Western aid agencies in Pakistan warned Wednesday they might have to halt flood relief efforts in the cash-strapped country because of funding shortfalls.
Floods in August hit Sindh province in the south, killing at least 430 people and disrupting the lives of nine million. Many people are still camping out in the open with little food, water or shelter.
Western aid agencies made an urgent appeal for $357 million (223 million pounds) in September, but only 23 percent of that has been secured.
If more cash doesn't arrive soon, aid agencies such as Oxfam, Save the Children and Care may be forced to leave flood victims to fend for themselves.
Aid agencies fear flood victims could suffer from a major outbreak of dengue fever, malaria and acute respiratory infection.
The sort of things that we're really concerned about are those very basic humanitarian essentials like access to clean water and sanitation which over 60 percent of the affected population at the moment still don't have access to, said Oxfam's Country Director in Pakistan, Neva Khan.
If we can't ensure clean water to as many people as possible, the risk of all these things increasing and causing a public health crisis is a key concern.
Aid agencies have said Pakistan's image of a haven for Islamist militants -- especially after U.S. special forces found and killed Osama bin Laden in a Pakistani town in May -- have made it a bad brand to sell to global donors.
While a combination of factors -- donor fatigue, the global financial slump, competition from other crises such as the East African famine -- have all played a part, geopolitics and security remains one of Western donors' major concerns.
The U.N. says the floods have wiped out massive swathes of agricultural land, killed thousands of livestock and destroyed food stocks in Sindh.
The government is in no position to step in because the South Asian nation's economy is weak and heavily dependent on foreign aid. It has yet to care for some 800,000 people displaced by last year's floods.
Hardships are likely to increase as winter approaches.
Children's immunity is very weak, and we fear winter will make the situation worse if aid is not immediately stepped up, Save the Children's Pakistan Country Director, David Wright, said in a press release.
(Editing by Michael Georgy)