The threat of a wave of additional deaths among earthquake survivors in northern Pakistan is becoming more acute with each passing day as families continue to arrive in relief shelters, fleeing the sudden advance of winter, according to the latest report from the United Nations Children's Fund (UNICEF).
The danger arises from the cold, poor sanitary conditions and inadequate nutrition, yet UNICEF's $93-million emergency appeal is only 64 per cent funded.
The ingredients for life-threatening illnesses are all to be found in the camps, the agency reported from Muzaffarabad, one of the areas worst hit by the quake which killed some 80,000 people, injured as many others and left up to 3 million homeless.
Makeshift, unsanitary cooking pots lie in the dirt in front of each tent. Poor diets and a lack of clean water have left many weak and vulnerable.
"The hygienic situation is fairly deplorable, so I would have to say that water and sanitation is our main priority right now," UNICEF Health Officer Tamur Mueenuddin said.
"Children are malnourished, viral infections are rampant. They begin often with acute upper respiratory syndrome and sometimes the viral infections will include diarrhoea infections as well," he added.
The struggle against disease takes place on several fronts. A vital part of the effort is providing clean water. When the 8 October quake destroyed the water system around Muzaffarabad, UNICEF immediately began installing makeshift water tanks in the camps and digging pit latrines.
Education is also essential. Displaced families who had never seen a latrine before are educated about their use. Children are taught to wash their hands with soap and water regularly. These simple things are crucial for maintaining health and preventing more deaths.
Training the Pakistan Army in camp management has also become a UNICEF priority. Now, local military officials regularly survey the camps, with an eye for the water, sanitation, and nutrition needs of the population.
But as the number of displaced people in the camps continues to grow, so do their needs for shelter, water, sanitation, nutrition, and health care. More resources are needed to sustain and expand the relief effort.