Unprecedented flooding—arising from and demonstrably tied to climate change— continues to ravage Pakistan, with the official death toll rising by more than 250 since last week.

1,391 people are now reported as having perished due to the floods, which have inundated a third of the impoverished South Asian country. A further 12,700 have been injured. On Friday, Pakistan’s National Disaster Management Agency reported that 36 new fatalities had been recorded within the previous 24 hours.

The official death and injury counts are widely recognized to be gross undercounts, since many areas remain totally cut off due to the destruction of hundreds of bridges and other infrastructure. Furthermore, there is a growing threat of infectious disease.

More than 33 million people, or one in every seven Pakistanis, are variously described as displaced, homeless or directly affected by the floods. Among these are 16 million children.

Even prior to the devastation wrought by the floods, nearly half the population was considered food insecure. Millions of people are now forced to live in makeshift shelters or barely maintained camps. Due to a lack of emergency supplies at these sites, many people are sleeping in the open air.

Flood survivors face shortages of food, drinking water, and sanitary supplies. The lack of toilets has compelled camp residents to relieve themselves outside in the surrounding areas. Worst affected by these unbearable conditions are children and pregnant mothers. According to the United Nations Population Fund, there are 650,000 pregnant women among those affected by the floods, of whom 73,000 are expected to deliver this month.

The absence of adequate sanitary supplies has created ideal conditions for the spread of infectious diseases. Skin infections and stomach flu, spreading widely among those in the camps, have been attributed to the unavailability of toilets. More than 134,000 cases of diarrhea and 44,000 cases of malaria have been reported in Sindh alone. Other mosquito-borne infections are also spreading, with Karachi reporting 1,265 dengue cases in August and 347 cases in the first five days of September.

There is virtually no coordination of rescue efforts to locate people stranded by the floods. Nor are the relief efforts, largely entrusted to the armed forces, in any way commensurate with the scale of the crisis. 81 of the country’s 160 districts have been affected by flooding, and with heavy rain forecast for the coming days a rapid receding of the flood waters is unlikely.

The National Flood Response Coordination Centre (NFRCC) reported Wednesday that the military flew 20 helicopter sorties during the preceding 24 hours, rescuing 217 stranded individuals while delivering 30 tons of relief items to affected areas. The navy and air forces are also running rescue and relief missions, but of a smaller scale.

Despite a slight drop in water levels in recent days, Manchar Lake, the country’s largest fresh water lake, is under constant threat of bursting its banks, which could cause a massive loss of life. To prevent such an outcome, several planned breaches have been made in the lake, which is situated in the central part of Sindh province. As anticipated, the breaches have led to the flooding of many nearby villages and forced the evacuation of several hundred thousand people. On Wednesday, officials in Bhan Syedabad issued an evacuation alert to 150,000 residents, and 10,000 displaced people who had sought refuge there.

The provincial government of Balochistan, the poorest and least developed province in the country, described 32 of its 34 districts as “calamity hit” as of September 1. Khyber Pakhtunkhwa province in the north is also badly affected.

There are fears the flooding could wash away the ruins of Mohenjo-daro, one of the world’s most important archeological sites, which dates back to 2,500 BCE. Floodwaters have not yet touched the site, but it has been damaged by the exceptionally heavy rains, with several walls collapsing. A centre of the Harappan or Indus Valley civilisation, Mohenjo-daro has an elaborate ancient drainage system that has helped it survive previous floods. The site is considered the best preserved ancient urban settlement in South Asia.

On Aug. 30, the United Nations issued an urgent appeal to member states for $160 million to provide flood victims with food, shelter and medical supplies. Despite the massive humanitarian crisis, even this meagre amount has not been raised in the intervening week-and-a-half.

The top priority for Pakistan’s interim government, which is led by a coalition of the big-business Muslim League Nawaz (PML-N) and People’s Party (PPP), is to restrict spending to the limits specified by the International Monetary Fund, as part of a loan bailout package.

