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Freezing weather is due to descend on the mountains of Kashmir and northern Pakistan in November while only a small number of "winterised" tents have reached some 3m homeless survivors.

'WINTERISED' TENT Heavy-duty tent designed for long-term use by a single family PVC groundsheet sewn onto the sides for wind-proofing and to retain warmth Some types are designed to accommodate cooking stoves ICRC estimates that 30,000 such tents are required in Pakistan

UN Secretary General Kofi Annan has appealed for 450,000 more tents and shelters, as well as 2m blankets and sleeping bags, to be sent to Pakistan and its sector of Kashmir ahead of what he called the "merciless Himalayan winter".

In one area, the Kaghan Valley, just 91 had been distributed among an estimated 45,000 people as of 16 October, the BBC's Aamer Ahmed Khan reports.

In the ruined town of Balakot, people have been burning clothes donated by charities in an effort to keep warm.

Thousands of people from ruined villages may still be trapped on steep mountainsides posing a formidable obstacle to helicopter landings.

In any case, reports suggest the number of missions helicopters can fly is simply not enough to cover all the mountain villages affected before the snows begin in November.

After shelter, food supplies to mountain areas are emerging as the second priority of United Nations aid officials.

Mules come into their own

Villagers arriving on foot in the city of Muzaffarabad have been diagnosed with malnutrition and exposure as well as quake injuries.

The World Food Programme and Pakistani army are using packhorses and mules to deliver emergency rations.

As of 16 October, food had reached 440,000 people but an estimated 560,000 remained in "desperate need of assistance".

Where food does arrive by helicopter, there is the added problem of ensuring proper distribution.

"This will be only the second time we eat in three days," village girl Zobia Latiff, 13, told an AFP correspondent on a road outside Muzaffarabad on Thursday.

She had just begged some food off a passing motorist for herself and her little brother.

Taslim, aged six, had not eaten a full meal since the quake destroyed their village and injured their parents, his sister said.

The plight of both young children and expectant mothers is high on the list of UN concerns.

No home to go to

On 18 October, the UN's children's fund warned there were still 120,000 children who had not been reached by the relief effort in remote mountain areas.

At the makeshift hospital in Muzaffarabad, nearly half of those being treated for injuries were children, Unicef said.

Weeping by night, they appear dazed during the day, aid workers relate.

Apart from the trauma of being suddenly orphaned or horrifically injured, children are at particular risk from exposure and hunger.

"One cold night is enough to put the life of a child in danger," Brig Gen Zafar Gondal, an army doctor in Muzaffarabad, told AP news agency this week.

There are tens of thousands of pregnant women in the quake zone, according to the UN Population Fund which has appealed for $3.2 million to meet their needs.

With hospitals in ruins, expectant mothers need adequate nutrition, medicines and antenatal care while the physical and psychological trauma caused by the quake could aggravate their problems, the fund warns.

"People with normally non-life threatening injuries who have not yet received treatment or have not been accessed by relief teams are now at serious risk of fatal infection or crush syndrome," the World Health Organisation (WHO) reported this week.

Dirty water disease fears

No major outbreaks of disease have been recorded but poor sanitation and lack of clean water, coupled with food problems, are major concerns while the scope to deliver medical aid to the mountains is limited.

Tetanus, or lockjaw, has claimed at least three lives and stands to become one of the biggest threats, Dr Irfan Noor writes from North West Frontier Province in his diary for the BBC News website.

The disease, which is a bacterial infection that can cause fever, high blood pressure and severe muscle contractions, is unpredictable because of the incubation period, and vaccine is in short supply.

Thousands of severely injured people have been airlifted to the Pakistani capital, Islamabad. Once treated, however, many of them have nowhere to go, the WHO reports.

Pakistani Prime Minister Shaukat Aziz has sought to allay fears of orphaned or stray children falling victim to kidnappers.

The government will care for all orphans and no non-relatives will be allowed to adopt them, he said.

Unicef has warned of "the possibility children could fall into the hands of unscrupulous individuals or groups".

Looting was reported in the chaos following the quake but, in a part of the world where many people keep rifles in their houses, there have been few reports of violent crime.