In the aftermath of a large-scale flooding disaster that affected Pakistan in 2010 (and again in 2011), The Lancet published a paper on the crisis in the country that wrote about a family affected by the disaster in the following words:

And then about the wider crisis, the article stated the following:

The message in this article was clear. The state in Pakistan was failing to reach out to affected citizens in the aftermath of the flooding disaster to provide a basic level of human security. This flooding disaster was unusual; in terms of people affected and the sheer scale of area submerged under water, it was undoubtedly the worst that post-1971 Pakistan had ever seen. But the idea that this had ‘damaged’ relations between the state and its citizens because of ‘the government's shambolic aid efforts’ (Shah 2010), ‘fracturing’ the social contract, was neither new nor novel (BBC News 2011; Ellick and Shah 2010; Rashid 2010).

Pakistan was created as an independent state carved out of British India in August 1947. The state and its citizens are still widely seen as being unable to build a lasting relationship with each other in the seventy years since its creation. Their interaction is regularly referred to as fraught, fragmented or simply non-existent. The absence of a meaningful relationship between the state and its citizens has been the subject of much scholarly and political analysis. Ayesha Jalal's work, for example, highlights some of the cleavages in the state–citizen relationship, particularly with regard to the confusion in understanding nationhood, statehood and identity in Pakistan.