I don't use CloudFlare I manualy check about once a week. but unfortunately I've had to ban some npubs from my file server recently because I've seen things along these lines. I knew it would happen eventually, but it was genuinely depressing to see.
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I also manually moderate my relay. Cloudflare only does DNS for the relay. I don’t have proxying on, so no caching or edge stuff.
I’ve been hesitant to run a bigger hosting service for images because of this. And Nostr.build has done a great job. nostr:npub138s5hey76qrnm2pmv7p8nnffhfddsm8sqzm285dyc0wy4f8a6qkqtzx624 is working on a project that makes it much easier to host and keep an eye on things. Anyone with a VPS or a home server they are willing to expose to the WWW can host their own and their NIP-05 using it.