Pakistani authorities are struggling to prevent their largest lake from bursting its banks after last-ditch efforts to reduce water levels have failed.
Lake Manchar, in Sindh province, is dangerously full after record monsoons flooded a third of Pakistan.
Three breaches of the lake’s shores so far – to protect areas downstream – have displaced 100,000 people.
However, it could overflow and rescue teams are scrambling to remove many more people who are still at risk of drowning.
Floods in Pakistan have affected an estimated 33 million people and killed at least 1,314, including 458 children, Pakistan’s National Disaster Management Agency said.
Estimates suggest that the floods have caused at least $10bn (£8.5bn) in damage.
Sindh province produces half of the country’s food supply, heightening fears that many will face severe food shortages in a country already struggling with an economic crisis.
On Sunday, officials breached Lake Manchar after it had flooded two rural towns, hoping to prevent it from further bursting its banks and flooding more populated areas.
The move affected about 400 villages – a total of 135,000 people. The decision to deliberately flood some villages is controversial – the lake spans two areas, Dadu and Jamshoro, where hundreds of thousands of people live and about 80% of the area is underwater.
Villagers affected by the willful breach were warned to evacuate. However, local sources say not everyone was brought to safety in time – some did not want to leave their homes or animals, a lifeline for many in rural communities and there are few places to go.
The army has been brought in to help with the evacuation, but mostly locals come to each other’s aid.
Some who fled their homes in the last days before the Manchar breach were taken to a nearby government facility used as a shelter for displaced people, but conditions leave much to be desired.
Many displaced people live on the side of the road without shelter, food or clean drinking water.
“We have nothing here, we try to find food for our children all day, some nights we sleep without food,” one woman told the BBC.
“We’re afraid the roof might collapse on us – it’s damaged,” said another villager. “Our children get sick and we sleep on the floor – there are no beds for many of us.”
Officials have said just over a quarter of a million people are in shelters, a fraction of the 33 million Pakistanis affected. Relief efforts cannot keep up with demand – there are simply too many needs and too few resources.
Damaged infrastructure also hampers relief and rescue operations. Some connecting roads in Sindh province have either collapsed, flooded or backed up for days with traffic in queues.
Pakistan is facing one of its worst climate-induced natural disasters in years, as torrential rains and melting glaciers in the country’s northern mountains have caused devastating floods and submerged nearly a third of its territory.
Meanwhile, the UN children’s agency Unicef said more children are at risk of dying from disease in Pakistan due to a lack of clean water.
The disaster has also highlighted the sharp disparity between the countries that contribute most to climate change and those that bear the brunt of its impacts.
Pakistan produces less than 1% of global greenhouse gas emissions, but its geography makes it extremely vulnerable to climate change.
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Additional reporting by Zubaidah AbdulJalil