Rescue teams led by the Pakistani army struggled to reach many of the hardest hit areas of the rugged North West Frontier Province and Pakistan-administered Kashmir, and the authorities said more helicopters were needed to reach flattened towns and villages.

"For the first two days we have been either digging ground to recover bodies or digging to bury them," said Sikander Hayat Khan, prime minister of Pakistani Kashmir.

"Kashmir has turned into a graveyard."

Estimates by officials suggest a final toll closer to 40,000, with children caught by the quake dying in their hundreds in village schools.

Tolls rise

Another 2000 people may have died in neighbouring India, and the fate of about 10,000 people living in remote villages on the border with Pakistan was still unknown, Indian officials said.

Pakistani Kashmir's PM said the
state had become a graveyard

The UN estimated that the number of people hit hard by the disaster was one million while the total affected population was expected to exceed four million.

In Pakistani Kashmir's capital, Muzaffarabad, where the old district was almost destroyed by Saturday's 7.6-magnitude earthquake, thousands are thought to have perished.

Extreme conditions

Many survivors were desperately short of food, medicine and water, and some took what they needed from shattered buildings.

"They've lost everything, they have no clothes, no food, nothing," said resident Asim Butt.

"They've lost everything, they have no clothes, no food, nothing" 

Asim Butt,
resident Muzaffarabad

Some gangs of young men looted anything they could, including cars and motorcycles, prompting police to fire shots in the air.

Pakistan's high commissioner to Britain, Maleeha Lodhi, said Islamabad was grateful for the aid offered but needed more, not just for emergency relief but for reconstruction later.

"We are dealing with a catastrophe on a major scale, so the relief effort has to be also on a major scale," she said.

Further dangers

The main roads into Muzaffarabad had been cleared, and some telecommunications restored, but the city was without power and threatened by disease from decomposing bodies and a broken sewerage system.

In Pakistan's capital, Islamabad, European, Arab and Japanese nationals were among an estimated 45 people missing two days after the quake destroyed two apartment blocks.

"There's a lot of the smell of death, but we are still confident, otherwise we wouldn't be here," said Anthony Thomas, of Rapid-UK, a British team assisting the rescue effort there.

Child rescued

Patience paid off when they pulled out an Iraqi child unscathed more than two days after he was trapped in the rubble. The rescuers were also hopeful of bringing out his mother and another child.

Six-year-old Nawasib is rescued
from his school in Balakot

The missing included two other members of the Iraqi family, a Swedish woman and her three children, at least one Italian man, a Spanish man, a Japanese man and another foreigner.

International donors announced tens of millions of dollars of emergency aid and were rushing in doctors, helicopters, food, tents and sniffer dogs.

"We know that every hour counts in an earthquake of this magnitude," UN Emergency Relief Coordinator Jan Egeland said.

Unmet needs

However, many victims voiced frustration at a lack of visible help on the ground days after the quake hit.

Despite aid pledges from around the world, there was little or no medical attention for many of the more than 40,000 injured in Pakistan more than two days after the disaster.

Workers load aid supplies sent by
Saudi Arabia to Pakistan

"Most of the people here are cursing the government for still not providing proper attention and we agree with their feelings," said Ayub, one of 120 medical students helping victims in Muzaffarabad.

Aid agencies said more than 120,000 people urgently needed shelter and up to four million could be left homeless by what was South Asia's strongest quake in 100 years.

The UN has appealed for donations. Planes with international aid had arrived from Saudi Arabia, Turkey, Britain, Japan and the United Arab Emirates. Russia, China and Germany also offered assistance.

The US military in neighbouring Afghanistan said it was diverting eight helicopters to assist with emergency operations.

Rivals cooperate

Pakistan accepted offers of relief supplies from old rival India, with which it contests ownership of Kashmir, but Foreign Ministry spokeswoman Tansim Aslam said no Indian troops would be allowed on to its territory. Pakistan also declined the offer of Indian helicopter support.

Muzaffarabad, a once-pretty river town, was a scene of devastation, with virtually every building destroyed or damaged and bodies left lying by roadsides.

Rescuers in Balakot attempt to
free a man trapped in rubble

An eight-member team of British rescuers using a sniffer dog, drills, chainsaws and crowbars pulled a 20-year-old tailor from the rubble on Monday, 54 hours after a two-storey building collapsed over him and dozens of others.

The man, Tariq, was wide-eyed and covered in dust when he emerged, and he begged for water.

"I haven't eaten in three days, but I'm not hungry," said Tariq, who suffered a leg injury and was carried away on a door serving as a stretcher.

He had been trapped beneath concrete and wooden beams, and dead bodies lay on either side of him.

In Balakot, a badly hit town in North West Frontier Province, townspeople broke through a heap of concrete at a school and rescued two girls after hearing cries for help.

Scenes of devastation

People carried corpses through shattered streets and the smell of death hung in the air. A sports field had been turned into a centre for homeless and injured, and a makeshift morgue.

Hundreds of people huddled under pieces of cloth strung up against the blazing sun while the injured lay on beds, awaiting helicopter evacuation.

Pakistan will need long-term
support for reconstruction

A mosque's minaret hung down the side of a wrecked building. People pushed a body down a main street on a trolley past another lying by the road, an upturned hand sticking out from a blanket.

Bodies still lay under the ruins of many buildings and crushed cars stuck out from the mounds of rubble.

Doctor Khalid Querishi, treating the injured, warned of the danger of secondary infection.

"The only solution is to move them from here because after a while the stench of these dead bodies will become unbearable and infectious. It is going to take time to remove the bodies."