Resources in their new homes are very stretched
Harsh desert sunlight scorches the mud huts of Ghausabad, Quetta's most distinctly Afghan area.
They are huddled together in their own circle of shelters and shops, all sprawled on the south-western fringes of this Pakistani city.
Many have been here more than a decade.
Others, an unknown number up to an estimated 6000, have just arrived. They are fleeing the latest fighting and the constant hunger that plagues their homeland.
They tell moving tales of hardship and loss.
Olyan Khan walks back and forth to the bazaar, looking for drugs for his infant son, Adamkhan.
The boy is six months old and weighs just 4 kg (9 pounds). Skin hangs in folds from emaciated limbs, he cries or lies weakly mute, deeply dehydrated and malnourished.
"I just want him to live," Olyan declares, "I don't care about anything else."
Hungry and scared
Olyan and his small family fled their village about a week ago in the distant Jowjzan province in the north of Afghanistan.
Hunger from drought combined with local violence to drive them away.
The prospect of an attack on their country by America - heard in news broadcasts on the BBC Pashto service - cemented their decision to leave.
Oliyan tells his story, and begs for money and medicines for his son.
While he is doing so Ahmed Shah, a 32-year-old farmer from Faryab, also in northern Afghanistan, starts to shout: "With things so bad, what use is more war?"
"We need peace, not politics, not fighting, not anything. Now we need food," he gestures to the baby, now crying loudly, "otherwise there's no future at all. What's the point of all this?"
Change in fortune
Ahmed was reasonably well off by the standards of his village in Faryab. His fields were productive this year, and he had some money saved up.
All that is gone after he decided to leave Afghanistan for the fourth time in the past decade.
"It cost 9000 rupees (about $150) to ride to the border in a truck. Then we camped and walked, getting turned back and walking again until we made it across. Now we're here and look what's left," he said.
He pulls two one-rupee coins from his pocket and throws them on the ground. They land in the dried mud, next to his ragged, leather sandals. "What's the point, what's the point," he keeps repeating.
Later an older man, Haji Jan, explained that Ahmed's 10-year old daughter had died in a road accident soon after they crossed the border. She was buried near his shelter of plastic scraps in Ghausabad.
One ray of hope for Oliyan at least - the men who had brought me to "Little Afghanistan" were able to offer him some help for his son.
They were with an Afghan charity called Guardians, and they had a medical clinic in nearby Uzbek Bazaar.
Health worker Faridooh Ahadi told the desperate young refugee to bring the boy to the next day's surgery.
Challenging times ahead
At the clinic the head of the charity, Humayoun Barak, is worried about the days ahead, even as his team of doctors and health workers reach out to the new refugees around them.
"We've got a situation developing that needs co-ordination on a massive scale. Even now, the people coming here need the absolute basics, and that includes acute medical care. No one is set up for that yet," he said.
Guardians is based in the Afghan city and Taleban spiritual capital, Kandahar. Its 100-plus workers make artificial limbs for the city's many, many victims of landmine explosions.
Barak is preparing to return to Kandahar, come what may, because he fears the humanitarian crisis next door will be worse than what Pakistan could face.
The charity works closely with the United Nations High Commissioner for Refugees (UNHCR) which is still trying to set up facilities for the more than one million refugees on the move in Afghanistan right now.
"We're working along what could be the most tense border in the world right now," says Rupert Colville of UNHCR, a veteran Afghan operative.
"We have so many challenges, and so many people in desperate need. It's going to be a long, tough haul."