Flood-affected people carry their belongings out from their flooded homes in Shikarpur, Sindh, Pakistan, on Thursday. AFP

Gulf Today/Riaz Khan/Associated Press

Pakistan has received nearly 190% more rain than the 30-year average in the quarter through August this year, totalling 390.7 millimetres (15.38 inches). Sindh province, with a population of 50 million, was hardest hit, getting 466% more rain than the 30-year average.

At least 380 children were among the dead, Prime Minister Shehbaz Sharif told reporters during a briefing at his office in Islamabad.

At a charity clinic in a southern Pakistani village, dozens of people affected by relentless rains and floods crowd around the door waiting to talk to a volunteer doctor.

A child sits on dry ground near his family after fleeing from his flood-hit home in Shikarpur, Sindh. AFP

The village of Bhambro is in a poor district of Sindh province, hard-hit by record floods that have destroyed more than a million homes and damaged critical infrastructure including health facilities across the country.

Bhambro is surrounded by vast stretches of flooded farmland, its streets full of mud and strewn with debris and manure — conditions ripe for outbreaks of malaria, cholera and skin diseases such as scabies.

"Skin diseases are the main problem here because of dirty, stagnant water and unhygienic conditions," said Sajjad Memon, one of the doctors at the clinic, which is run by the charity Alkhidmat Foundation.

He used the flashlight on his mobile phone to examine patients, who were mostly reporting scabs and rashes on Tuesday.

Displaced families, who fled from flood-hit areas, collect water from an underground water tank in Karachi. AFP

Many had made their way to the clinic walking barefoot through filthy floodwater and mud.

"My child's foot is burning with pain. My feet too," said Azra Bhambro, a 23-year-old woman who had come to the clinic for help.

Rubina Bibi was cooking food for her family in her mudbrick home in her village in northwest Pakistan when the nearby mosque blared a warning from its loudspeaker. Flood waters were coming, it announced, everyone should move to safer ground.

She and her family didn’t take it seriously. There had been flooding in their village of Majooki more than a decade ago, and they hadn’t needed to flee.

This time, however, it was on a different scale entirely. Days of torrential rains had sent a massive surge of water down the nearby Swat River — so powerful that on that day, last Friday, it broke through a reservoir that usually controls the river’s flow.

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When the water hit Majooki hours after the warning, it poured into the house where the 53-year-old Bibi lived with her two sons, a daughter-in-law and her grandchildren.

One of her grandchildren, 5-month-old Dua Humayun, was sleeping on a cot in the house’s courtyard. In an instant, the baby was swept away by the rushing waters. It was too fast for anyone to even think of saving her. She was gone.

Millions in villages, towns and cities around Pakistan were caught off guard by the swiftness and power of the waters.

Bibi spoke to The Associated Press at a tent camp set up in a sports complex in the city of Charsadda for hundreds of people left homeless by the deluge. She spoke of her granddaughter’s death with composure, but inside the tent, her daughter-in-law could be heard sobbing.

"The floodwaters entered our house suddenly. We didn’t have time to take anything as we were leaving,” Bibi said. She, her sons and daughter-in-law carried her surviving grandchildren tightly as they waded through waist-deep water out of their home. They then walked in the stifling summer heat for four kilometers (2.5 miles) to Charsadda.

People cross a river on a suspended cradle in the town of Bahrain, Pakistan, Tuesday. AP

The district around Charsadda has been one of the hardest hit areas. The Swat River meets the Kabul River nearby, and the nearby farmlands are laced with tributaries - all of them still surging with swollen waters despite a pause in rain in recent days. Authorities have warned that more rains are expected in coming weeks.

The city of Charsadda, home to more than 120,000, has been trashed. On Tuesday, some neighborhoods remained flooded with water shin-deep or higher.

Residents whose homes still stood took out their soggy blankets and furniture and other possessions to dry. Others surveyed wrecked mud-brick or shoddy cinder-block homes with collapsed walls and roofs. Deep, thick mud coated everything.

A woman sits in her damaged home, after heavy rains in Charsadda, Pakistan, Tuesday. AP

Many of Majooki’s residents are now at the tent camp in Charsadda’s Abdul Wali Khan Sports Complex. Hundreds of tents stood in rows, and children lay inside on plastic mats with what few belongings they took with them piled nearby. Some eat rice or other staples being distributed by the government.

"It is very hot here. We have a tent and a plastic mattress, but there is no fan. We are not getting enough food,” Bibi said.

A widow, Bibi had worked washing clothes and cleaning in homes, and one of her sons was a construction worker. Now they are without work for the foreseeable future. She and others from the village have not been able to return and have no idea what remains of their homes.

People cross a river on a bridge damaged by floodwaters, in Bahrain, Pakistan, on Tuesday. AP

The floods’ devastation has hit Pakistan as it is already struggling to keep its crisis-stricken economy from collapse. The government is severely strapped for cash, and inflation has been spiraling. The International Monetary Fund gave a boost this week by releasing a long-awaited, $1.17 billion tranche of a bailout negotiated in 2019, but only after the government promised painful austerity measures.

The United Nations on Tuesday launched an emergency appeal for $160 million in aid to help flood victims. Planeloads of food, medical supplies and other aid have arrived in recent days. But Prime Minister Shahbaz Sharif warned on Tuesday that any delay in the provision of help would be disastrous.

At the sport complex tent camp, another Majooki resident, Saifoor Khan, recalled how he too ignored the call to flee that came from the mosque loudspeaker that day.

Sludge piles up outside a house as a man uses a bucket to clear it after heavy rains. AP

"I have no idea for how many days and weeks we will have to live in these tents,” he said.

"I pray that no one faces such an ordeal.”