Freezing overnight temperatures, driving rain, deadly landslides, scarce food, little shelter and no communications networks -- earthquake survivors face many problems as they wait for help.
Most of the villages hardest-hit by Saturday's 7.6-magnitude temblor are nestled on hard-to-reach forested slopes in Pakistani-controlled Kashmir in the Himalaya mountains, where winter is fast approaching.
"It's been very difficult at this stage to gauge the scale of the disaster because there are enormous logistical difficulties getting up into the north," said Andrew MacLeod of the UN's Disaster Assessment and Coordination (UNDAC) team.
PHOTO: AP
MacLeod said only one road into the area was open, adding: "It's not just doing the assessments and finding out what the problems are and where the people are that need help. It's getting the assistance there."
Muzaffarabad, the capital of Pakistani-controlled Kashmir, sits on a bluff where two rivers join, nestled at the bottom of the steep, heavily forested Kashmir valley and overlooked by a large peak, Pir Chunasi.
The city, where more than 11,000 people are confirmed dead, is linked to the outside world only by two twisting roads which climb out of the valley -- both believed to have been either blocked or destroyed by quake-induced landslides.
The shattered town of Balakot is on similar terrain -- verdant slopes rising sharply from a raging river -- making relief efforts there an enormous challenge.
"People don't have tools or anything. It's such a disaster," Jan-Peter Stellema, who works for the international aid charity Medecins sans Frontieres (MSF -- Doctors without Borders) in the village of Lamnian, told the BBC.
"Bringing aid by road is not possible. By donkey or by mule might be possible, but air operations are definitely necessary," he said by satellite telephone -- which he said was the only means of communication in the valley.
Pakistani President Pervez Musharraf has appealed to the international community for help, including helicopters to access remote areas.
"It's not only rescue work that is being affected, we have to start relief efforts as well. There's a huge need for field hospitals, water, sanitation and for food," Gerhard Putman-Cramer, head of the UNDAC team, said.
His colleague MacLeod warned that the onset of winter also would complicate relief efforts, as agencies would have to provide shelter "that is going to have to last people through the entire winter and through most of next year."
"It's quite cold at night now and we haven't even seen the winter begin, let alone the first falls of snow," he said.
Temperatures in Muzaffarabad remained at about 15?C overnight, but in Balakot, survivors faced overnight temperatures hovering just above the freezing mark, along with rain and wind.
"We survived the earthquake but now we realize we will die of hunger and cold, Mohammad Zaheer, a survivor in Balakot, said.
"Is there anyone who can help us, relieve us from this misery?" Mohammad said.
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