Pakistani villagers carry their belongings through flood water following heavy monsoon rain at Golarchi town in Badin district, about 200 km east of Karachi, on September 13, 2011. (Photo: Asif Hassan / AFP / Getty Images)

These days when it rains in South Asia, it doesn’t just pour — it floods. A month of monsoon squalls has deluged hundreds of towns and villages in northwest India and Pakistan. The latter has seen the most acute flooding, and, on all evidence, has been the least prepared for it. At least 233 people have already died and 300,000 are now stranded or in makeshift camps — a figure that will surely grow. Officials in Pakistan claim some 5.5 million people so far have been affected by rising waters. That’s still only a fraction of the 20 million hit by last year’s catastrophic rains, but the forecast looks ominous.

Neva Khan, Oxfam’s Pakistan country director, spelled out the dimensions of the crisis on the relief agency’s website:

There is an urgent need to provide immediate and life saving relief to the millions affected. It hasn’t stopped raining in Sindh for the last 10 days. Large swathes of land are underwater and people are desperately awaiting relief. They have lost their crops, homes and livestock for the second time – and been pushed from last year’s disaster to this one.

Sindh, the vast, fertile province abutting the Arabian Sea, appears the worst affected. Across Pakistan, some 900 villages have been wholly submerged and millions of hectares of arable land — some still irrevocably damaged by last year’s floods — are under water.

What’s most depressing about the situation now is how keenly it echoes the 2010 calamity. Omar Waraich, TIME’s Islamabad correspondent, wrote this excellent piece a year ago for the magazine’s international editions. As the waters rise, Pakistan faces a familiar cocktail of maladies from last summer.

Then, the civilian government headed by the unpopular President Asif Zardari was hampered by political infighting and its fundamental subservience to the real power of Pakistan’s influential military. Now, not much has changed (though Zardari is still in his position, a surprise to some). Then, militants and terrorists were exposing the fragility of the Pakistani state with cold-blooded strikes on some of country’s major cities. Now, after a rancorous summer of barb-flinging with the U.S., not much has changed either — not least when suspected al-Qaeda allied militants raided a prominent naval base in Karachi earlier this year. Then, the cash-strapped government pleaded for foreign assistance. Now similar calls are being issued, with similar notes of desperation.

In the weeks to come, inquests will be made into whether enough had been done to shore up riverbanks, provide shelter and food for the hundreds of thousands left destitute for over a year, and prepare for the next season’s rains. Already, there are reports of angry civilians blockading roads — like last year — demanding outside intervention and aid. Cities like Karachi, which this summer has seen a spasm of internecine blood-letting, will be further strained by refugees fleeing the countryside.

On many levels, though, the disaster is not man-made. The floodplain of the great Indus river, home to over 100 million people, birthed one of the world’s first ancient civilizations. But the river likely also swallowed it up. Because of its own particular ecology, the Indus can’t be controlled by similar mechanisms of levees prevalent in the West. And climate change has made weather patterns more unpredictable and volatile. This BBC story from a year ago cites the research of an Indian scientist:

Professor Rajiv Sinha, from the Indian Institute of Technology in Kanpur, who has had first hand experience of Asian river floods, takes a more strident position. “What all the climate models predict is that the distribution of monsoon rains will become more uneven in the future,” he told BBC News. “Total rainfall stays the same, but it comes in shorter more intense bursts.” In August 2010, more than half of the normal monsoon rain fell in only one week. Typically it is spread over three months. Professor Sinha remarked: “Rivers just can’t cope with all that water in such a short time. It was five times, maybe 10 times, more than normal.” So, if the unusually intense 2010 monsoon is the shape of things to come – and that is uncertain – the future may hold more flood misery for the people of Pakistan.

It’s a closing sentence that has proven sadly prophetic.