Medicine and food have flowed into areas of northern Pakistan as rescue operations in the devastating Kashmir earthquake increasingly becomes a relief mission for those who survived.
At daybreak on Wednesday six huge trucks and three large vans belonging to Pakistan's largest private trust, the Edhi Foundation, arrived in worst-hit Muzaffarabad, the capital of Pakistan-administered Kashmir, laden with relief supplies.
But witnesses saw very little rescue work going on in the city of about 70,000 people, and there were no reports of rescuers finding any signs of life in the rubble.
Local officials estimate the quake - at 7.6 magnitude the strongest to hit the region in a century - may have claimed up to 40,000 lives.
But the official toll remains at 23,000 dead and 51,000 injured in Pakistan, and 1200 deaths on the Indian side of the line of control, the de facto border. Some 2.5 million have been made homeless.
Rescue teams are still to reach many of the more remote mountainous areas hit by the quake. Relief is even further away.
"Things are improving, but in the areas rescue teams have not yet been able to reach, hope basically is fading," said a senior UN official, who did not want to be identified.
Rains halt relief
Relief authorities were most concerned about the weather and the onset of winter, which usually comes in mid to late October.
Some snow could already be seen at the top of mountains from Battagram, 230km from Islamabad in North West Frontier Province.
There is a short supply of blankets
and plastic sheets
On Tuesday, relief flights had to be halted for two hours because of torrential rain and hailstorms that also added to the misery on the ground where people are being forced to sleep out in the open.
"Because of rain and the onset of cold weather, provision of shelter is our first priority. We are in short supply of blankets and plastic sheets," a senior military official involved in relief operations said on Wednesday.
"We also badly need shrouds to bury the dead," he said.
Pledges of aid and relief worth hundreds of millions of dollars have poured in from around the world, and Pakistani leaders who have deployed thousands of troops to the region have been saying that the relief operation is picking up speed.
But resident and international relief officials could not help but express frustration at the pace of relief.
Up to 90% of homes have been
destroyed in Muzaffarabad
Medical experts say an unhurt man can last three days without water and a woman four days, although in such disasters there are often extraordinary survival stories.
A local journalist in Battagram said the arrival of the first aid on Tuesday caused scuffles.
"The people are very angry over the late arrival of the aid... Many people were lying under open sky in hail and rain yesterday with no shelter.
"Today, the weather is clear and the army has promised to give 750 tents to us," he said.
The World Food Programme said food was needed for at least a million people, but a first shipment sufficient to feed 240,000 for five days might not arrive until later on Wednesday.
"This food is needed urgently," said WFP spokesman Amjad Jamal.
"People are trying to recover from a major disaster; they are in shock and their bodily resistance will go down if they do not have enough food."
An 80-year old quake survivor
amid her collapsed house
The United Nations said there was a risk of cholera and pneumonia and Muzaffarabad's health director Khawaja Shabir said malaria and other diseases were already breaking out, with hospitals wrecked and many doctors dead.
"We're helpless in handling it on our own as right now we don't have a single hospital left in Muzaffarabad, no medicine, no paramedic staff, nothing," he said.
On Tuesday, the UN appealed for $272 million to provide winter tents, food, blankets, medicine and water purification equipment, as well as to rebuild schools.
Prime Minister Shaukat Aziz has expressed confidence that Pakistan will see the situation improve dramatically over the next days.
"They (helicopters) will fan out to villages outside the main cities so that the people receive relief there, in addition to the ground troops who are fanning out also, to go village to village and help out where needed," he said late on Tuesday.
Pakistani PM Shaukat Aziz is
confident things will improve
US Secretary of State Condoleezza Rice, on a visit to neighbouring Afghanistan, said she would fly to Pakistan later on Wednesday to show support for a military ally.
US officials said the US military was increasing humanitarian aid to Pakistan. President George Bush had offered an initial $50 million in US emergency aid.
Nato ambassadors in Brussels agreed to provide a small fleet of Boeing 707s to help move aid.
A Nato spokeswoman said the first aircraft with 7.5 tonnes of relief supplies would leave for Pakistan on Wednesday.
There was some good news in the capital Islamabad on Tuesday night when a 75-year-old Pakistani grandmother and her daughter were pulled from a collapsed apartment block after rescuers said they thought they heard sounds from seven different people.
Relief workers say they are also
in need of burial shrouds
At least 40 people are thought still missing there, including European, Arab and Japanese nationals.
In Muzaffarabad, although the rains had stopped, the misery continued as most spent a shivering fourth night in the open amid the ruins, too afraid to use what is left of their damaged houses.
The lucky ones managed to find themselves blankets and even some tents to protect against the cold. Others made do with pieces of cardboard and slept between mounds of rubble on the pavements.
All emerged from the freezing night to find that snow had fallen on the peaks surrounding the once-picturesque Kashmiri city.
"That was the fourth night we slept in the open," said Khurshid Bibi, pointing to her family of 15 camped on the roadside outside their collapsed house in Gulshan street.
"We were very, very cold. We need tents and blankets.
"We've seen the foreigners sending in help, but nothing from our own government"
Quake survivor Khurshid Bibi
"It's hard living on the street. My mother is very ill. We are scared of robbers and of aftershocks," she said.
Like many others, she and her family want to rebuild their home but they need government aid.
"We've seen the foreigners sending in help, but nothing from our own government," said Bibi, as a US Chinook helicopter flew overhead marking the first mercy flight of the day.