When I last saw my colleague and friend, Dr. Qamar Zaman, a physician and a health specialist for Church World Service in Pakistan, the prognosis for Dr. Zaman's country was not good.
The floods that earlier this year inundated one-fifth of Pakistan, affecting some 18 million people, were a slow-moving tsunami, Dr. Zaman said in September. "This will kill people slowly," Dr. Zaman told me as I completed an assignment in the northern region of the country.
Now, three months later, as winter settles in on Pakistan, I asked Dr. Zaman in an interview from New York how flood-affected parts of the country are faring and what Americans who remain concerned about Pakistan need to know, particularly as we celebrate the December holidays. At this time of year, our world can seem very far indeed from Pakistan's harsh realities.
I had hoped that the news from Pakistan would be, at best, mixed. But the news remains tough and largely discomforting.
If there is any good news, it is that worries about possible famine in Pakistan, something I had heard expressed by some humanitarians responding to the flooding, have not materialized. That is a relief, as one of the indelible images in my work this year was seeing malnourished children in Pakistan -- kids living in ignored, impoverished areas and who, even before the flooding, were vulnerable to diseases and to stunting.
Luckily, Dr. Zaman told me, the World Food Program, the United States Agency for International Development, the Canadian International Development Agency and smaller humanitarian groups did a good job of distributing emergency food -- though Dr. Zaman added there are still areas that, nearly five months after the start of the floods, remain inaccessible by road.
The tricky part remains trying to promote food security -- the availability and access to food -- in flood-affected areas. One small but important step being tried by Dr. Zaman's colleagues is to distribute cows among those living in the worst-hit areas as a way to keep people "going at least for some time." The cows will provide availability to milk -- something nearly impossible for those living in extreme poverty.
What about other concerns, not related to food?
Dr. Zaman said that with temperatures dropping below zero in the evenings, there has been a big spike in respiratory tract infections, particularly among children who are most vulnerable "because they are living where there is no proper heating available -- if they have any shelter at all," he said.
For the moment, the respiratory tract infection cases are centered more in the northern half of the country but are likely to increase and spread throughout the country as winter sets in and once rain starts, Dr. Zaman said. "We've been lucky in at least one respect in recent weeks: the weather has been dry in almost all parts of the country. But that won't last."
To comprehend the full picture, it helps to understand that the issue of shelter remains critical. "Either they are sharing one-room accommodation with their relatives or are in tents which are not winterized and thus are prone to winter-borne diseases," he said.
This is the picture in northern Pakistan. The situation in the middle and southern sections of the country remains critical, as well. Last week, in an interview with AlertNet, Manuel Bessler, who heads the U.N. Office for the Coordination of Humanitarian Affairs in Pakistan, said 1 million people living in makeshift shelters or displacement camps still need basics like food, water and medicine.
Bessler called the situation dire.
"We have a protracted humanitarian crisis in the south where we still have 1 million people displaced because of flooding in the province of Sindh," Bessler said. "The basic survival items of food, water and sanitation, shelter and healthcare are urgently required."
I asked Dr. Zaman if he had any thoughts related to the holidays here in the United States -- a time when it is easy to forget about places like Pakistan.
He said he understood the need to embrace comfort -- of being with "loved ones in front of the warm winter fire with a decorated Christmas tree." Still, Dr. Zaman said it would be good if Americans, in the midst of the holidays could, in the spirit of solidarity and empathy, spare a minute to think of those in Pakistan who are struggling at the end of what has been a difficult and traumatic year.
"I know the troubles of Pakistan seem very far away from Americans," he said. "But at the same time I am confident that Americans in this continuing hour of need will think of their brothers and sisters in this part of the world who, incredibly, in the 21st century, are facing, and in some cases are dying from, preventable and curable diseases like pneumonia."
I hope Dr. Zaman is right. Remembrance, solidarity and empathy should be a large part of what Christmas is about.
Chris Herlinger, a New York freelance journalist, is a writer with the humanitarian organization Church World Service. He was recently in residence at the Collegeville Institute for Ecumenical and Cultural Research in Collegeville, Minn.