– Ella Red Cloud-Yellow Horse, marooned for days by a blizzard and then a flood, needed to get out. Supplies at her house were running low. She had come down with pneumonia. She had a chemotherapy appointment to keep.

But her long driveway was blocked by mountains of mud — impassable even for an ambulance or a tractor.

So Red Cloud-Yellow Horse, 59, set off toward the road on foot. She fell repeatedly, almost got swept away in the current of a creek, and became stuck in the mud. Finally, more than an hour later, she made it the half-mile to the highway where she was picked up.

“I couldn’t breathe,” she said, “but I knew I needed to get to the hospital.”

Such stories are startlingly common these days on the Pine Ridge Indian Reservation in South Dakota — a stunning stretch of land larger than Delaware — as an overwhelming bout of snow and flooding has set off a humanitarian disaster that seems unlikely to abate soon.

With some residents approaching two weeks stranded in their homes, and with emergency rations able to reach parts of the back country only by horse, boat and helicopter, Pine Ridge remains in a state of shock and triage.

Officials with the Oglala Sioux Tribe, which administers the reservation, say they lack the training, manpower and equipment needed to deal with such a large-scale crisis. And there’s a pervasive sense on Pine Ridge, a place of long-strained relations with the state and federal governments, that help has been woefully slow to arrive, and that few people beyond the reservation know or care much about its plight.

“This is a state of emergency right now,” said Henry Red Cloud, whose family’s losses in the flooding include five homes, a forklift, a truck, a van and the building where his solar energy business was based.

Red Cloud now rides a flat-bottomed boat each night to the one home on his family’s property that is not a total loss. “What we need to be doing is building sandbag walls — not a Southern border wall,” he said.

Pine Ridge was far from alone in being hit with damaging quantities of snow and water this month. Huge portions of the Midwest were swallowed by rivers in the past 10 days, with devastating consequences for farms, roads and small riverfront towns. So far, at least three people have died, and the affected states have estimated that they have suffered more than $1 billion in damage and economic harm.

But while conversations about recovery were already underway in the hardest-hit portions of Nebraska and Iowa, where most roads have reopened and many rivers have started to recede, Pine Ridge, with a population of about 20,000, remained in a state of hour-to-hour chaos. Some of the tribe’s scarce heavy equipment was lost in the mud. Jail inmates were enlisted to fill sandbags. New parents worried as they ran low on infant formula.

Unlike in Nebraska, where the National Guard rescued 111 people, including some by helicopter and boat, outside help for Pine Ridge was conspicuously scarce at first. South Dakota Gov. Kristi Noem has been seen by many Pine Ridge officials and residents as slow to respond. But Noem, who visited the reservation Saturday, said that the tribe had only made formal requests for help in recent days, which she quickly approved. Since then, Noem said the state had sent ATVs, a boat rescue team and a small group of National Guard soldiers to distribute drinking water.

The tribal-led relief effort on Pine Ridge has been mired in challenges. Though employees pulled marathon shifts and slept in their work vehicles, there were simply not enough people or equipment to reach everyone needing help, residents said. Julian Bear Runner, the Oglala Sioux Tribe’s newly elected president, said many had voiced frustration with the tribal government’s response.

“People are getting angry,” Bear Runner said, “and that’s understandable.” But he added, “We’re doing the best we can with what little we have.”

Tribal officials said the federal Bureau of Indian Affairs had also provided equipment and manpower to help.

The crisis on Pine Ridge is a collision of nature, poverty and inadequate infrastructure. No sooner were Pine Ridge’s highways mostly cleared of snow than temperatures shot up, and the rush of newly melted water overflowed from creeks and rivers. The flooding — the worst in at least a generation, several residents said — turned the rugged dirt roads that many people live along into a liquefied mud soup.

Adding to the urgency, late last week about 8,000 residents lost drinking water.

“It’s gotten worse,” Bear Runner said Friday.

Pine Ridge is a place accustomed to struggle, and its people have had well-publicized battles with alcoholism and teen suicide. Half the reservation’s residents live in poverty, according to the Census Bureau, and the unemployment rate is 20 percent, compared with about 3 percent for South Dakota as a whole. Many people on Pine Ridge live in aging houses a mile or more from a highway, and some depend on wood-burning stoves to keep warm.

“The lack of resources, the lack of water, lack of transportation and the lack of facilities: this really compounds all of the issues,” said Valentina Merdanian, a tribal council member who on Friday was fielding calls from stranded constituents and trying to organize rescue crews.

In the few quiet moments, some people expressed worry that the treacherous conditions could become a new normal. “With climate change, it’s getting worse and worse,” said Robert Pille, who had to leave his home because of the floods. “This is going to be a regular thing.”

Tribal officials were still working to determine whether as many as four deaths in the past two weeks could be attributed to the storm, including some involving patients who needed medical help and could not be reached by ambulance. Tribal Police Chief Robert Ecoffey said Friday that it was not known whether those people would have survived if an ambulance had reached them.

In the meantime, some on Pine Ridge were hunkering down for what could be weeks more with little or no access to the outside world.