Samina Wali is three months pregnant and desperate for an abortion. One look at her living conditions and it is easy to see why she would consider such a taboo action in an area of Pakistan known as the Jihadi belt. Her home and its contents have been reduced to a pile of rubble. And, unlike many of the now homeless survivors of the earthquake, the 30-year-old, who already has six children, doesn't even have a proper tent.
"I have no shelter. How can I give birth?" she asks a medic, gesturing to the plastic sheet under which she lives with her family.
Samina will not get her wish. Abortion is forbidden in Pakistan except for medical reasons. There is, of course, the distinct possibility that the baby will not survive. Disease and infection are now rife among the tent dwellers in the ruins of Bazargai, a mountain village in Batamori in the North West Frontier Province. But a more pressing killer is the weather. Within 10 days everything will be under several feet of snow.
The medic Shabana Ashraf continues her rounds in the village, where every house bar one has been flattened. The 24-year-old is one of five staff running a medical camp in Bazargai. Operating out of two tents - one for women and one for men - it caters for around 5,000 people living in the surrounding area.
Survivors with major injuries have been taken to hospital, and the medics are now focusing their attention on keeping survivors alive through the winter. More than 100 patients are treated each day, around 30 per cent of whom already have chest infections, including potentially fatal pneumonia. Typhoid has also broken out, and scabies is rife. Diarrhoea, dysentery and depression are also common.
Shabana is one of two female medics in the camp and as such a vital resource, as some men are reluctant to allow their wives to be seen by male doctors. There were more women victims of the tragedy than men, for they were more likely to be at home when the earthquake struck at 8.45am. "When the women doctors came to the camp, the number of patients increased," said Dr Rubina Saigol, director of ActionAid Pakistan, which runs the facility.
"A lot of time men didn't want to take their women to see a male doctor and a lot of women were denied medical care. This is a highly religious area. The idea of purdah and the four walls of the house is very strong here. Women have less access to hospitals, because of strong social traditions. Our entire emergency response is specifically geared towards helping women and children, because they are the most affected." The charity has also hired a gender co-ordinator to make sure women receive the aid that is due to them.
There are particular medical problems for the women here. With no toilets, men are able to use the fields at any time, but women only feel comfortable venturing out there very early in the morning or at night. The incidence of urinary tract infections is high, and women no longer have the privacy to wash and dry the strips of cotton they use during menstruation. Fifty per cent of married women are pregnant. Both mothers and newborns will run the risk of tetanus and septicaemia. The camp is hoping to establish a birthing centre.
Shabana picks her way through the piles of rock and timber and calls at the tent of her next patient, Husan Afroz. The 65-year-old's hypertension has worsened since the disaster. "I'm in pain. I feel that the earth is moving all the time. I can't sleep," says Husan, who also has severe arthritis.
"I'm still terrified and in shock. I thought I was going to die. I don't feel comfortable in a tent. I can't stand up. I'm always bent, and it's a problem for my knees."
Another patient, Mehboob Jan, is 85 and has chronic TB. Her 22 relatives, none of whom has been inoculated, are living in two adjacent tents. "I was at home when the earthquake hit," she recalls. "All the walls collapsed. I thought somebody had lifted up the house and dropped it. I was saying my prayers, and I think that's why I survived. Somebody pulled me out.
"Now there's no toilet or water to wash myself before praying. I just go through the actions." She will be transferred to hospital by the end of the day.
Zarina Bibi, 60, is sitting on a mattress in her tent in obvious pain. She has suffered from a cracked pelvis since her kitchen wall toppled on to her. For the first week, her male relatives refused to allow her to go to hospital until they were convinced by the medical staff that it was the best thing for her. However, since she has returned to the camp following treatment, the family hasn't been keeping up with her physiotherapy, and she will have to return. She also has problems caused by the menopause that will need to be addressed.
The mother is lucky to be too old to have been pregnant when the earthquake hit. "Women who were pregnant have been crushed and the foetuses are dead," says Shabana. "We don't have the surgical instruments for the abortions. If we had surgical items we could deal with such types of conditions as well as the D&Cs." Many women are now asking for contraceptives, another taboo subject, because they feel unable to look after more children. It is a feeling Samina Wali knows only too well.
Medical Supplies: How your money will save lives
ActionAid puts your money to work within days - and makes it go a very long way.
Stocking a medical camp for two weeks - £235
A doctor's salary for one week - £140
Birthing kit for a health worker - £49
Heavy duty winter blanket - £21
Stove - £5Reuse content