The extent of the devastation caused by the earthquake that hit northern Pakistan became apparent today as officials pleaded for more international help to cope with a disaster that may have killed double the 20,000 confirmed dead so far.
Rescue teams led by the Pakistan Army struggled to reach many of the hardest hit areas of the rugged North West Frontier Province and Pakistan-held Kashmir, and authorities said more helicopters were needed to reach flattened towns and villages.
An elderly Kashmiri earthquake victim with a child waits for relief in Tanghdar, 180 km north of Srinagar, today
"For the first two days we have been either digging ground to recover bodies or digging to bury them," said Sikander Hayat Khan, prime minister of Pakistani Kashmir.
"Kashmir has turned into a graveyard." Estimates of the death toll by officials suggest a final toll closer to 40,000, with children caught by the quake dying in their hundreds in village schools.
Another 2,000 people may have died in neighbouring India, and the fate of about 10,000 people living in remote villages on the border with Pakistan was unknown, Indian officials said.
The United Nations estimated that the number of people hit hard by the disaster was one million while the total affected population was expected to exceed four million. In Pakistani Kashmir's capital Muzaffarabad, where the old district was almost destroyed by Saturday's 7.6-magnitude earthquake, thousands are thought to have perished.
Many survivors were desperately short of food, medicine and water and some took what they needed from shattered buildings. "They've lost everything, they have no clothes, no food, nothing," said resident Asim Butt.
Some gangs of young men looted cars and motorbikes, prompting police to fire shots in the air.
Pakistan's High Commissioner to Britain, Mahleelah Lodhi, said Islamabad was grateful for the aid offered but needed more - not just for emergency relief but for reconstruction later. "We are dealing with a catastrophe on a major scale, so the relief effort has to be also on a major scale," she told CNN.
The main roads into Muzaffarabad had been cleared, and some telecommunications restored, but the city was without power and threatened by disease from decomposing bodies and a broken sewerage system.
In Pakistan's capital, Islamabad, European, Arab and Japanese nationals were among an estimated 45 people missing two days after the quake destroyed two apartment blocks.
"There's a lot of the smell of death, but we are still confident otherwise we wouldn't been here," said Anthony Thomas, of Rapid-UK, a British team assisting the rescue effort there.
"We know that every hour counts in an earthquake of this magnitude," U.N. Emergency Relief co-ordinator Jan Egeland said.
However, many victims voiced frustration at a lack of visible help on the ground days after the quake hit. Despite aid pledges from around the world, there was little or no medical attention for many of the more than 40,000 injured in Pakistan more than two days after the disaster.
Aid agencies said more than 120,000 people urgently needed shelter and up to four million could be left homeless by what was South Asia's strongest quake in 100 years.
Pakistan has decided to accept offers of relief supplies from old rival India, with which it contests ownership of Kashmir, but Foreign Ministry spokeswoman Tansim Aslam said no Indian troops would be allowed onto its territory.
Agencies