Emergency by numbers

Here are the facts:

18 million people are affected by these floods. That's more than half the population of Canada. At the height of the floods, about a fifth of the country was underwater, an area about the size of England. 1.2 million houses have been destroyed so far, and the flood waters continue to build in Sindh. 4.5 million people have no shelter -- none. They eat, sleep, drink and defecate under 40 degree heat and 80 percent humidity. They are surrounded by mud, flies, dead livestock, and stagnant water. And the worst part is that all of this misery is nothing compared to what may come.

Acute watery diarrhea is spiking everywhere, especially in conflict-ravaged Khyber-Pakhtunkhwa. Many, if not most, of these cases are probably cholera, but we won't say so, because we don't want to upset the government. It doesn't matter anyway -- whether it's cholera or just AWD, the result is the same: people hemorrhaging water. Without treatment, it's fatal. (These same people are still being bombarded by air raids, incidentally; apparently the Pakistani air force has kept some of its attack helis on reserve for the war on terror. I'm sure the people of KPK, not to mention the aid workers trying to reach them, are thankful.) Meanwhile, stagnant pools of water are beginning to hatch their mosquito larvae. Malaria is on the rise, and respiratory infections too. People are dehydrated and hungry, so their immune systems are sitting ducks. In a few weeks, children already stunted with malnutrition will begin to waste, and we will see pictures the likes of which we typically associate with African famines. The aftermath of these floods could be catastrophic on a scale that we have not seen in recent times -- not in Haiti, not in South Asia after the tsunami. In the worst case, hundreds of thousands could die.

How likely is that? I'm not sure anyone really knows for sure. There were a lot of dire predictions after the tsunami, which thankfully did not come true. But the situation in Pakistan is different, in both positive and negative ways. On the plus side, the government is stronger, and the basic services more robust, than in Haiti or Indonesia. The humanitarian community had more pre-existing capacity in Pakistan than it did in either of those places. But unlike in Haiti, where the devastation was relatively localized, or the tsunami, where the burden of responding was spread across many countries, the Pakistan floods are widespread (affecting 75% of districts) and yet must be dealt with by a single government and a single network of NGOs and UN agencies.

We don't have the capacity to respond. We just don't. We never will. It isn't a question of dollars or people or helicopters -- though we need all of those things, desperately. It's just physically impossible. By the time we mobilize what is needed, the flood waters will be long gone. The world will have kept turning. It will be too late for many. So where does that leave us? Making tough choices about who, among all these miserable 18 million, will receive help. Most will get very little assistance. Many will get none at all.

I'm confident that there is enough international attention on this disaster that we will be able to stave off the worst. But millions of people in this country will spiral into ever-deepening vulnerability. Will this creaking state be able to manage? One thing is for sure: these floods will have a lasting impact on Pakistan for decades to come.