Quake victims fear for lives as the snows arrive

"Look, it has arrived. We sit under a naked sky and we shrink at night. We have nothing between us and the snow," said Abdul Kareem Imanullah, pointing at the white powdered mountain peaks of the Himalayas in the Jhelum Valley.

For Mr Imanullah, his fellow villagers from remote mountain communities and the 3.5 million people made homeless by the earthquake in Kashmir, the first snowfalls and sub-zero temperatures at night signify the danger of yet more illness and death.

Mr Imanullah's village of Rinja is among 13 mountain communities made up of more than 20,000 people, that is inaccessible by road, and soon the snow will prevent helicopters from landing to distribute aid.

The earthquake of 8 October levelled entire towns. In some of these, six weeks on, the survivors have yet to recover the bodies of the dead from under the rubble.

And those survivors who have received some aid are living in tents, although hundreds of the women and children are now fighting respiratory illnesses, diarrhoea and scabies.

Aid agencies have warned of the devastation that the winter could bring and many predict that the death toll will be significantly higher than the 73,000 thought to have perished during the quake, before the year is out. Deteriorating weather conditions across the region are hampering access to remote regions for road or helicopter aid distributions.

The depth of snow will climb to about 20ft by mid-winter in some areas of the Jhelum and Neelum valleys, giving those who have not received winterised tents or tarpaulin very little chance of survival.

The first child is reported to have died of pneumonia in Rinja and many more who have been injured or left homeless in the disaster are feared to face the same fate before long.

Some of those who have been displaced have set up unofficial "tents villages" that are not overseen by aid agencies or the army, and are overcrowded with highly unsanitary living conditions.

Many such villages lining the road to Balakot have begun to light fires in their tents and makeshift homes, to make meals and to keep warm, heightening the risk of injury and burns as well as respiratory illness among children from the inhalation of smoke.

The Red Cross is taking 50 helicopter deliveries across Kashmir every day in what the agency calls a "race against time".

Sarah Baumgartner, a Red Cross spokeswoman, said: "We need to get winter shelter for these people and every day counts now. We really have to work fast." Oxfam has scaled up its response. It plans to support about 640,000 people over the winter months, especially the increasing number of people moving from remote villages into temporary urban camps.

In the district of Mansehra, the agency is expecting between 40,000 and 60,000 people to arrive from the Khagan valley near Balakot.

Jane Cocking, who is in Pakistan leading Oxfam's emergency response, said: "Unless conditions are improved in these camps, diseases like cholera could spread like wildfire. If disease does break out in camps, the number of deaths could far exceed those in danger in their villages."

The charity has also been investigating alternative shelter for high-altitude areas, distributing shelter kits in some regions.

Landslides are increasing, as topsoil is loosened by fallen snow and rain, which is leaving many villages vulnerable.