Rough mountainous terrain, harsh winter weather and lack of equipment, mainly helicopters, have made the relief distribution an arduous task, U.N. humanitarian aid officials said Tuesday. Survivors are growing desperate as harsh winter weather is setting in and there is not enough food and shelter.

Time is running out.

"We have been presented with a huge and complex logistical challenge - one of the toughest we've ever faced," said James Morris, executive director of the Rome-based World Food Program.

The magnitude 7.6 quake which killed at least 40,000 people in Pakistan has injured 65,000 people and left an estimated 3.3 million people homeless, said the U.N. Office for the Coordination of Humanitarian Affairs. OCHA fears the death toll could rise sharply if aid does not reach far-flung communities soon. Aftershocks continue to terrorize survivors.

A high-level meeting to garner more financial support for the U.N.'s $312 million flash appeal originally scheduled for Oct. 24 in Geneva has been pushed back to Oct. 26. Jan Egeland, the U.N.'s emergency relief coordinator is holding the meeting.

So far, $60 million of the flash appeal issued last Tuesday has been pledged. This concerns the International Federation of Red Cross and Red Crescent Societies, which has been accustomed to getting money quicker in the past, especially for a disaster of this magnitude.

The international federation ordered 16,000 winterized tents at a cost of more than $9.2 million even though, the agency said, it only has slightly more than $10 million in its earthquake account.

"With time so short before the onset of winter, we must take a significant financial risk to save lives," said Susan Johnson, director of operations for the international federation in Geneva. The agency already has 20,000 tents on the way to the affected region.

Temperatures have been falling to below freezing and hypothermia is becoming a risk to thousands of people living under thin plastic sheeting. Many of the injured have been carried down from the mountains and many have gangrene, said OCHA.

Aid agencies are in a race to bring food, mainly high-energy biscuits, water and winterized tents to survivors. About 20 percent of affected areas have not been reached by aid workers, said OCHA.

"The aid agencies have managed to give some help to hundreds of thousands of people, but there are an estimated half a million more people out there in desperate need, who no one has managed to reach," said Morris.

Only 16,000 injured survivors have had medical attention, said the international federation; a small fraction of the numbers who need help.

The priority continues to be obtaining helicopters, food and winterized tents. The local supply of tents has been exhausted and many that were sent were unsuitable for the rocky terrain and frigid climate, said OCHA.

Bad weather over the weekend halted helicopter deliveries so the WFP used packhorses and mules to carry food aid along precipitous mountain paths to reach the people who desperately needed supplies.

Aid is now trickling in to remote parts of northern Pakistan.

The combined response from the WFP, Pakistan's army, and several non-governmental organizations has ensured half a million people have now received enough food to last them for the next few days, said the WFP in a statement issued Tuesday.

The WFP hopes to raise enough money to feed 1 million people for the next six months. It has made an appeal for $56 million, figured into the U.N.'s flash appeal.

Three cargo flights arrived overnight in Islamabad, the Pakistani capital, from Dubai and Jordan, and a fourth was in the air; all part of an airlift of hundreds of tons of relief supplies, including thousands of urgently needed tents, U.N. High Commissioner for Refugees Antonio Guterres said Tuesday.

A 47-truck convoy carrying 1,500 10-person tents, 50,000 plastic sheets, 20,000 blankets and 10,000 jerry cans from agency warehouses in Kabul was sent by the WFP and the UNHCR. It arrived Monday night in Peshawar, said the refugee agency.

With the help of Turkey and NATO, the U.N.'s refugee agency is preparing to rush 860 tons of supplies from its warehouse in the Turkish port of Iskenderun.

In addition to feeding and housing victims, international agencies are working to protect the youngest survivors. Some 1 million children are in need of immediate shelter and medical care, said OCHA.

UNICEF warned against the potential exploitation of children and called for the registration of all children when they are admitted to public or private hospitals. It appealed to the government to place child protection officers in all major hospitals treating children. It urged hospitals not to discharge children unless they are released to family members.

There have been reports of children being taken from health facilities by individuals or NGO's claiming to be able to look after them, said the U.N. Children's Agency.

"While in this difficult period following the devastating disaster which has hit Pakistan there are certainly many people acting out of the best intentions towards vulnerable children," UNICEF said. There is also the possibility children could fall into the hands of unscrupulous individuals or groups."

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