From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

And we begin this hour in Pakistan. It's been three weeks since devastating monsoon rains began submerging crops and washing away homes and send millions of rural poor scrambling for higher ground. The United Nations now estimates that more than eight million people are in urgent need of food, shelter and water.

There is some good news. The initial sluggish response from global donors has gradually picked up pace. And in the north of the country, the flooded Indus River is beginning to recede.

But NPR's Julie McCarthy is in the southern Punjab province, and she reports that while the rains there have subsided, the dire conditions have not.

JULIE McCARTHY: Hungry flood victims beg for food.

(Soundbite of crowd)

McCARTHY: Men, women and children wade through waters teeming with venomous snakes. Strong currents sometimes pull people under as they attempt to return to their villages that have become islands.

Life rests on a thin reed in flood-ravaged Pakistan. The headmaster of a government middle school in the inundated district of Muzaffargarh is dying. Abdul Hamid has renal failure and needs dialysis.

We have brought your doctor here, and we've stopped off to see you. Have you been able to see a doctor?

Mr. ABDUL HAMID (Middle School Headmaster): No.

McCARTHY: Have you been able to get dialysis?

Mr. HAMID: There is no passage. We can't go to the hospital. There is no transport. How can we go to the hospital? It is a problem of life and death.

McCARTHY: If you can't go for dialysis, it is. Dr. Wasim, this is your patient?


McCARTHY: What do you do with a patient like this? How do you treat him?

Dr. HASSAN: He's totally in a state of life and death. Anything can happen at any time. Even - he can live or he can die.

McCARTHY: Last week, the school principal with an ashen face took a motorcycle over a road so badly rutted. It took us four hours to cross in a car. He hasn't had dialysis since.

Dr. HASSAN: (Foreign language spoken)

McCARTHY: We have to be fatalists and leave it to destiny, he says. That's what's happening here.

The way Katrina laid bare the abject poverty of Gulf Coast America, Pakistan's floods have exposed the dismal conditions and poor governance in the southern Punjab.

The provincial government insists it has deployed over 800 mobile medical units. In five days, we spotted just one. The same goes for aid trucks.

A crowd gathers to watch the water rapidly rising in a canal outside the village of Shehr Sultan, where the floods continue to spread. Local elders say they have never seen the Indus River flood this far east. And that the canal now raging with water has been dry for a decade.

It's widely believed that whatever measures were taken to divert water protected the lands of the rich at the expense of the poor.

Not so, says Sardar Zulfikar Khosa, who advises the chief minister of the Punjab.

Mr. SARDAR ZULFIKAR KHOSA (Adviser to the Chief Minister, Punjab Province): Who would be stupid enough to take on the responsibility of drowning, say, 30 villages or 40 villages? Which idiot would ever go and make such a decision? This is a collective decision. It has not, I repeat, not an individual's decision.

McCARTHY: The province's chief irrigation engineer says this flood was a once-in-a-500-year event, a force that was unstoppable.

But that hasn't stopped deep-seated resentment against Pakistan's wealthy and powerful from surfacing in this flood.

Unidentified Group: (Foreign language spoken)

McCARTHY: The cities have been spared while rural villages are drowning, they shout.

And you say that government says: Yes, we're here with you. We'll stand by you. We'll help you. But you simply haven't seen them.

Eighteen-year-old Mohammad Imran, an electrician, says if the government did show up, there could be trouble.

Mr. MOHAMMAD IMRAN (Electrician): (Through translator) If we guys are going to suffer losses, we are not going to sit quietly. If we are suffering, we will not sit quiet.

McCARTHY: The flooding that destroyed whole villages and killed at least 1,500 people has been called President Asif Ali Zardari's Katrina.

Zardari left the country on a European tour as flood waters ravaged the militant-filled northwest.

Analyst Haider Abbas Gardezi lives in the southern Punjab city of Multan. He says while the president showed insensitivity by leaving, he is by no means the only one deserving blame in a government that was slow to act. But he says this is a defining moment for the government.

Mr. HAIDER ABBAS GARDEZI (Political Analyst): They are standing in a crossroad. They have to see that if they cannot manage things in a very proficient way. If they cannot go to the people in a very transparent, democratic and a friendly way - things can really fire back, and this vacuum can be filled by those forces which are (unintelligible) which we don't want.

McCARTHY: There are fears that the Islamist militants could exploit the growing anger and undermine the fight against the Taliban and its honeycombed of associates.

Extremist groups have moved quickly to fill the void in relief work. The interior minister said today banned extremist groups will not be allowed to visit the flood-affected areas. How that would be enforced amid the chaos here is not clear.

Listening to Zaffar Hussain what is clear is that people feel set adrift. We reached him by boat in the cutoff village Bahawal Nala. He had just that day buried his sister and his brother-in-law.

Mr. ZAFFAR HUSSAIN: (Foreign language spoken)

McCARTHY: Five people in my family were crossing this water in search of rations on the other side, Zaffar says. We were holding hands but got knocked over in the wake of a wave made by a passing truck. We lost our grip, and my sister and her husband were swept away.

The cost of the flood is also counted in the four million acres of ruined farmland, most of it here in the country's cotton belt.

The moon is lighting this area, and you can see a lake of water before us and the outlines of what were huge mango orchards. Dr. Wasim Hassan is with me here. He has lost 500 acres of crops, mostly cotton, some sugarcane and rice.

Doctor, could you sum up for us the loss here.

Dr. HASSAN: People are just, you know, in front of their trees, in front of their cotton, in front of their sugarcane, and they are just, you know, weeping. They're passing through I was going to simply say through a big field. If you ask me to assess the time, I will simply say it will take around about 8 to 10 years for Pakistan, for a farmer for a comeback.

McCARTHY: Eight million people need the bare necessities of a roof, a meal and clean water, yet the global response to their crisis has been lackluster.

One explanation is donor fatigue. But if anyone should be fatigued, it is the men and women and children of Pakistan slogging through one watery indignity after the next.

Julie McCarthy, NPR News, in the flood zone of Pakistan.

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