The monsoons in Pakistan have been exceptionally harsh in recent decades, resulting in extraordinary drought conditions and record flooding events. The changing frequency of extreme events is widely attributed to climate change. However, given this region's long history of floods and droughts, the role of natural climate variability cannot be rejected without a careful diagnosis. Here, we examine how oceanic and atmospheric variability has contributed to unusual precipitation distributions in West South Asia. Variations in sea surface temperatures in the tropical Pacific and northern Arabian Sea, and internal atmospheric variability related to the circumglobal teleconnection pattern and the subtropical westerly jet stream, explain more than 70% of monthly summer precipitation variability in the 21st century. Several of these forcings have co-occurred with record strength during episodes of extreme monsoons, which have exacerbated the overall effect. Climate change may have contributed to increased variability and the in-phase co-occurrences of the identified mechanisms, but further research is required to confirm any such connection.