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Heavy rain on Saturday disrupted air operations supplying the desperately needed aid to survivors of the earthquake as the confirmed death toll soared to 38,000, with 3.3 million homeless.
And, with 62,000 lying injured without proper medical care--many with no care at all--fears are growing that thousands more may die of infections and other complications in the coming days.
"Several thousand people may die in the next few days. Their wounds have turned septic, they have fractures," Sean Keogh, of Britain-based Medical Relief International (Merlin), said after reaching remote areas on foot.
Pakistani officials announced a sharp spike in the death toll to 38,000, a rise of 13,000, as international rescue operations ended and bulldozers started clearing rubble full of bodies.
The number of homeless was also revised upward from 2.5 million to 3.3 million, Interior Minister Aftab Sherpao told AFP, as destitute survivors faced an eighth night out in the open in the freezing Himalayan foothills of Kashmir.
"It's a colossal tragedy," Sherpao said.
President Pervez Musharraf, speaking to reporters at Chaklala Air Base, said the toll would almost certainly rise.
"I think it will keep rising... When we go into these villages of the Neelum and Jhelum river valleys, I am reasonably sure it is going to rise," he said.
Heavy downpours throughout the morning briefly halted helicopter relief flights and turned the roads to mud, while fresh snow appeared on higher mountains where dozens of remote villages remained cut off from precarious supply links.
"The relief operation has been badly disrupted by this bad weather. There are many places we haven't yet reached. But we hope to get to some of them today," Anwar Khan, President of Azad Kashmir, told AFP.
"The snow is a problem and what we urgently need is tentage."
Limited helicopter flights resumed by late morning as the clouds cleared, but rain continued to fall over the region and more was forecast for the afternoon.
Health experts warned that the wet and cold could claim more victims through hypothermia, and that gangrenous infections could also turn fatal for many of those still waiting for evacuation.
Keogh, who had spent three days making a medical assessment on foot through the Panjkot region of the Neelum Valley, 40 kilometres (25 miles) north-east of Muzaffarabad, said he had little hope for thousands of injured villagers.
"They are sheltering under sheets of iron. There's heavy rain, snow and it's very cold," he told an AFP reporter who reached him at the remote village of Dhanni via helicopter.
"In one village, 2,000 people need treatment. There are no roads to reach them. The only way to get to them is by helicopter. A lot of survivors will die quite soon from their infections. We're seeing the first signs of gangrene."
The World Health Organisation co-ordinator in this devastated city, the centre of relief operations, said: "In these conditions, people will freeze. They will suffer hypothermia."
"There is a small window of less than a week to get to them. Those who are critically injured have very little chance," said Altuf Musani.
Thousands of destitute people huddled under plastic sheets as the rain lashed Muzaffarabad and the surrounding mountains for most of the morning.
Desperate survivors were seen scrambling in the rain and mud for packets of biscuits and other supplies which were being thrown from the backs of trucks by a variety of non-governmental organisations and other groups.
Prime Minister Shaukat Aziz said that despite 500 million dollars in aid pledges, Pakistan's needs remained enormous.
"We need tents and pre-fabricated houses. A lot has come but the requirement is huge," he told reporters in Islamabad.
A week after the catastrophe, UN agencies were only just starting to make their presence felt, witnesses said.
"There is enough for everyone. Line up! There is enough for all of you," shouted an independent aid volunteer at the top of a brightly painted truck as the crowd fought for food and blankets.

Copyright Agence France-Presse, 2005

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