Race to bring aid to three million quake homeless as snows close in

Three RAF Chinook helicopters are on the way to northern Pakistan, where they will join an epic struggle to bring half a million tents and relief supplies to the three million people left homeless after a colossal quake struck the Himalayan foothills a fortnight ago. Only a few weeks remain before about 15,000 hamlets that are still cut off by landslides will be waist-deep in snow.

Britain has pledged a further £20m in emergency aid, bringing its contribution to £33m. But Pakistan's President, Pervez Musharraf, has said the country needs at least £2.82bn to rebuild the towns and villages of Kashmir and the Northwest Frontier Province.

Meanwhile, the homeless need shelter and medical attention before they die from exposure or infection. Nato has agreed to send 12 giant C-17 cargo planes loaded with supplies and to deploy up to 1,000 troops, mainly civil engineers, to help repair the ravages of the 7.8-magnitude tremor, which obliterated mountain roads, snapped bridges, swept schoolrooms into raging rivers, levelled buildings and killed at least 79,000 people. More bodies are expected to be retrieved from under landslides.

Until roads are reopened, soldiers have to climb on foot, carrying supplies in rucksacks, to settlements on remote mountain ridges. Setting up improvised helipads for relief flights to these districts is a priority. Even pack mules cannot make it up some of the steep slopes, while parachute drops can be risky.

"We need helicopters, a lot of helicopters and all types of helicopter," said Jan Vandemoortele, the UN official co-ordinating the international relief effort.

The magnitude of the disaster has shocked even the most experienced aid workers. They say that the extreme weather and the rugged terrain, spread over 30,000sq km, make the logistics of the operation even more difficult than after last year's tsunami.

The provision of shelter is another pressing need. One aid official said that 541,000 winterised tents were needed - about 200,000 more than the entire global supply. Only 122,000 tents have been delivered so far.

"But most of all the scarcest commodity at this time is time," Mr Vandemoortele said. "Winter is closing in," he added. "We have to quicken the pace and scale up the action on the ground."

Conditions in the improvised camps where victims are sent to recover after surgery - because the field hospitals require their cots for new patients - are filthy. About 150 tons of raw sewage are flowing from them every day into the open. Without improvements to sanitation, aid workers say a new wave of deaths is likely.

Immunisations are under way to stop the spread of disease. Five people died from tetanus last week and Pakistan's Health Ministry announced that 42 more cases were being treated.

Captain Assad Ullah Jan, a military doctor at an open-air clinic in Paras, a ruined village near the epicentre of the quake, was not surprised by the tetanus epidemic. "There was nothing else to staunch the bleeding - no cotton, bandages, or clean rags - so many people used cow dung mixed with mud to keep flies off their wounds," he said. "This introduced tetanus spores."

Dr Badria Jibril, a volunteer from Rawalpindi, warned that many people risked losing limbs. "Amputation is becoming increasingly common as they turn gangrenous," she said.

On Friday, families carrying limp children jostled for places on board a Pakistan army helicopter evacuating patients from Paras for surgery in the town of Mansehra. Clutching plastic bags containing their identity papers, dozens tried to cram inside and the pilots had to force three people off before the aircraft could take off.

Khadija Butt had hiked for eight hours to reach Paras, shepherding four feverish children along a steep, narrow track, because aftershocks from the earthquake had blocked the main trail with boulders and uprooted trees. Once aboard the helicopter, she stared grimly out the window as the ground fell away. "Four of my family lie dead down there," she said, gesturing at the scarred hillsides below.