The trail of destruction across Khyber Pakhtunkhwa is shocking. Whole buildings have been reduced to piles of rubble in Nowshera and surrounding areas. Nearby, water remains: fields are inundated, mini ‘lakes’ have formed. That children are the most at risk of disease from the floods is obvious. In the hot, humid afternoon summer weather, children jump, dive and play in these new neighbourhood ‘lakes’ left behind by 2010’s great flood. A lack of clean water to drink, and to cook and wash with, has only compounded the problem.

In Upper Dir, a region affected badly by flash floods, and where 49,353 households have been affected — 702 houses have been completely washed away and 6,651 partially damaged — children comprise the biggest group of patients treated by non-governmental organisation SWWS (Support With Working Solution). Javed Akhtar, executive director of SWWS, has sent his medical team to five locations and has treated 6,261 people: 57% have been children. Acute diarrhoea, a typical symptom of gastroenteritis, has been prevalent, along with skin diseases and respiratory infections.

In places such as Kohistan and Swat, communities are simply cut-off from the rest of the country. Relief goods need to be airlifted in. In Swat, Todd Shea of Pakistan-based NGO CDRS has seen roads that just disappear. “North of Bagh Deri, there is a road that runs alongside the river, but then it just ends at a cliff.” Elsewhere, he has seen towns so devastated that there is no rubble left behind. “The flood wiped it off the planet.”

Here are a few pictures from Nowshera district where one local said, “I finally evacuated my family when the water started rising three feet per hour.”

Click any picture to begin the slide show: