The floods that hit Pakistan in 2010 were the worst in the country’s history. The humanitarian response achieved remarkable successes in minimising the immediate loss of life and providing relief to millions of people. However, it could have been better: more than 800,000 families remain without permanent shelter and more than a million people remain in need of food assistance. These unmet needs must be addressed as a matter of urgency. As Pakistan faces another monsoon season and the likelihood of more disasters, the country is not prepared. Many factors which have hampered the relief and reconstruction effort are still present, such as an inadequate disaster management system and a lack of emergency relief co-ordination and leadership. These institutional challenges must be resolved as soon as possible. The government and donors need to invest heavily in measures to reduce disaster risks such as better early warning systems, flood control, and more resilient housing. They should also tackle the underlying social inequalities which leave people vulnerable to disasters through a pro-poor national development plan. Spending on risk reduction and preparedness not only saves lives and livelihoods but hugely reduces the economic impact of disasters.