Background The global date trade accounts $1.2 billion and 8 billion trade of Pakistan, providing a major source of export revenues as well as of livelihood and income for 100,000 growers, farmers and exporters.The musculoskeletal disorders and occupational injuries being 2nd most common cause of disability measured by DALY (Disability Adjusted Life Years) to the global burden of disease and have emerged as a major challenge for developing countries in the SDGs era. Our study explored determinants and risk factors and affordable strategies for the treatment and rehabilitation in the date palm climber communities.

Methods A sequential mixed-methods study was conducted in rural areas of Sindh from March’ to August’2019 using purposive sampling. The cross-sectional survey explored the musculoskeletal degenerative changes and costs of treatment and productivity loss. The qualitative inquiry (FGDs and interviews) explored the determinants of reduced access and reasons of disabilities and fatalities.

Results Out of 350, around (315) 90% date tree climbers sustained major to fatal injuries with almost all having vertebral and foot deformities. As for treatment (292)83% considered the expenses incurred in consultation fee, medicines, and travel as high. Around (297) 85% rendered meager earnings, unavailability of cheaper medicines and rehabilitative treatment coupled with persistent poverty negatively affected the prognosis and quality of life and paved way for preferring quitting the profession. The qualitative inquiry augmented these findings with all the stakeholders.

Learning Outcomes The paucity of cost-effective rehabilitative services amid socioeconomic burden lead to poor occupation health and preference to quitting of profession.