This cold weather and snow is making it much harder for relief supplies to reach the people who need them. Shelter, clean water and sanitation continue to be the priority needs for people affected by the earthquake.

"Today in Islamabad it is about 15 degrees above zero. Last night, people living high in the mountains affected by the earthquake, survived another night at well below zero in the snow," said the World Health Organization (WHO) Director-General Dr LEE Jong-wook after visiting Balakot and Muzzafarabad. "These people face several months of freezing, winter conditions. And so the UN pledge is to help ensure they survive—with shelter, food, and basic health care."

"At the Abbas Institute of Medical Science in Muzaffarabad, I met nine-year-old Amina," said Dr Lee. "Her home collapsed when the earthquake struck crushing her foot. She received treatment at the institute and has been recovering there for weeks, slowly gathering the strength she needs so that she can return to her village. In Amina’s eyes I saw hope. In her father's face I saw resilience, but as she heads back to the camp that will be her home throughout the winter she needs our help. We can’t forget Amina’s family and the hundreds of thousands of other families like hers as the temperature drops and the snow falls."

"The terrain, the weather and the sheer number of people in desperate need makes joint efforts top priority," said WHO Regional Director for the Eastern Mediterranean Dr Hussein A. Gezairy. "Even though much has already been achieved by the Pakistan government working together with the international community, still more work is needed."

The earthquake on October 8, 2005 killed 73,000 people and seriously injured 70,000 more. Three million people were left homeless and today, hundreds of thousands still lack the shelter they need to survive the winter weather that is now closing further in each day.

There has been a generous response to the initial appeal for international assistance, but more is still needed. Of the US$ 27 million WHO requested from the international community to fund a health response in the affected area, just over half has been received. WHO needs these funds for a very simple reason: to help people survive the winter. At this rate, without more funds, WHO resources will run out in January.

There is still much work to do. Hundreds of thousands of people still need better shelters. Getting health care to people above the snow line is a major challenge. The more people there are in camps, the more water, sanitation and health support they need. WHO is supporting the Ministry of Health to implement the "winter plan".

Already, injuries have been treated, often in difficult conditions, by doctors from across Pakistan and abroad. Basic health units and field hospitals have been established; 300,000 children have been vaccinated. One hundred prefabricated basic health care units are under construction in the affected areas.

"One particular issue I want to highlight is the need to train more women in health," said Dr Lee. "This month, 13,000 women in the earthquake area will deliver a baby. And 2000 of those women, as well as 1500 of those babies will need urgent health care. But there simply are not enough women health workers to help them."

"Yesterday in the Kashtara Camp in Balakot, I went back to school," said Dr Lee. "I sat in on a small class teaching women in the camp the importance of washing your hands and using clean water. We know that good hygiene can save lives and it is encouraging to see this practiced in the camps. It is also good to see the collaboration of WHO and UNICEF to bring water tankers and clean water to this camp, this will also save lives."

At the same time, the worldwide drive to eradicate polio and prevent other communicable diseases continues, even in these remote areas. The disease surveillance system is up and running. Outbreaks can now be spotted quickly, and action taken to stop them. Access to safe water and sanitation is improving.

Now the priority is to make sure people have what they need throughout the winter. Resources must be used well, to ensure we can support the thousands who are still vulnerable. The survivors still need shelter from the elements. The cold weather will bring more pneumonia and other deadly respiratory infections.

The threat of water-borne disease, which can spread quickly through camps, is ever-present. Diarrhoea and dysentery pose a continued risk. Pregnant women and their newborn infants are particularly at risk from disease and the lack of medical facilities. They need special care. WHO will support all efforts to train and deploy more female health workers. And we must continue to rehabilitate people with disabling injuries, and those who have suffered the mental trauma of loss, as well as of survival, in a devastated community.