Hundreds of thousands of people caught up in fighting between the Pakistani army and Taliban militants in the northwest of the country face a critical situation, aid agencies warn.
Relief workers have been struggling to provide emergency relief to around 1.5 million people who have fled the Swat valley, a former tourist beauty spot, since the military launched a major offensive against the insurgents in early May. But concern is also mounting for those who remain trapped inside the conflict area.
"It is a closed military zone so there has been virtually no access to aid workers, independent observers or journalists, but we know that people are facing serious problems," said Ali Dayan Hasan, senior South Asia researcher for Human Rights Watch.
"There has been no power since April 29 as generators do not have any fuel to run, the phone lines are down, there is limited clean water, food stocks are running low and there is an acute shortage of medicines."
While the Pakistani army has relaxed curfews several times to allow people to leave the area - made up of Buner, Dir and Swat districts - hundreds of thousands of civilians are thought to have stayed behind.
On Thursday, the government said that up to 200,000 people have been stranded by the army offensive, and authorities might have to drop food to them from the air.
Aid workers say many are elderly people who are unable to make the trek through the mountains to safer areas, as well as poorer people who cannot afford the cost of transport to flee the war zone.
Some farmers have been unwilling to leave their properties and fields as it is currently the harvesting season for wheat, but have sent their wives and children out of the area.
Health workers say they are particularly concerned that no hospitals or private clinics are functioning in Swat district as medicines have run out and staff have fled.
"We are really worried as the war-wounded cannot be treated and patients with chronic health problems such as cardiac patients, pregnant women with complications and insulin-dependent patients do not have any medical support," said one health worker.
He added there are fears there could be a repeat of last year's cholera outbreak, which affected over 4,000 people in the area. "We are worried about this as there is no clean drinking water available, and so food and water is likely to become contaminated," he said.
CASUALTIES
The International Committee of the Red Cross (ICRC) has begun relief activities in Dir and south Buner, where government troops have cleared out militants. ICRC staff say the conflict has clearly taken its toll in these regions.
Fields that would usually be filled with farmers harvesting their crops are lying fallow, shops are closed and basic goods are scarce as commercial suppliers stay away.
The military says it is trying to minimise civilian casualties, but according to aid workers, some residents have been wounded and killed during the fighting in Buner.
"We supplied medicines to the main hospital in Daggar town and they have treated about 240 people with war wounds," said Sebastian Brack, ICRC spokesperson in Islamabad.
"There have been deaths for sure, and we saw a couple of dead bodies on road into Buner, but we have no definitive figures on civilian causalities."
Some aid groups are calling on the Pakistani authorities to consider all possible mechanisms to ensure that food, fuel and medical supplies reach those inside the conflict zones, including air-drops and the establishment of a humanitarian corridor.
"While up to two million people have made it out to relative safety, the International Rescue Committee (IRC) remains highly concerned about the many civilians still trapped in the conflict area," said Mike Young, IRC's country representative.
"Lives are undoubtedly in danger and many of the sick, elderly and vulnerable may not be able to flee at all. People need immediate access to vital life-saving services or assistance in evacuating the conflict zone and reaching safety."
Our Standards: The Thomson Reuters Trust Principles.
