The infant is one of six children Bano has been trying to keep alive since last October's earthquake devastated this remote town of Battal, situated in the mountainous north of Pakistan's North West Frontier Province (NWFP).

She lost one child in the catastrophe and her husband is still missing.

"We need more food, more blankets," says Bano, her clothes muddied from the slush beneath her feet. "The cold is our biggest problem now."

Her family's story is repeated in hundreds of flimsy tents scattered on the snowy slopes around the town.

Battal's residents were among the hardest hit by the 8 October Kashmir earthquake, which affected three million people, the vast majority of them in Pakistan.

The powerful earthquake, measuring 7.6 on the Richter scale, left more than 73,000 Pakistanis dead and a similar number injured in NWFP and Pakistani-administered Kashmir (AJK).

Amid widespread damage, the local school collapsed, killing scores of children inside.

"Hardly a house here was left standing, not a single family was spared a tragedy," says Jan Muhammad, the administrator of a camp in the town.

Second catastrophe

As survivors mark 100 days since the calamity, aid workers are warning that a second humanitarian disaster is looming. Plummeting temperatures have caused a rise in cold-related illnesses - especially among children and the elderly.

Most tents rushed to the region after the earthquake were unsuitable for winter conditions although since then aid agencies have been busy "winterising" shelters.

Bano is trying to keep Kayanat
and five others alive in a tent

As the first heavy snowfall struck the region last month, the UN reported that at least 18 people had already died from the cold. Many tents collapsed under the weight of the snow.

With temperatures falling to
-15C in some areas, heating remains a serious problem with open fires in crowded spontaneous tented camps posing a grave risk. Four children were among the latest to die when their tent caught fire in the Battgram district of NWFP earlier this week.

Farhana Faruqi Stocker, international agency Oxfam's country director in Pakistan, says: "It's a race against time to help the survivors, many of whom remain in inaccessible camps and villages high up in the mountains with inadequate heating and unpredictable supplies of food."

More than two million people rely on food aid - half of them from overstretched relief agencies - according to the UN's World Food Programme (WFP).

Uphill task

The relief effort faces a huge and complex challenge. The Himalayan terrain literally presents aid convoys with a mountain to climb, with hundreds of villages and settlements across an area the size of Switzerland only accessible by cable car or on foot.

A lack of co-ordination among NGOs has also hampered relief work at times with duplication of effort in some areas while too little has reached other remote settlements.

Children are the most vulnerable
to cold-related illnesses

Promised funds for the UN - the body best placed to provide co-ordination and leadership - have been slow to arrive. Barely half of the $549 million it asked for has reached its emergency response fund. Some UN agencies need more money urgently.

Michael Jones, WFP Emergency Coordinator, says: "Helicopter airlifts represent a lifeline for over 500,000 quake survivors in remote mountain valleys and other inaccessible locations."

"In order to maintain airlifts until the end of April, an immediate funding shortfall of $12.6 million needs to be filled."

Jones told Aljazeera.net that ground logistics support would require an additional $5 million, and ensuring access to food needed a further $15 million in the next few weeks. "Thus, WFP alone will require a further $32.6 million to cover just the emergency phase."

Bad to worse

Meanwhile, the onset of winter has made a bad situation worse. Many camps, for example, were located in paddy fields, which provided some of the few flat places in the mountainous region. But such fields are designed to retain water and, following heavy snow and rain, many have become waterlogged.

Fresh heavy snowfall this week led once more to the suspension of vital helicopter aid flights. Landslides triggered by rain and snow have blocked many roads amid reports of people and vehicles being swept off the mountainside.

Flimsy tents are all that stand
between life and death

Despite all the challenges, the relief effort has made a huge difference to the lives of many.

At Meera camp near Battgram - one of the largest in the region - Colonel Ahmad Fraz Khan of the Pakistani army is overseeing the welfare of more than 18,000 displaced people.

"We've made preparations to take another 15,000," he says, "About 40 families arrived just yesterday."

A range of materials and facilities have been provided by dozens of local NGOs and a variety of international sources: food from WFP, water and sanitation from Oxfam, tents from the Red Cross and various items from USAid to name a few.

A Cuban army field hospital provides medical services.

"We're now providing schooling to at least 2500 children and for 90% of them, it was their first day at school," says Colonel Fraz. "We've also built a community centre for women with the help of NGOs, where they get training on sewing machines and we teach them how to stitch."

Rebuilding lives

The centre, Colonel Fraz adds, needs more sewing machines. Moreover, he sees a need to offer training for people to become electricians and masons - skills that would be vital for the nascent reconstruction effort.

This raises the crucial question of what happens next. Thousands of people lost their livelihoods, lands and livestock and many need to be relocated from vulnerable sites below rocky slopes that continue to be rattled by tremors. 

Tahir, a resident of Havellian camp near Abbottabad in NWFP, says: "We've lost our lands and cattle - we can't go back and risk losing our children too."

Numan and Nazia sit near the
remains of a house in Battal

Oxfam's chief in Pakistan says women face particular problems, such as widows who have no documented proof of property and therefore risk missing out on compensation.

"Nevertheless, an opportunity exists to plan reconstruction in such a way that people are not simply returned to the conditions of poverty and poor infrastructure that existed before the earthquake," says Stocker.

To maintain the momentum for reconstruction, as well as getting through the emergency phase, the international community must remain engaged and support the Pakistani authorities and the work of NGOs, she says.

"Losing interest at this stage would mean not just losing the opportunity to rebuild people's future, but at this critical stage, many could lose their lives," she warns.

Shaheen Chughtai is currently in Pakistan assisting the international relief agency Oxfam.