Flood victims camped out near inundated fields and crowded hospitals on Monday as authorities and international aid groups struggled to respond to Pakistan's second major bout of flooding in just over a year.
Monsoon rains since early August have killed more than 220 people, damaged or destroyed some 665,000 homes and displaced more than 1.8 million people in the southern Sindh province, according to the government and the United Nations, which Sunday made an emergency appeal for funding.
"First it started to rain, then water gathered here and there and later the floods came," said Mohammad Hashim, who was sitting by the side of a main road in Badin district. "We did not get any relief. We are helpless, with nothing left to eat. Where do we go?"
The road is the highest stretch of land in the area, and on either side the floods stretch for kilometers (miles).
Sindh saw similar scenes during last year's floods, which at their peak affected all four of the country's provinces and triggered a massive international aid response. While some districts in the region have been flooded out twice, many of the hardest-hit towns and villagers this year were unaffected in 2010.
The return of the floods is testament to the powerful penetration of the monsoon rains that envelop much of Asia at the end of summer. It also points to the limits of Pakistan's government, often blasted as weak and corrupt. During normal times, Islamabad officials are seen as barely helping citizens.
As the rain did last year, the floods are undercutting the legitimacy of the shaky government, which is widely disliked and struggling against Islamist militants, political turmoil and massive economic problems.
Mohammad Rafiq, an army soldier involved in rescue and relief work, said there was little coordination.
"The affected people have set up their tents where they felt it was suitable. There are so few dry and safe places available to them."
Thousands of people, flushed from their homes in some of the country's poorest villages, have made temporary shelters from bits of plastic, cloth and wood. Many had brought household possessions like beds and pots and pans with them. Some had brought their cows, which were tethered on the road.
The 52-bed Badin Civil Hospital was treating more than 100 patients.
Ameer Zadi said she had to carry her younger sister, Begum, on her back through the waist-high waters after she was bitten by one of the many snakes that have been disturbed by the floods. Begum was lying on a dirty bed with flies buzzing around. It was unclear whether the snake was venomous.
Elsewhere, 20-year-old Zubaida Ismail was recovering from a miscarriage that occurred when her house collapsed.
Six months pregnant, she lay bleeding in the remains of her home until an army boat appeared and took her to safety, then to the hospital, her sister said.
A doctor at the hospital, Rahim Rahimoo, said the situation there was "under control" but he was concerned about waterborne diseases and malaria, noting that the volume of patients was increasing daily.
In 2010, the floods followed the course of the River Indus and its tributaries from the foothills of the Himalayas to the flatlands of Sindh, where the river empties out into the Arabian Sea.
Many of the countries that helped out then, including the U.S., have mobilized again this year to assist victims.
The U.S. said it paid for food packages for 23,000 families and its local partners will soon begin handing out tents, clean water and other supplies. Japan and China have also pledged relief goods or money, according to the Pakistan government.
"The numbers (of affectees) are growing by the day and we would like to be able to reach as many people as possible with humanitarian assistance ... so hopefully they can return to homes and recover," said Stacey Melissa Winston, a spokeswoman for the United Nations.