Over 70,000 people, including 30,000 children, were left homeless by a quake that measured 6.4 on the Richter scale and caused at least 270 deaths. Nawab Aslam Raisani, chief minister of Balochistan, has warned the death toll could be more than 300, as authorities continue to search for bodies in remote areas.
The UN Children's Fund (UNICEF), which conducted a preliminary assessment with the Pakistan government, expressed its concern for "the urgent needs of children and women". UNICEF said 108,000 people have been affected by the quake, 50 percent of whom are children.
"The most urgent needs of survivors are shelter, safe drinking water, food, warm clothing and emergency medical assistance," said UNICEF in a statement. It termed safe water a "priority", and warned that children are particularly prone to diseases such as cholera and diarrhoea when it is not available.
Many quake survivors have lived out in the open since the quake struck, some still without adequate shelter or warm clothing, aid workers said. Temperatures in the hilly Ziarat District, the worst hit by the quake, fall to below freezing each night. As winter approaches, the Pakistan Met Office has warned they are likely to fall further.
Shaukat Awan, Home Secretary of Balochistan, said 1,000 homes had been destroyed by the quake in Ziarat and 5,500 people affected. The quake has exacerbated the water scarcity problem the district had with many existing water sources damaged.
"We used to fetch water from a small spring here," Zunaira Khatoon, 30, told IRIN while pointing towards some hills in her village outside Ziarat. "But after the quake the water has stopped trickling out."
UNICEF said that about 12,000 people in Ziarat lacked safe water and were dependent on supplies from water trucks. The agency added that it had begun supplying clean water to women and pregnant mothers but local officials said more work was needed to ensure the survival of children.
"We are very worried about the children. Many are falling sick," Dilawar Khan Kakar, mayor of Ziarat District, told IRIN. He said more tents were needed, though the supply of relief items had improved over the past few days.
Ayub Kakar, Ziarat District health officer, said children were suffering from pneumonia, chest infections and diarrhoea.
"It is the cold that is crippling and the lack of food. My children have not had an adequate meal since the quake struck. We are surviving on biscuits and rice," said Wazir Khan, 30, a survivor from Ziarat and the father of four young children.
The problem for women injured during the quake has been aggravated by the fact that there are no female doctors to treat them. In the deeply conservative Ziarat and Pishin districts, the majority of people are traditional Pashtuns who are unwilling to allow their women, and even female children, to be treated by men.
"This has been an issue. Women do not allow us to examine them and some may have untreated fractures or other injuries. They are obviously in pain. It is difficult for female doctors from Quetta [Balochistan's capital city] to come up here due to security issues," Umar Gul, a volunteer doctor Quetta, said. "I was finally able to treat a nine-year-old girl with four fractured fingers only after over a day spent persuading her father to allow her to be seen."