Pneumonia Hits Pakistan Quake Zone

RATNOI, Pakistan (Reuters) - 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 October 8th 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 is 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 U.N. 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 are fears thousands could die of hypothermia and predictions of a new death toll outstripping that of the quake could become a reality.

U.N. 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.

"SHEER SURVIVAL"

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, U.N. 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.

A refugee camp has been established at the town of Meira with room for 40,000 people, and another in Batgram with a capacity of 5,000. Others are planned.

The Pakistani army says it has distributed about 15,000 of the 39,000 tents needed in the Batgram region, but only 200 are heavy duty versions suitable for the harsh Himalayan winter, where temperatures plunge to minus 20 degrees Celsius (minus 4F).

"Even with the best equipment in the world, living in tents in snow is sheer survival," Poulsen said. "We are concerned that people, especially women and children, can just die in the night."

"We can have a very nasty situation when winter starts."

U.N. workers, hampered by a failure of world donors to respond to an emergency appeal for funds, fear they could be faced with a big rush from the highlands when winter really starts to bite without proper facilities to shelter them.

World Food Programme coordinator Keith Ursel said more than 150,000 people were still in areas largely cut off by landslides and reachable only from the air and the international helicopter fleet flying relief supplies had only a limited capacity.

WFP is struggling to feed a million of the 2.3 million people needing emergency food and Ursel said he was terrified by the impact forecast rains and snow could have on relief efforts.

Bad weather will make many already dangerous roads completely impassable and ground helicopters.

"It's a very, very critical problem. If the rains come these roads will close and that's going to be very bad," he said.

Foreign aid workers, many of whom were involved with the Asian tsunami, are baffled by the failure to fund the earthquake relief with similar generosity. So far only $135 million of the $550 million the U.N. has sought has been provided.

"Everyone is doing their best," said U.N. coordinator in Bagh Jemilah Mahmood. "But each day it's 50 tents that are delivered rather than 500. In the tsunami there were many more helicopters flying in and out and the aid here really is needed."