Pakistani flood survivors already short on food and water began the fasting month of Ramadan on Thursday, a normally festive, social time marked this year by misery and fears of an uncertain future.
Damage to crops, roads and bridges have caused food prices to triple in some parts of the country, adding to the pain of millions affected by one of the worst ever natural disasters to hit the already poor nation.
"Ramadan or no Ramadan, we are already dying of hunger," said Mai Hakeema, a 50-year-old who sat alongside her ailing husband in a tent outside the city of Sukkur. "We are fasting forcibly, and mourning our losses."
Observant Muslims fast from dawn to dusk each day for a month each year to control their desires and show empathy for the poor. The month is marked by increased attendance at mosques, a rise in charitable giving and family gatherings.
The fast begins on Thursday in flood-ravaged Pakistan, where the vast majority of the nation's population of 165 million are Muslim.
Floods triggered by heavy monsoon rain over much of the country began nearly two weeks ago, and have killed about 1,600 people and disrupted the lives of about 14 million, including about 2 million who have been forced from their homes.
Many survivors from flooded villages have lost their stores of food as well as crops in the field and livestock, and are surviving on occasional handouts, living in the open.
Fear of fasting
As a massive international relief effort is gearing up to help the flood victims, aid workers fear that the traditional fasting ritual could endanger the health of people already facing food shortages, and complicate efforts to deliver assistance.
People only getting poor nutrition are not well placed to fast although abstaining from drinking water for much of the day could protect people from water-born diseases, said a doctor involved in the relief effort.
"Definitely, they are not in a good position to fast. The food they are taking is not enough," said the doctor, Ahmad Shadoul.
While millions of flood-affected people were performing the fast, Mufti Muneebur Rehman, one of the country's top religious scholars, said victims living in difficult conditions dependent on charity could skip the fast and perform later in the year.
"I am sad to miss the first day of fasting," said Ghullam Fareed of Gormani village in eastern Punjab province. "Later, when we reach home, we will do compensatory fasting."
In the northwest, where residents tends to follow a more strict brand of Islam, many refugees said flood or no flood, they would fast.
"I cannot disobey God, so I am fasting as it is part of my faith no matter what the conditions are," said Fazal Rabi, 47, who was staying in a tent village in Akbarpura.
On Wednesday, the U.N. appealed for $460 million to provide immediate help, including shelter, food, clean water, sanitation and medical care.
"Make no mistake, this is a major catastrophe," U.N. humanitarian chief John Holmes told diplomats from several dozen countries in launching the appeal in New York. "We have a huge task in front of us. The death toll has so far been relatively low compared to other major natural disasters, but the numbers affected are extraordinarily high."
The United States said it was more than doubling the number of helicopters it is providing to help.
Defense Secretary Robert Gates said the USS Peleliu was off the coast near Karachi, carrying 19 helicopters and a complement of about 1,000 Marines. The helicopters will help rescue people and deliver food and other supplies.
The Pakistani government's response to the crisis has been criticized by many as too slow and patchy, and the civilian leaders have struggled to rally public opinion in their favor.
Pakistani Prime Minister Yousuf Raza Gilani flew to southwestern Baluchistan province Thursday to see flood-hit areas. He told The Associated Press that Pakistan still needs more helicopters to assist in the relief work.
"We will try our best to reach millions of people to ensure that they get food and other basic items during and after the month of Ramadan," he said while aboard a military plane.