To date, the government has allocated just 70 billion rupees or US $314 million for cash handouts to the more than 33 million flood victims—many of whom have seen their homes, crops and livestock destroyed.  

The floods were preceded by extremely high temperatures in March and April, which regularly surpassed 45 degrees Celsius (113 Fahrenheit) and in some places 50 degrees. This was followed by an early start of the monsoon season and rainfall that was three to eight times the average during July and August. The extended heat waves accelerated long-term glacier melting in the Himalayas and Hindu Kush mountains. This has triggered a phenomenon known as glacial lake outburst-floods, as large bodies of water formed by melting glaciers suddenly overflow their makeshift banks and rush down the mountainside to inundate lower-lying areas. In addition to the deadly flash floods, the glacial lake outbursts have triggered devastating landslides.

Dr. Fahad Saeed, the “regional lead for South Asia” for Climate Analytics, an international climate science and policy analysis organization, told BBC the devastating floods in Pakistan are “absolutely a wake-up call” to governments around the world. “All of this is happening when the world has warmed by 1.2 degrees Celsius. Any more warming than that is a death sentence for many people in Pakistan.”

Ahead of his visit to Pakistan on September 9, United Nations Secretary-General Antonio Guterres addressed the continuing refusal by global powers to respond to climate change. “There is a lot of attention,” said Guterres on the war in Ukraine. “But people tend to forget there is another war—the war we are waging on nature, and nature is striking back, and climate change is supercharging the destruction of our planet. To deal with climate change, that is the defining issue of our time, with a business-as-usual approach is pure suicide.”

Such purely rhetorical protests are falling on the deaf ears of the major powers.

Guterres did not mention that the United States is the leader in scuttling an effective response to climate change. This week, Washington pledged $30 million to assist Pakistan’s climate change victims, less than a dollar for every person impacted. This pitiful sum pales into insignificance compared with the tens of billions of dollars in military assistance the US has poured into Ukraine to expand a war against Russia that has already killed tens of thousands on both sides and threatens to trigger a catastrophic nuclear conflagration.

Last week Pakistan’s government placed flood damages at $10 billion, but that figure has been dramatically revised upwards as the scale of the disaster becomes more apparent. Its new estimate is $30 billion or more than 60 percent of Pakistan’s $47 billion national budget. According to Pakistani authorities, more than 5,700 kilometers of roads have been damaged, over 240 bridges destroyed or rendered unusable, and more than a million dwellings either washed away or heavily damaged. UNICEF says 18,000 schools have been damaged or destroyed.

The UN Food and Agriculture Organization reported on August 29 that nearly 80 percent of the crops in Sindh, the country’s second largest province, have been ruined. Among the worst affected is the cotton crop. Raw cotton is Pakistan’s third largest export and is vital to Pakistan’s textile industry, the country’s biggest export earner.

The destruction of crops will also drive up food prices, under conditions where Pakistan, like countries around the world, is being battered by energy and other price increases. Earlier this month, the Pakistan Bureau of Statistics reported the inflation rate has reached an all-time high of 45.5 percent.

The biggest inflation driver came from the removal of subsidies for energy products, which caused prices to skyrocket. As part of an agreement with the IMF, which last week released a $1.16 billion loan tranche to Pakistan, the government is bound to increase gas prices by a further 53 percent. In addition, according to Dawn, it is pledged to revive the general sales tax on petroleum products and slash other price subsidies. The gas price increase alone is intended to generate 786 billion rupees in additional revenues for the government, more than 10 times the sum Islamabad has committed to support the tens of millions of flood victims.

Meanwhile, the floods in Pakistan are disrupting the food supply to Afghanistan, worsening the catastrophic humanitarian crisis in that landlocked country. There are also 1.3 million Afghan refugees living in Pakistan, of whom 420,000 are estimated to be living in the areas worst hit by the floods.