Pakistan on Saturday sharply increased its estimate of the number of people affected by catastrophic floods to 20 million, and the United Nations said 6 million of those victims lack access to food, shelter and water.

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ISLAMABAD, Pakistan — Pakistan on Saturday sharply increased its estimate of the number of people affected by catastrophic floods to 20 million, and the United Nations said 6 million of those victims lack access to food, shelter and water.

The floods, which continue to inundate new parts of the country, have caused a humanitarian disaster that has overwhelmed the capacity of the government and international aid groups. Foreign assistance has been slow in arriving, and aid organizations warn that many more deaths could follow unless flood victims receive help soon.

U.N. officials Saturday confirmed the first cholera case among survivors. As people go without access to clean drinking water and basic health services, deadly cholera outbreaks can spread quickly. Other cases are suspected among the tens of thousands of people suffering from diarrhea and fever.

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Cholera can lead to severe dehydration and death without prompt treatment, and containing cholera outbreaks is considered a high priority after flooding.

Revising an earlier official estimate that 14 million people were affected by the floods, Prime Minister Yousuf Raza Gilani said 20 million — nearly 12 percent of the population — had been displaced.

Shaken stability

The crisis has battered Pakistan’s economy and undermined its political stability at a time the United States needs its steadfast cooperation against Islamist extremism. The U.N. has appealed for an initial $460 million to provide relief to Pakistan but has said the country will need billions to rebuild once the floodwaters recede.

Because of the flooding, Pakistan canceled celebrations Saturday marking its creation and independence from Britain in 1947. President Asif Ali Zardari met with flood victims in the northwest, and U.N. Secretary-General Ban Ki-moon was expected to visit affected regions Sunday.

About 1,600 people have died during the floods, which began in late July.

Fresh flooding swelled the River Indus on Saturday, threatening nearby cities, towns and villages in southern Sindh province, said Mohammed Ajmal Shad, a senior meteorologist. The Indus was already more than 15 miles wide at some points, 25 times wider than during normal monsoon seasons.

Authorities were trying to evacuate or warn people in Jacobabad, Hyderabad, Thatta, Ghotki, Larkana and other areas in Sindh province that had been spared floods.

Ghulam Sarwar, 42, said he, his wife and eight children had already fled the town of Thal because of flooding. Overnight, they had to get out of Jacobabad after the fresh warnings. Now they wait in a small tent relief camp on the edge of the city of Sukkur.

“Our whole world has been ruined by the flood, and the whole of Sindh is drowning,” he said. “We do not know how long we will have to suffer.”

The Pakistani government’s reputation — shaky to begin with — has suffered during the crisis, especially after the president decided to visit Europe as the crisis was unfolding. Zardari has tried to make up for that gaffe by meeting with flood victims in hard-hit areas since returning.

“We are with you. Pakistan is with you, and the people of Pakistan are with you,” he told survivors at a relief camp in the northwest’s Nowshera city Saturday. He promised the government would rebuild victims’ homes.

Aid experts say the pace of international aid to Pakistan has been relatively slow compared to other major crises. They say the slow onset of the disaster, the global economic downturn and the perception of Pakistani corruption might all be factors.

Gilani agreed to a proposal from opposition leader Nawaz Sharif that an independent body be appointed to raise relief funds and oversee their spending to boost Pakistan’s credibility in the eyes of the international community.

The United States has donated the most to the relief effort, at least $70 million, and has sent military helicopters to rescue stranded people and drop off food and water. The government hopes the assistance will help improve its image in the country — however marginally — as it seeks its support in the battle against the Taliban in neighboring Afghanistan.

“So far, if anyone has practically given us maximum help, it is America,” Gilani said Saturday when a Pakistani reporter suggested the U.S. has done little since the crisis started.

More U.S. supplies

The Pentagon said Friday that ships carrying more relief supplies and helicopters had left the East Coast and would arrive off Pakistan in late September.

How much credit the United States will receive in the eyes of the Pakistanis is not clear. Some of the aid has been channeled through Pakistani and international groups because the government did not want to be associated with the unpopular Americans.

The U.S. help is putting to a practical test President Obama’s strategy to engage Pakistan as a strategic partner on multiple levels, including economic development, counterinsurgency, law enforcement and judicial reforms, and intelligence sharing.

“This is a country where we have an enormous interest in their going after the Taliban and other extremist jihadi groups,” said Mark Schneider, a senior vice president at the International Crisis Group, a nonprofit organization that focuses on conflict resolution. “If this kind of activity supports the Pakistani government and people supporting the Pakistani government, it’s all to the good.”

Some experts on the region had recently warned that public resentment of the government generated by the floods could wear away public support for the military campaign against militants, integral to American goals in the region. Those worries only deepened as hard-line Islamist charities rushed to fill the void in humanitarian aid left by the government’s slow and chaotic response.

Sen. John Kerry, D-Mass., who leads the Foreign Relations Committee, said he would visit Pakistan soon to assess the damage and whether the United States needs to rethink how $7.5 billion in long-term, nonmilitary aid to Pakistan will be spent as a result of the flooding.

American officials say they are trying to rekindle the same goodwill generated five years ago when the U.S. military played a major role in responding to an earthquake in Kashmir in 2005 that killed 75,000 people.

Material from The New York Times is included in this report.

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