Quake victims face second wave of death in the snow

Still reeling from the devastating earthquake in Pakistan-administered Kashmir, miserable survivors huddle in crowded quarters, preparing for the onset of a Himalayan winter. In some Kashmiri villages, a new calamity is unfolding, with nearly half of them suffering skin diseases, respiratory problems or other cold-related illnesses, health officials say.

Two months after the 7.6 magnitude tremor destroyed their world, a second wave of death is expected to scythe through vulnerable communities in the mountains. "Scabies, flu and respiratory-tract problems are common," said Irshad Hussain, a doctor at a field hospital in Ghari Dopata, 20 miles south-east of Muzaffarabad, the capital of Pakistani-ruled Kashmir.

Some 700 cases of scabies have been treated in his clinic, close to the epicentre of the quake that killed 87,000 people and left nearly three million homeless. About 200 people suffered from colds but only a few had contacted pneumonia. Measles vaccinations are still a priority.

Health workers in tented villages for displaced villagers risk catching scabies, the highly contagious microscopic skin mites that cause relentless itching. Colds and flu spread quickly in the cramped wards where people, often with lowered immunity due to stress, mingle with outsiders. Health authorities say these diseases are hard to contain because of the lack of clean clothing and soap.

Living in temporary camps or in damaged buildings, many survivors find it difficult to bathe regularly, because they are modest and hot water is scarce.

Families stranded above the snowline, at 5,000ft, are being helped by the humanitarian agency Concern Worldwide which pledged to provide shelter and blankets to 20,000 people before Christmas. Syed Suleiman Shah, a senior relief worker for Concern, said: "Shelter, shelter, more than anything that is what we need as much as possible now."

Save the Children is distributing 6,000 tents and Shelterbox an other UK charity is distributing more than 10,000 tents and survival equipment. The push to provide shelter is urgent because when storms disrupt helicopter flights next week, the most remote villages may be cut off.

Nick Mathers, of Save the Children's in Muzaffarabad, said: "Up to 50 families are coming down from the mountains each day, and the numbers are increasing. This is their last resort. People don't want to leave their homes, their land and their livestock. If they have shelter and can find a way to stay in their villages, they will stay put."

Muhammed Saeed, a senior government meteorologist, forecast heavy snowstorms and lots of sleet across Kashmir next week. The high peaks have been dusted by snow for more than a month, but now the foothills will be blanketed and some roads may be cut again. Across the high-altitude, quake-hit zones, relief agencies and non-government organisations predict a "second wave" of deaths.

Yet some senior military officers say no such threat exists. "Those destined to die in the quake have died and there's nothing anyone can do about it," one army officer, with the relief effort in Pakistan-administered Kashmir, said. "But let me assure you, not a single survivor is now likely to die of cold or hunger."

In Lahore, a 43-year-old doctor in charge of a Lahore hospital ward, where victims of the quake are recovering, has been arrested on suspicion of raping an 18-year-old patient. The doctor denied sexual contact with her and said she had asked to marry him.