Hundreds of pneumonia cases are already being treated in Pakistan’s earthquake zone and hundreds of thousands risk death or disease unless they move below the snowline or get emergency shelter. With many survivors in the highlands without food, shelter or medical treatment four weeks after the devastating Oct. 8 quake, underfunded relief workers speak anxiously of a “second disaster in the making”. “Many, many people will die and many will be children as they are most vulnerable,” said Dagmar Chocholaclova, a Czech doctor in Ratnoi, a village near the town of Bagh in Pakistani Kashmir.

With night temperatures already below freezing and rain and snow forecast this week, her clinic has treated hundreds of cases of pneumonia and other acute respiratory infections like bronchitis. She estimated the clinic was treating only about one percent of patients from 28 settlements around Ratnoi as most people could not make the trek of many hours to reach it. “People are cold. They say they won’t die from hunger, they say they will die from cold,” she told reporters who toured the quake zone with UN officials on Sunday.

Louise Patterson, a coordinator for the American Refugee Committee, said hundreds of children were coming in with pneumonia symptoms and many survivors were sleeping in the open without any kind of shelter, or even blankets. She said there were fears thousands could die of hypothermia and predictions of a new death toll outstripping that of the quake could become a reality. UN officials dub an all-out bid to avert a second wave of deaths from cold and hunger after more than 73,000 people died in the earthquake “Operation Winter Race” and say time is the enemy.

They have not yet had hypothermia cases, but they say hundreds of thousands of people in the highlands of the quake zone, spread over a vast area of Kashmir and North West Frontier Province, face a stark choice. Either they come down from their villages above the 5,000 ft (1,500 metre) snowline, or they build emergency shelters in the remains of their homes with materials such as plastic sheeting provided by relief agencies and survive as best they can.

The United Nations is working on a two-pronged solution that involves expanding and setting up lowland camps for tens of thousands of refugees, while providing as many shelter kits as possible for those who stay in the highlands. Aid workers say many families are reluctant to move, as they fear losing homes and livestock, but may send more vulnerable women and children to the lowlands while a few fit men stay put.Hans Christian Poulsen, UN aid coordinator in the town of Batgram on the western part of the quake zone, said 80,000 people may need to move from the isolated Allai Valley region. Another 60,000 are in danger in the Khagan Valley further north.

<B>David Brunnstrom</B>