Near DUBAIR, Pakistan -- The Indus River in northern Pakistan is no longer at flood stage. But its forceful, muddy currents are a constant reminder of what has become a harsh, mournful Ramadan.
Unfortunately, this week's celebration of Eid, the end of the holy month of fasting and purification for Muslims, promises little in the way of hope or succor for those affected by Pakistan's devastating floods.
Aid is getting through to those who survived the disaster in the mountainous district of Kohistan and nearby regions. But the experiences of destruction and loss, of trauma and displacement, are real and palpable, even among those who have received humanitarian assistance in recent days.
"Normally Eid is a time of happiness," Fatama, a 45-year-old mother of six whose home was washed away by the flooding, told me late last week. "But this Eid we don't feel anything. Our every happiness was our house. That was our paradise. Now we're homeless. We don't know where to go."
Another resident of the region's steep, stark valleys, 72-year-old Noor Paras, a farm laborer, said this year's Eid "will be a very simple day, with no money for celebrations or for new clothing."
Though Paras is better off than some -- Paras has sons who can send him money from Karachi -- he still must rebuild his home that adjoins the Indus and see to it that the rest of his family is safe and protected.
He speaks with wariness of returning to his home after the floods -- "what we saw was like a sea," he said -- and wonders "how can we come back, to our actual life?"
"We just pray to God that God will protect us."
While the attempt to return to some semblance of normalcy now dominates the daily rhythms of life, worries about approaching winter are starting to creep in, too -- worries that are based on the stark realities that marked life even before the floods.
Kohistan -- located in the northern province of Khyber Pakhtunkhwa -- is a harsh, neglected place. The region and the wider province have been the site of fighting between Pakistani security forces and anti-government insurgents. The area has few medical facilities. While mountainous living might seem to make people hearty, in fact residents already suffered from malnutrition, tuberculosis, diarrhea, acute respiratory ailments and eye and skin infections prior to the worst natural disaster in Pakistan's history.
When I joined my Church World Service colleagues from Pakistan this past weekend at mobile health clinics working at locales in Kohistan and nearby regions like Mansehra, what was most striking were the acute needs of people who have no access to basic health services.
"This is the only health care we receive," said Mohammad Khalid, one of dozens of patients who crowded into a makeshift clinic in the flood-affected village of Mohandari, near Balakot. Skin infections were common; malnourishment among young children was obvious.
Flooding in Kohistan has essentially stopped while other areas of Pakistan continue to be inundated --flood waters continue to flow south in the province of Sindh, for example. But the floods in the entire province of Khyber Pakhtunkhwa still destroyed about 200,000 homes by some estimates, and the area bore some of the worst casualty rates of the flooding. Only now are some areas becoming accessible.
The expected food crisis that will likely affect all of Pakistan as a result of washed-out land and crops, destroyed bridges and roads, and lost livelihoods and jobs will make life in this hardscrabble northern area all the more painful and difficult, said Dr. Qamar Zaman, a medical coordinator for Church World Service.
"This is a slow tsunami," Zaman said on the eve of the week of Eid. "This will kill people slowly."
(Chris Herlinger, a New York freelance journalist, is also a writer with the humanitarian organization Church World Service.)