Pakistani President Pervez Musharraf is confronting growing outrage from the survivors of Saturday’s devastating earthquake over the gross inadequacy of relief efforts, which have yet to reach many outlying areas.

According to Prime Minister Shaukat Aziz, the official death toll has reached 25,000 and another 52,000 people have been injured. The actual figure, however, is certainly higher. Official estimates put the number of dead at anywhere between 40,000 and 100,000.

Pakistani military spokesman Major General Shaukat Sultan declared: “It is a whole generation that has been lost in the worst affected areas.”

A wide swathe of northern Pakistan—including areas of Pakistan-controlled Kashmir (Azad Kashmir) and the North West Frontier Province—was affected by the huge quake. Whole villages and towns were flattened. Much of Muzaffarabad, the capital of Azad Kashmir was destroyed, leaving the city of 600,000 without electricity, running water and other basic services.

Hundreds of thousands of people have been left for days without food, medicine or shelter to face driving rains and the cold as winter approaches. The UN estimated that at least one million people have been left homeless. Prime Minister Aziz has put the figure at 2.5 million but others insist that it is higher.

Some of the blocked roads through the mountainous areas have been cleared but relief supplies and rescue workers have just begun to reach major towns. Villagers from outlying areas have been forced to walk long distances to obtain any assistance.

According to the UN, 1,000 hospitals have been destroyed in the affected region. The World Health Organisation declared: “The devastation has created major obstacles in urgently helping the thousands of injured people to get the medical care they need. Many health workers—including doctors and nurses—have died or been seriously injured.”

Medical teams are stretched to the limit and lacking in basic supplies. In many cases, untreated fractures and other injuries have led to gangrene. At the hospital in Mahsehra, staff had medicines but were deeply concerned what would happen after the patients, particularly the poor, left the hospital.

One doctor explained to the Los Angeles Times: “We use the most powerful antibiotics. But they have open fractures, compound fractures, and we are dealing with them in a hurry. They will have infections later because they are so poor that I don’t think they can get any medications by themselves. They won’t survive.”

Médecins Sans Frontières (MSF) warned on Tuesday of a possible epidemic of water-borne disease in Muzaffarabad where 11,000 have been confirmed dead. MSF spokeswoman Isabelle Simpson said that teams reaching the city found it “much more destroyed than anticipated”. The danger of disease was especially high “as very few people have shelter up there, they’re crowding into homes and camp-type situations”.

Growing anger

The appalling conditions and the lack of assistance have generated rising despair, frustration and anger. Those worst affected are the poor who in many cases have lost everything. Much of the affected area had already been hard hit by heavy rains and snowfalls last winter, followed by floods and avalanches in February.

“The government is only showing us the relief on television,” a storekeeper, Abdul Razzaq, in Bagh told the Dawn newspaper. “We haven’t seen a drop of water or medicine coming to us, not even a single grain.” Another resident, Sharafat, added: “We have been totally neglected by everyone. No one knows the state we are in.”

Abdul Aziz told the New York Times that he fed his four children on Monday morning with “whatever I could snatch”. He said that his family had no shelter and only a single blanket. Angry over government relief operations, he exclaimed: “We have only what’s on our back”.

A local journalist in Hattagram told Reuters that the first aid only reached the city on Tuesday. “The people are very angry over the late arrival of the aid... Many people were lying under open sky in hail and rain yesterday with no shelter.” Today, he added ironically, “the weather is clear and the army has promised to give 750 tents to us”.

In a village outside Muzaffarabad, Syed Abdul Wadood Shah explained that locals were furious. “If they find a government official here he will die... We don’t want to leave but the situation is so bad, we have to find food. Officially there is aid but on the ground there is nothing.”

Across the border in neighbouring India, the situation is no different. The official death toll in Indian-controlled Kashmir has reached more than 1,400. Visiting the region, Prime Minister Manmohan Singh said 4,500 people have been injured and 32,000 homes destroyed in the towns of Uri and Tangdhar alone.

Singh promised that “no resources will be spared” to ensure aid reaches the victims “in the quickest possible time”. Yet a local in the village of Pingla Haridal told the media: “The world has forgotten we exist. You are the first people here asking about us, besides some soldiers who pulled bodies out on the first day.”

Political tensions

In Pakistan, where the scale of the disaster is larger, the Musharraf regime is desperately fending off criticisms. The president toured some of the affected areas on Monday and declared in exasperation: “We are doing whatever is humanly possible. There should not be any blame game.”

The government has increased its aid to 5 billion rupees ($US84 million), five times the initial allocation, and announced compensation of 100,000 rupees ($S1,600) to families of the dead.

Yesterday Musharraf, in a nationally televised address, acknowledged the slow relief efforts and pleaded for more international aid. “I am deeply saddened that some people had to wait for days before aid reached them,” he said. “The tragedy is much bigger than the capacity and capability of the government as a whole.”

Kashmir, the battleground for two wars between Pakistan and India, is one of the most heavily militarised areas in the world. The two countries came to the brink of war after an attack on the Indian parliament building by Kashmiri militants in December 2001. More than one million troops backed by tanks, artillery and warplanes were rapidly mobilised and maintained in the inhospitable border areas for months.

Following the earthquake, however, the relief operation has been restricted to around 40,000 to 50,000 troops. The main reason for putting the army, which is notorious for corruption, in charge is not to assist the victims but to prevent the eruption of angry protests.

Musharraf said access to many affected areas had been hindered by blocked roads and the number of transport helicopters available. His comments highlight the limited character of the international relief effort. Press headlines uniformly refer to the aid “pouring into Pakistan” from around the world, but the amounts are tiny in comparison to the magnitude of the disaster.

The Bush administration has upped its promised assistance to $50 million and increased the number of helicopters on loan from 8 to 25. According to Pakistani Prime Minister Aziz, total international aid pledged has reached $300 million. However, with at least one million homeless, this relief effort will do little more than patch up the survivors and send them back to the precarious, poverty-stricken existence they previously endured.

Washington’s primary objective in providing aid is not to assist the quake victims, but to prevent Musharraf from becoming the political victim of a backlash. The White House pressured the Pakistani president into ending his support for the Taliban regime in Kabul and backing the US military intervention in Afghanistan in late 2001. Musharraf’s action provoked hostility in Pakistan and left him politically vulnerable.

There is a general nervousness in Pakistani ruling circles that anger over the government’s response to the quake will boil over into protests. Opposition parties have been muted in their criticism. The press in Islamabad has emphasised the need for unity and hailed the response of the many volunteers who have flooded into the affected areas as an example for all.

The Dawn declared in an effusive editorial yesterday: “The government is under attack for not reaching the victims in time, and the newly set up federal relief commission has a monumental task ahead of it to ensure the survivors... are provided with the necessary means of sustenance. In this gloomy scenario where there is much to mourn, we can only hope that the spirit of fellow-feeling and help seen all around today will continue long after the international aid workers have gone home.”

The gloom in Islamabad is not so much over the hundreds of thousands of victims, but rather the political dangers facing Musharraf and his regime.