It was in the early hours of the morning on Monday 29 October when two earthquakes registering 5.2 and 6.4 on the Richter scale flattened villages in Pishin and the former resort area of Ziarat in Balochistan, a south-western province of Pakistan bordering Iran and Afghanistan.

CARE International's Pakistan director described the humanitarian situation that followed as "the saddest thing I've seen in my life". CARE estimates the quakes have killed 500-600 people and injured thousands more.

The disaster comes just three years after another earthquake devastated the mountainous Kashmir region north of here. It left 75,000 dead and another 3.5 million homeless, mostly in Pakistan and, to a lesser extent, in India.

Pakistan Government authorities are still rebuilding Kashmiri communities shattered by that disaster. In India, political unrest and an increasingly draconian crackdown on pro-independence demonstrations have meant that rehabilitation of earthquake affected areas has been slow.

Although the Balochistan quake occurred many thousands of kilometres away, it bears striking similarities with the Kashmir earthquake in 2005. Then as now poorly constructed mud dwellings exacerbated the death toll as many families, typically large in these remote parts of Pakistan, were killed when their homes collapsed on top of them.

"I have lost 22 people in my family," said Malik Nizamuddin from the village of Killi Malik Piao in Ziarat while recounting the moment his house collapsed.

The Ziarat district was at the epicentre of the quakes. Catholic Relief Services (CRS) estimates that around 95 percent of the dwellings constructed of mud and timber were completely destroyed.

Pakistan's Education Ministry estimates that around 25 percent of school buildings around Quetta, Balochistan's capital, were damaged while dozens of livestock animals perished. There is currently no electricity or gas in most of the affected areas.

The terrain in these parts of Balochistan is not as difficult to traverse as mountainous Kashmir. But agencies have struggled to deliver assistance because of damage to infrastructure. The quakes badly damaged roads, power and communication lines, and health care centres. As a result, camps for displaced people are running dangerously short of food, water and other supplies.

"There is no flour, no food," village elder Ibrahim told BBC Pashtu. "The roads are blocked. We are all helpless, poor. We have the handicapped, the old. We do not have any food or means to get any. We are just lying helpless."

The Balochistan quake comes at a difficult time for Pakistan: it is already fighting the twin threats of a Taliban insurgency and an economy weakened by the global recession, rampant inflation and an energy supply unable to satisfy demand.

Over the past few months the Pakistan army has intensified military operations against Taliban militants in neighbouring North Western Frontier Province, to the north of the regions most affected by the earthquakes. Now Pakistan Army soldiers are swapping weapons for food stuffs.

Already desperate for foreign capital to replenish its rapidly diminishing capital reserves, the Pakistan Government is now scrambling for foreign humanitarian assistance to deal with the aftermath of the quakes. The United States and China have pledged $US1 million in humanitarian assistance while Saudi Arabia is giving a further $100 million.

According to UNICEF the earthquake has affected over 100,000 people, half of them children. The International Committee of the Red Cross says that includes 4,500 families, or about 32,000 people, who need immediate shelter. Like other Pakistanis who have fled the man-made catastrophe that is the war between the Taliban and the Pakistan Army, they are now migrating to displaced person camps throughout the North Western Frontier Province.

Yet most have no choice but to live outdoors exposed to the elements. Cold nights and wind chill make living conditions difficult as temperatures fallen to minus 4 degrees Celsius.

"My family and I, including my four young grandchildren, spent all night outdoors, without any kind of shelter," Ziarat resident Zairaf Khan told IRIN.

"No tent and no blankets were provided to us. We just pulled out our quilts from our house and huddled under them."

Pakistan's Red Crescent Society and the National Disaster Management Authority (NDMA) have already distributed aid to thousands of families affected by the quake including tents, tarpaulins and blankets, along with food and essential household items. Several other non-governmental and civil society organisations - including the World Food Programme, World Health Organisation, Oxfam, the Turkey Red Crescent Society, and Medicin San Frontieres - have also commenced relief efforts.

But even those fortunate enough to have received assistance face extreme hardship.

Not all of those who have fled the disaster-hit areas have lost their homes. Several communities have left partially damaged houses fearful that the weakened structures will collapse on them. According to the coordinator of UN humanitarian affairs (UNOCHA), over 1000 aftershocks have been felt in Ziarat, Pishin and Quetta, capital of Balochistan since the earthquakes occurred two weeks ago. The aftershocks have exacerbated the fears of those living in partially damaged homes.

Such fears are a reminder that the damage caused by natural disasters such as this go beyond the damage to property or livelihoods. Even if immediate humanitarian demands are met only time will tell if displaced communities will ever fully recover from Pakistan's latest humanitarian crisis.

Reuters AlertNet is not responsible for the content of external websites.