The worst natural disaster in the country's history has already affected 20 million people in nearly a month of flooding triggered by heavy monsoon rain, and left 1,500 dead by official count.

Five million people have been made homeless across the country but that figure could surge higher if the swollen Indus river, whose fast-moving waters are piling pressure on sagging embankments, continues to fill up.

"The next two to three days are very critical and we will have to strictly monitor the situation in the towns near the mouth of Indus river, which will have exceptionally high levels," Sindh province irrigation minister Jam Saifullah Dharejo told AFP.

He said thousands of irrigation officials had been deployed to strengthen river barriers at high-risk spots near the teeming city of Hyderabad, but a full moon this week would fasten water flows and increase the risk of flood.

Pakistan's chief meteorologist Arif Mehmood confirmed the risk remained high in the south, while waters had receded in hard-hit Punjab, Khyber Pakhtunkhwa and Kashmir provinces, leaving huge needs in their wake.

Prime Minister Yousuf Raza Gilani said more than 3.5 million children were at risk from disease, with more than 200 health centres water damaged and a third of a total of 100,000 female health workers displaced from their homes.

"As human misery continues to mount, we are seriously concerned about the spread of epidemic diseases," Gilani told a meeting of health experts.

"There is likelihood of water-borne diseases such as cholera, diarrhoea and dysentery, especially in children who are already weak and vulnerable," he said.

Millions who saw their homes wiped out are surviving on aid handouts and are in desperate need of food, shelter and clean drinking water.

Under-fire President Asif Ali Zardari has warned his crippled nuclear-armed nation, a key United States ally in the fight against Islamic extremism, could take years to recover.

"Your guess is as good as mine but three years is a minimum," Zardari told reporters on Monday when asked how long it would take Pakistan to go through relief, reconstruction and rehabilitation.

"I don't think Pakistan will ever fully recover but we will move on," the president said, adding that the government -- strongly criticised for its slow response -- was working to protect people from similar disasters in future.

The UN estimates 4.8 million people have been made homeless.

Tens of thousands of people have been evacuated from flood-threatened areas close to Hyderabad, a city of 2.5 million people on the lower reaches of the Indus, where at least 36 nearby villages have been swept away.

Dozens of volunteers could be seen in the outskirts of Hyderabad on Tuesday manning bulldozers and cranes, while others used shovels and hammers, to reinforce battered river embankments with broken bricks, stones and sandbags.

Three hundred miles (480 kilometres) from Hyderabad, authorities continued to battle to save Shahdadkot from the surging waters, after most the city's 100,000 residents had been escorted to safety or made a hasty getaway.

Global aid pledges, which have been slow coming, have now topped 700 million dollars amid fears that losses as a result of the floods could reach 43 billion dollars.

On Tuesday the president's office said the government planned to distribute 20,000 Pakistani rupees (234 US dollars) to each flood-affected family.

Pakistan officials are in talks with the International Monetary Fund in Washington amid reports Islamabad was asking the fund to ease the terms of a loan worth nearly 11 billion dollars.

Last week Pakistani officials said Finance Minister Abdul Hafeez Shaikh would ask the IMF to restructure the current loan or consider new financing.

Pakistan foreign minister Shah Mehmood Qureshi will meet his European counterparts in Brussels next month to seek greater trade access for Pakistani goods in a bid to alleviate financial hardship caused by the disaster, the president's office said.

Disaster management officials say that the scale of the flooding is much larger than Pakistan's 2005 earthquake, which killed 73,000 people and made 3.3 million homeless.

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