Since last reported, the flooding in Pakistan has spread and has now struck more than four million people. The UN reports it has left at least 1,600 people dead. The floods have been confirmed as the worst in eighty years.
Heavy monsoon rains led to the flooding of the huge Indus River, destroying homes in the north of the country and causing a large amount of damage in the north-west frontier province of Khyber Pakhtunkhwa. Manuel Bessler of the United Nations said: "What we are facing now is a major catastrophe. We are afraid it will get worse.”
Army and government forces have rushed to evacuate hundreds of thousands of people from parts of the Punjab province of Pakistan, where the disaster spread to yesterday, and from Sindh province, where the flood is expected to reach by the weekend.
The flooding is now in its second week and the situation is unlikely to improve any time soon, especially since in many parts of the country there is still torrential rain, with more forecast. In other parts of Pakistan the water has receded, but this leaves a layer of mud and slime and this covers very large areas. For those affected by the floods, disease is the biggest problem now. The insanitary conditions have already caused diarrhoea and respiratory infections. Cholera and other water-borne diseases may appear if sanitary conditions for those displaced by the calamity are not established. Medical supplies are desperately needed for doctors to keep a pandemic or epidemic of a water-borne disease from infecting the victims of the flooding.
Relief has been hardest to provide in the north-west where many bridges and roads have been washed away. Whole towns have been cut off and this makes providing aid to those areas a very difficult task.
Air force pilots have been volunteering to fly aid missions to badly hit areas, transporting medical supplies, clean water and food to where it is needed. The transport planes carry enough foodstuffs to feed one hundred families for a month. Motivation for the missions among pilots is very high, as is the tension in the transport planes as they fly at 36,000 feet over the flood-hit country. Only from the air is the full extent of the damage visible. Pilots have been flying the maximum number of hours allowed and pushing the limits of their endurance to give the victims of the flood food, water and everything they need to survive.
Many foreign governments and aid agencies are contributing to the disaster relief effort. The U.S. Army has been flying relief missions, airlifting people from areas where they are stranded. The first mission involved four U.S. Chinook helicopters landing in the tourist town of Kalam in the Swat Valley, north-west Pakistan. The resort had been cut off for more than a week, according to a reporter there. The Chinooks flew hundreds of people to safer areas lower down. A U.S. Embassy spokesperson said that 800 people had been evacuated and relief goods had been distributed.
The U.S. government pledged 10 million dollars in assistance following the first reports of the disaster. Yesterday the country promised a further 25 million dollars in aid. A spokesperson from the Embassy said: "The U.S. is making a new contribution of 25 million dollars in assistance to flood-affected populations, bringing its total commitment to date to more than 35 million dollars." The money will go to international aid organisations and established Pakistani aid groups to provide food, health care and shelter to people displaced by the floods.
Malaysia has also decided to contribute US$1 million for relief efforts in the form of humanitarian aid. The Foreign Ministry said the aid was a manifestation of the government and the people's concern and sympathy. "The government of Malaysia hopes the contribution will help alleviate the suffering of flood victims in Pakistan."
In Britain, the Disasters Emergency Committee, an umbrella organisation representing 13 of the leading UK humanitarian agencies, has been coordinating relief efforts and has launched an emergency appeal for public donations to help the victims of the crisis. Charities and aid agencies have been quick to respond to the disaster, sending aid and response teams to the worst hit areas. Food, water, shelter and medical supplies have been provided but much more is needed. 
Patrick Fuller of the Red Cross (the International Federation of Red Cross and Red Crescent Societies), who has been based in the country for a few days, described the situation on the ground as "desperate" and said the worst hit areas are "totally dependent" on outside help. He said the Red Cross movement is working with local partners to get aid packages, containing cooking tools and shelter such as tents and blankets, to 35,000 families.
The Red Cross alone has distributed 10,000 food packs and 1000 tents across the affected areas so far. However, figures for the amount of aid distributed are constantly changing as this is an ongoing relief effort.
Fuller reported that in Nowshera, which is in the north-west of the country close to the Indus River, "80% of homes have been badly damaged or destroyed, all the mud-brick houses have been washed away.
"In the most remote areas - where roads are cut off - donkeys are making eight-hour hikes to reach people.
"We are trying to move people into temporary camps - giving them timber, roofing sheets and basic shelter - but there is the added complication that many are reluctant to leave whatever homes they have left."
This has also been a problem in the south of the country in Sindh province, where the flood is expected to reach by the weekend. Evacuations have been going on to move people out of the path of the flood but many will not join the mass exodus and have chosen to brave the waters.
"Many people rely on open wells, which have been contaminated, so access to clean water is a problem. We are worried about communicable diseases, like respiratory infections, skin diseases, diarrhoea," Mr Fuller said.
The charity have been setting up mobile medical teams to better combat disease and infection.
Though the relief effort at the moment is focused on the survival of those hit by the catastrophe, on those who "had their lives swept away in seconds", the relief effort is expected to last a full six months. 
Those who will be most affected in the long term by this disaster will be the poorest. They will have had everything washed away from them so they will have to start from scratch. Sadly, for those living in the poorest areas in the north and centre of Pakistan, the fight for survival is only just beginning and though they may feel they are enduring much at the moment, getting their lives back together after the first stages of this calamity are over is going to be even harder.
The Disasters Emergency Committee has said it has managed to give aid to 300,000 people so far. Many UK charities have been distributing food and medicine, as well as water purification tablets, cooking tools, shelter and hygiene kits. They have been using rafts, boats and donkeys. Brendan Gormley, chief executive of the DEC, said: "These devastating floods have left millions fighting to survive with little food, clean water or shelter."
The DEC has appealed for donations from the public of the UK to help the victims of this crisis. The appeal is to allow the charities to continue relief work in the worst hit areas of the country.
Following a television appeal by the DEC, £2.5 million was raised and this has enabled the 13 charities the committee represents to reach 300,000 people with emergency supplies. 

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Spreading floods in Pakistan worsen, at least 1600 dead