She said that Pakistani forces began bombarding her village in Waziristan at four in the morning, striking the mosque where the men were gathered for dawn prayer. Her nephew was among the wounded. “When the sun rose, we left,” she said.

Refugees arriving in recent days said the five-month-old operation was continuing and even expanding. They told of Pakistani jets bombing villages and the army firing artillery barrages.

“The fighting was between the Taliban and the government, but our villages were bombarded and that’s why the people got fed up and left the area,” said Musa Kalim Wazir, a shepherd from Tank village in Dattakhel district. People did not dare to return to their homes, because whenever the army came under attack by insurgents it responded by bombarding nearby villages, he said.

Afghan officials, still grappling with a host of problems of their own, not least a continuing insurgency and thousands of internally displaced, now face an added burden of a quarter of a million refugees from Pakistan whose presence is turning into a long-term prospect.

“Winter is already here and all of the refugees are facing a shortage of assistance,” said Muhammad Akbar Zadran, the governor of Gurbaz district. “A group of refugees came to my office, and they told me that different diseases were spreading among their children. If they don’t get urgent treatment then it is possible that in coming days we will witness a precarious situation.”

He said: “All of the refugees have many problems; they have come here with just the clothes on their backs, and they left everything behind. If the government and people don’t respond to their needs then it will be a great problem.”

Afghanistan’s latest trial comes amid growing refugee crises around the world and a global shortage of humanitarian funding. The United Nations appealed for $25 million to assist the Pakistani refugees through the end of the year, but assistance organizations have gathered only about $10 million, said Bo Schack, representative in Afghanistan for the United Nations High Commissioner for Refugees.