As the Obama administration dithers over what to do for the best in Afghanistan, neighbouring Pakistan is paying an increasingly heavy price. Like a spate of previous Taliban attacks in recent days, today's mayhem in Lahore underscored fears that the principal consequence of Washington's Afghan paralysis, albeit unintended, is the further destabilisation of the Pakistani state.

Pakistanis might be forgiven for wondering whether, with friends like these in Washington, who needs enemies? The rumbling row over a $7.5bn, five-year US aid package is a case in point. Imperious conditions attached to the bill by a Congress reluctant to send more unaccounted billions "down a rat hole", as Democrat Howard Berman charmingly put it, were condemned as insulting and colonialist in Pakistan.

By linking the cash to tighter civilian control of Pakistan's military, Washington was trying, clumsily, to strengthen Asif Ali Zardari's government. But it achieved the exact opposite. The president was accused of failing to defend the country's sovereignty, much as he has failed to halt escalating American cross-border air raids, and the occasional covert ground incursion, on targets inside Pakistan.

After hurried consultations in Washington, Shah Mahmood Qureshi, Pakistan's foreign minister, obtained an "explanatory document" from Congress this week that he said effectively waived some of the bill's more objectionable caveats. But this is unlikely to silence critics who draw on deep anti-American sentiment among the Pakistani public dating back to the 2001 invasion of Afghanistan and the launch of George Bush's "global war on terror".

"Poll after poll shows Pakistanis increasingly do fear the threat posed by Islamic extremists ... but they believe the US is an even bigger danger to their country," Bruce Riedel of the Brookings Institution was quoted as saying this week. Many Pakistanis rated the threat posed by the US to their independence and security above that from historical foe India, he said. "Any time you out-poll India as the bad guy in Pakistan you are in deep trouble."

Intense Obama administration pressure on Pakistan to root out the Tehrik-e-Taliban (Taliban Movement of Pakistan), close allies and collaborators of the Afghan Taliban, resulted in this spring's costly military offensive in Swat, in North West Frontier province, which displaced hundreds of thousands of civilians.

Yet the Swat campaign is likely to be dwarfed by an imminent Pakistani army offensive in South Waziristan, in the ungoverned tribal areas adjacent to Afghanistan. Although senior Pakistani officials deny they are doing Washington's bidding, it's no secret that US commanders are increasingly focused on both sides of Afghanistan's eastern border with Pakistan, where Taliban militants and their foreign jihadi and al-Qaida allies have staked out common ground ignoring national boundaries.

Pakistan's Taliban leader, Hakimullah Mehsud, who replaced Baitullah Mehsud after the latter was killed in a US drone missile strike in August, said in a recent video that attacks such as today's in Lahore would quickly cease if the government stopped behaving like a US lackey and broke its American alliance. If that happened, Mehsud said he would turn his guns on India, presumably in Kashmir. To many Pakistanis, that may not sound such a bad idea.

The realisation that Washington is stoking a conflict approaching all-out civil war is gradually dawning in the US. New York Post columnist Ralph Peters drew a comparison with post-invasion Iraq. "Civil war never quite happened [there]. Yet no one seems to notice that we're now caught up in two authentic civil wars – one in Afghanistan, the other in Pakistan," he said. By lumping the two together in one "Afpak" policy, the Obama administration had effectively made both problems worse.

Neither extra US troops, nor extra aid, nor more "hugs-not-slugs counterinsurgency nonsense" was the answer, Peters argued. "The only hope for either beleaguered territory (these really are territories, not authentic states) is a decision by its own population to fight and defeat the Taliban."

The impulse, fanned by this sort of imperial hubris, to get out of Afghanistan, or at least to narrow the fight to a counter-terrorism campaign against al-Qaida, has gathered US adherents in recent months. But a Washington Post editorial argued this week that with al-Qaida much reduced, the Taliban in both countries now constituted the main enemy. Pakistan was moving towards "full-scale war", it said. Pulling back in Afghanistan could have disastrous, possibly fatal consequences there, too.

By this measure and others, only one conclusion is possible: Pakistan is already so destabilised by US actions since 9/11 that it cannot be left to fend for itself. In such tortuous logic is found the death of empires.