This article looks at the experiences of two areas hit hard by the 2010 mega-floods in Pakistan, one in Khyber Pakhtunkhwa and one in Sindh. It examines how different humanitarian actors understand climatic changes, risk and vulnerability, how this influences their choices of disaster risk reduction activities, and whether these activities promote changes which are merely cosmetic, or transformational. The findings point to the need to expand institutional understandings of risk and vulnerability to include social vulnerability in disaster risk reduction measures, and the importance of knowledge sharing and collaboration between humanitarian and development organisations, government and local communities, particularly at the district levels, to be able to address long-term risk reduction and adaptation.