in the morning, for years.