Heavy rains and winds lashed the port city of Karachi on Sunday, killing at least four people as Cyclone Phet swirled along Pakistan's coast after claiming the lives of 15 people in Oman.
Provincial health minister Saghir Ahmad told AFP at least four people had been killed by electrocution in Karachi since rains started lashing the city on Saturday night. Such deaths typically occur as a result of fallen power lines or faulty equipment becoming damp.
Tens of thousands of people have already been evacuated from vulnerable coastal villages in the southern province of Sindh, of which Karachi is the capital, but thousands more are refusing to abandon their homes.
"Cyclone Phet is expected to landfall near Karachi sometime Sunday evening packed with maximum winds of 100 kilometres (60 miles) per hour," chief meteorologist Mohammad Riaz told AFP.
Cyclone Phet initially made landfall on Oman's coast, where 15 people died, including a Bangladeshi and a Pakistani, and Riaz said it could move further east to India from Pakistan.
Hospitals in the Karachi area have been put on alert and medicines and tinned food stockpiled, as meteorologists warn the cyclone may uproot power and communication lines along the coast.
Riaz said the cyclone could generate ocean waves of up to four metres (over 13 feet).
President Asif Ali Zardari has ordered lawmakers in Sindh to speed up relief work in areas expected to be battered by torrential rains, according to an official statement.
Pakistani authorities have already evacuated 60,000 people from along the 1,000-kilometre coastline, including 23,000 on outlying islands.
However "thousands of people are still living in the city's coastal suburbs and are not ready to leave their homes," said Roshan Shaikh, a senior official with the provincial disaster management authority.
"Initially we decided to shift them forcibly, but we could not as it might create unrest. However we are ready to save them in the minimum possible time," Shaikh told AFP.
The provincial head of the disaster management authority, Sualeh Farooqi, warned Karachi's infrastructure was weak and the cyclone could cause numerous problems.
Thousands of large advertising billboards along the city streets have been taken down for fear that the winds could blow them over.
Hundreds of relief camps have been established in the affected areas but people have complained about the lack of facilities.
"My family had gone to a relief camp a couple of days ago but there were not enough food and medical facilities which forced us to come back home," Mohammad Hashim, a resident of the Karachi suburb of Rerhi Goth, told AFP.
Nadeem Ahmed, the head of the National Disaster Management Agency (NDMA), said all relevant agencies and the armed forces were on alert.
"We are ready with our maximum abilities and resources to tackle any emergencies," he told AFP.
Riaz said the authorities had recorded 128 millimetres of rain in the first spell of a cyclone-related downpour late Saturday and that more was expected.
"Heavy rains may cause flash flooding in Karachi and other parts of Sindh and the southwestern Balochistan province," he said.
The government has established relief camps in school buildings and set up health units and control rooms ready to operate if needed, an official said.
A government official in Balochistan province, Ataullah Mengal, said cyclone-related rains had injured 18 people in the coastal areas but no deaths had been reported.