MARDAN, Pakistan - Thousands of terrified Pakistanis dodged Taliban roadblocks to flee fighting Thursday between the army and insurgents in a northwestern valley, streaming into refugee camps and crowding hospitals with their fatigued and hungry children.
According to the United Nations, tens of thousands have fled their homes in recent days from the Swat Valley where a militant-government peace pact collapsed this week. The exodus adds to more than 500,000 already displaced by fighting elsewhere in Pakistan's volatile border region with Afghanistan.
Late Thursday, Pakistan's prime minister appealed for international help to deal with the refugee crisis. Yusuf Raza Gilani made the appeal during a television address.
The violence flared just as Pakistan's embattled president was appealing in Washington for more help to reverse the extension of Taliban-held territory to within 100 kilometres of the capital, Islamabad. The U.S. has welcomed Pakistan's fresh military action.
On Thursday, several thousand men, women and children - most riding cars, buses and tractors, but some of them on foot - took advantage of an easing in the army curfew to pour through Swat's main town, Mingora, in search of safety.
The ramshackle convoys were rolling up hours later at a string of camps set up by Pakistani authorities and the UN in the city of Mardan and neighbouring towns. Hospitals in Mardan treated dozens of civilians with serious gunshot and shrapnel wounds, children among them.
At the Tuberculosis Hospital in Mardan, hundreds of the displaced jostled before desks manned by hard-pressed volunteers to register for a tent and a handout of emergency supplies.
Yar Mohammad, a 50-year-old stone mason, told an Associated Press reporter he had "poured his blood" and his best years into the development of Swat, once a haven for tourists drawn to its Alpine-like scenery.
"Now I am seeing the buildings that I have helped to construct being blown up and destroyed," he said, blaming both the Taliban and the authorities.
The UN says at least 45,000 people have fled the latest fighting. The local government says it fears up to 500,000 people could be forced from their homes.
Some residents complained that the Taliban had blocked their escape. Ayaz Khan said he loaded his family into his car Thursday in the Kanju area of Swat only to find rocks, boulders and tree trunks laid across the roads, forcing him to turn back.
"I am helpless, frustrated and worried for my family," he told an AP reporter by telephone from his home.
The military claimed to have killed more than 80 militants in Swat and the neighbouring Buner region Wednesday. Officials have said nothing about civilian casualties. But those fleeing the region bore tales of families wiped out by stray shells.
Fazl Hadi, a doctor at another hospital in Mardan, said it had admitted 45 civilians with serious gunshot or shrapnel wounds in recent days and was bracing for many more.
Witnesses said armed Taliban militants were again roaming the streets of Mingora on Thursday. Troops were launching artillery and air strikes on militant targets in the area.
Gen. Ashfaz Parvez Kayani, the chief of Pakistan's army, said it would commit enough of its resources to "ensure a decisive ascendancy over the militants" in the country.
Kayani did not say whether the army intended to add to the some 15,000 troops already in the valley, but a U.S. military official said Americans were "noticing movement. There is a reorientation of some forces going on toward the northwest from the east." The official did not give his name because he was not authorized to speak to the media. He gave no more details.
Washington has said it wants to see a sustained operation in Swat and surrounding districts, mindful of earlier, inconclusive offensives elsewhere in the Afghan border region. Eight years after the Sept. 11, 2001, attacks, the area remains a haven for al-Qaida and Taliban fighters blamed for spiralling violence in Pakistan and Afghanistan.
But uprooting the insurgents from the valley will mean civilian casualties and massive disruption that could sap the resolve of the government, which is struggling to convince the nuclear-armed Muslim country that fighting the militants is in its interests as well as those of the U.S.
President Barack Obama and Pakistani President Asif Ali Zardari met Wednesday in Washington to explore ways to boost the country's anti-terror fight, seen by many as the most pressing foreign policy issue facing the U.S. administration.
"Pakistan's democracy will deliver," Zardari said in Washington.