The government figures provided the third week after Pakistan's earthquake are probably a serious underestimate, but they indicate the scale of the catastrophe: 50,000 dead, 74,000 injured and at least 3.3 million--far more than after the tsunami--left homeless, virtually all of them in the mountains, where snow begins to fall in November. The poverty of the overwhelming majority of the victims is only too apparent. Bagh, a town north of Muzaffarabad, has virtually ceased to exist. In Islamabad a relief worker told me that "there is a stench of rotting corpses everywhere. In their midst survivors are searching for food. Local people say that 50,000 have died in this town alone. And more will follow if medicines and food are not equitably distributed."

The continuing shortage of helicopters in Pakistan has meant that the survivors in the more remote mountain villages on the Indo-Pak border in Kashmir remain out of reach. In neighboring Afghanistan, where there is a glut of helicopters, NATO has been reluctant to release too many from the war zone despite the advice of Robert Kaplan in the International Herald Tribune, who had this to say about benevolent US-NATO rescue missions: "The distinctions between war and relief, between domestic and foreign deployments, are breaking down.... hunting down Al Qaeda in its lair will be impossible without the goodwill of the local population. That attitude can be generated by relief work of the kind taking place in Kashmir. It's the classic counterinsurgency model: Winning without firing a shot."

Despite the desperate situation, the Pakistani government declined India's offer of helicopters. National pride or sheer stupidity, it is unforgivable when lives are at stake. The uniformed establishment in Pakistan fears a lasting peace, because it would remove the reason for maintaining a gigantic military-industrial complex. The inability of the army to centralize and distribute relief has meant that local jihadi militias have tended to monopolize the handing out of food and tents. Enforced prayers in these conditions have become part of the problem.

This is by no means the worst disaster to hit the country. When a cyclone ravaged Bangladesh (then East Pakistan) in 1970, up to half a million Bengalis perished. The indifference of the predominantly West Pakistani elite undoubtedly helped fan the flames of nationalism, and the country split a year later. The October 8 earthquake can't be ignored so easily because Islamabad itself was struck. There has been an outpouring of support for the victims, but how long will it last? And what will happen when the gaze of the cameras shifts elsewhere?

This latest wound has brought others to the surface. A deeper and darker malaise, barely noticed by the elite but taken for granted by most citizens, has infected the country for decades. The balance sheet tells the tale of corrupt bureaucrats, tainted army officers and polluted politicians, of unending privilege and graft, protected mafias and the bloated profits of the heroin and arms industries. Add to this the brutal hypocrisy of the Islamist parties, and the picture is complete. It is in this context that many ordinary people on the street view the recent disaster. At a state school in Lahore the students collected toys for children who survived the tragedy; when asked whom they'd like to distribute the toys, the students voted unanimously against any politicians, army officers or civilian bureaucrats. They preferred a doctor.

There is much talk in Islamabad of reconstruction, and even civilian prime minister Shaukat "Shortcut" Aziz has spoken of a five-year plan to rebuild the destroyed cities and rehabilitate the victims, but does the military high command have the will to impose such a solution? Even in normal times the poor have limited access to doctors and nurses. The state-of-the-art hospitals in the big cities are exclusively for the wealthy. The shortage of medical staff has been a curse for the past fifty years. No regime, military or civilian, has succeeded in creating a proper social infrastructure, a safety net for less privileged citizens, who are a large majority of the population. At times like this the entire country feels the need, but the elite will soon forget till memories are revived by the next disaster. In a privatized world, where the prescriptions offered by global financial institutions are taken as holy writ by the rulers, the state is not encouraged to buck the system.

Will the rebuilt cities and villages be constructed differently to avoid another calamity? Edward Durrell Stone, one of the architects who built Islamabad in the late 1960s, was unhappy with the site because of the geological fault line and the weak soil. Overruled by the military dictator of the day, he advised that no structure higher than three stories ever be built. He was ignored.

What will happen to the widows and orphans? The Jamaat-i-Islami party has suggested that the orphans be placed under its control so they can be properly looked after, fed and educated in its madrassahs. There are worse fates for the children--the refugee camp in Islamabad has already become a scouting area for child-sex mafias and pimps in search of easy recruits--but the Pakistani government should resist this demand and create a network of state schools and orphanages where the children can be better protected. To leave them to the mercy of the Islamist groups could result in the loss of another generation.

Pakistan's rulers have usually shied away from complex, substantial issues facing the country. I fear this tragedy will not jolt them sufficiently to abandon their complacency. As always, it is the poor who will continue to suffer.

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