Fresh rains threaten further anguish for millions of people who have been affected by the country's worst floods for 80 years and UN chief Ban Ki-moon has urged the world to speed up international aid urgently.

Described as the worst humanitarian crisis in the world today, the three-week disaster has affected 20 million people, and has destroyed crops, infrastructure, towns and villages, according to the Pakistani government.

The United Nations has launched an aid appeal for 460 million dollars, but charities say the response has been sluggish and flood survivors on the ground have lashed out against the weak civilian government for failing to help.

Maurizio Giuliano, spokesman for the UN Office for the Coordination of Humanitarian Affairs (OCHA), feared that Pakistan was on the brink of a "second wave of death" unless more donor funds materialised.

"Up to 3.5 million children are at high risk of deadly water-borne diseases, including diarrhoea-related, such as watery diarrhoea and dysentery," he said, estimating the total number at risk from such diseases at six million.

Typhoid and hepatitis A and E are also concerns, he said.

"WHO (World Health Organisation) is preparing to assist up to 140,000 people in case there is any cholera, but the government has not notified us of any confirmed cases," the spokesman told AFP.

"We fear we're getting close to the start of seeing a second wave of death if not enough money comes through, due to water-borne diseases along with lack of clean water and food shortages," he said.

Cholera is endemic in Pakistan and the risk of outbreaks increases with flooding, but the government has so far confirmed no cases publicly.

One charity worker, speaking on condition of anonymity, told AFP that several flood survivors had already died of the disease.

The United Nations estimates that 1,600 people have died in the floods, while the government in Islamabad has confirmed 1,384 deaths.

Aid agencies said they are struggling to get funds for the disaster because the country suffers from an "image deficit", with donors less willing to commit cash to a country so often bound up in Western minds with extremism.

Melanie Brooks, spokeswoman for aid group Care International said the United Nations must explain to donor states that "the money is not going to go to the hands of the Taliban."

"The victims are the mothers, the farmers, children. But in the past, information linked to Pakistan has always been linked to Taliban and terrorism," she said.

The floods have sparked rage against the government in the nuclear-armed country on the frontline of the US-led fight against Al-Qaeda, where the military is locked in battles with homegrown Taliban in the northwest.

Several hundred people on Monday blocked the main highway linking the breadbasket of Punjab province to the financial capital Karachi, calling for assistance and holding up traffic for more than an hour, witnesses said.

"We have no food and no shelter. We need immediate help," shouted the protesters, who included women and children.

Intermittent rain fell Monday, turning refugee camps into mud, keeping alive fears of further breaches in the Indus river and canals and hampering relief efforts, officials said.

At the weekend a shocked Ban became the first world leader to visit the flood-affected areas, saying he would never forget the "heart-wrenching" scenes of destruction and suffering that he had witnessed.

"I'm here to urge the world to step up their generous support for Pakistan," he told a news conference with Pakistan President Asif Ali Zardari.

Ban said one-fifth of the country had been ravaged and officials warned that, in the long term, billions of dollars will be needed as villages, businesses, crops and infrastructure have been wiped out.

The World Bank said Monday it had agreed to provide Islamabad with a loan of 900 million dollars, saying the impact of the disaster on the economy was expected to be "huge".

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