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With a harsh Himalayan winter looming, survivors of South Asia’s massive 8 October earthquake now have the added problem of disease to contend with.

Hundreds of cases of acute watery diarrhoea were reported in camps in Muzafferabad, the regional capital of Pakistani Azad (Free) Kashmir, where 90 per cent of buildings have been destroyed or rendered unsafe.

Doctors are also concerned about outbreaks of measles, tetanus, whooping cough, diptheria, and polio.

Aid workers fear a lack of shelter could lead to thousands of additional deaths if relief efforts are not effective. As winter sets in, the situation could be compounded by disease outbreaks, threatening the lives of those who seek shelter in camps.

While some 32,000 people have been settled in planned camps, others are congregating in spontaneous camp settlements, which have poorly constructed or no sanitation systems or clean water.

“We are really worried about the weather. People are getting serious illness – acute watery diarrhoea is already present and pneumonia will be a serious issues as the weather gets worse,” Irja Sandberg, head of a delegation of the International Federation of the Red Cross and Red Crescent Societies, told ISN Security Watch.

Relief workers fear that as winter sets in and snowfalls begin on higher ground, people who lack sufficient shelter will converge on towns in Kashmir’s valleys or on camps, exacerbating the health and logistical difficulties of the under-funded and under-resourced emergency aid effort.

In the meantime, doctors in Pakistan-administered Kashmir say they are hoping to immunize some 800,000 children against potential deadly diseases within the next two weeks.

“The target is to immunize 800,000 children. We want to vaccinate them in the next two weeks’, weather permitting, before people get into close quarters in camps,” Dr. Tamur Mueenuddin, with the United Nations Children’s Fund (UNICEF) in the Pakistani Kashmir capital of Muzaffarabad, told Reuters on Sunday.

Meanwhile, a UN flash appeal has so far generated only 15 per cent of the US$550 million requested to support emergency relief provision such as food, shelter, and sanitation. The US has supplied over US$150 million of bilateral aid.

If more emergency funds are not delivered, the UN’s World Food Program (WFP) said it might be forced to cut back on its helicopter lift capacity.

Over US$1 billion has been pledged to aid reconstruction.

UN Secretary General Kofi Annan will visit Pakistan for a donor reconstruction conference on 19 November, when the UN will release its estimates for rebuilding earthquake-affected areas.

On 12 November, the World Bank and the Asian Developement Bank published a US$5.2 billion draft plan for reconstruction.

However, before reconstruction begins, international organizations, nongovernmental organizations, donor governments, and the Pakistani administration face a race against time to save lives as winter approaches.

Recent figures put the death toll at anything from 73,000 to 87, 000 in Pakistani Azad Kashmir and North West Frontier Province (NWFP), with a further 1,600 fatalities in Indian Jammu and Kashmir. Around 17,000 children died in the disaster, many of whom were crushed when their schools collapsed.

In quake-affected zones a total of 3.3 million people have been made homeless. Up to 250,000 may not have received any assistance yet, though helicopter drops have been made in inaccessible locations such as the Neelum Valley north of Muzafferabad.

Now, with winter nearing, it is possible that an overstretched relief operation will be hard-pressed to reach vulnerable areas at high altitude, while dealing with a flow of people to camps and towns.

“We especially need trained quality health staff. There is a shortage of medical personnel in-country. We need female medical staff and nurses,” Sandberg said.

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