Aid slows to a trickle as Pakistan crisis enters a new phase.

As the fl oodwater surges southwards, and Pakistan faces the likelihood of a public health emergency, the economic cost of the disaster threatens to run out of control. About a quarter of the country’s harvest has been destroyed and next year’s harvest is under threat. Sindh’s agricultural losses are estimated at US$1 billion. Much of the cotton crop—a crucial export—has been wiped out, and there has been massive damage to the country’s infrastructure. This month, the IMF released a $451 million emergency loan to Pakistan, which already owes its creditors some $50 billion. But the $460 million UN fl ash appeal for Pakistan—framed at a time when the catastrophe had yet to fully develop—is only two-thirds funded. It seems to fi t into a general picture of underfunding for the crisis. The French Government, for example, which receives about $62 million per year from Pakistan in debt repayment, has directly committed $2·45 million to the UN appeal. “The appeal never really got off the ground until the [UN] Secretary-General went out to Pakistan” Ian Talbot (University of Southampton, UK) told The Lancet. In the early stages of the fl ooding, the international community did not seem to comprehend the seriousness of the problem. After Ban Ki-moon’s visit, pledges began to arrive from governments and international organisations such as the World Bank. But the past few weeks have seen things slow down. Why? One reason is so-called donor fatigue. Last year, Pakistan called on the world to help with the 2 million refugees fl eeing the military operations in Swat (an area now devastated by fl ooding). This year saw the hugely destructive earthquake in Haiti. Indeed, alongside its appeal for Pakistan, the UN is running an additional 17 humanitarian appeals; none of which, incidentally, has received more than three-quarters of the requested funds. Then there is the nature of the Pakistani disaster. “Floods are not an easy one to understand”, explains