HARIALA, Pakistan, Oct. 13 -- A young medical student, Binod Rai, was breathing heavily after a 45-minute hike into the mountains on a mission to help earthquake victims who had not yet been reached.
Rounding a bend, he confronted a scene surpassing his worst expectations. Every hut in this hamlet atop a peak in Pakistani-controlled Kashmir had collapsed into a pile of rubble. Entire families -- parents and children -- were lying under makeshift shelters of tin and straw in the debris, moaning in pain from open wounds.
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 Photos
Hopelessness in Balakot
Earthquake victims and their families make their way to Balakot, Pakistan, in hopes of a helicopter ride to a hospital and safety.
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Rai, 24, began dabbing iodine on lesions and applying fresh bandages where he could.
"She has gangrene. This is a very, very serious injury," he said to a man whose mother lost most of an earlobe when she was hit by a falling rock. "You need to take her down the mountain for treatment as soon as possible."
The man, a 50-year-old laborer who goes by the single name Manna, hung his head. There were simply not enough healthy men left in the village to carry out the injured.
"We are totally hopeless," he mumbled.
It was a common refrain Thursday across northeastern Pakistan, five days after the strongest earthquake in the country in a century.
Between 25,000 and 35,000 people are now believed to have died in the quake. The United Nations estimates that 4 million people have been affected by the disaster, including 2 million who lost homes. Shelter is the most immediate need, and there are growing fears of hunger and disease.
In Islamabad, the capital, Jan Egeland, the top relief official at the United Nations, said Thursday that relief efforts were not keeping pace with the needs of hungry and homeless survivors across the vast earthquake zone, many in isolated mountain villages such as Hariala where the onset of the harsh Kashmiri winter is only weeks away.
"I fear we are losing the race against the clock in the small villages," Egeland told reporters after flying by helicopter to Muzaffarabad, the leveled capital of Pakistani-controlled Kashmir. "I've never seen so much devastation before. . . . Every day the scale of devastation is getting wider."
Whatever aid has reached remote villages has been delivered largely in an ad hoc fashion by volunteers such as Rai. But they have been hampered by a lack of resources and coordination as well as by the growing threat posed by violent looters.
All three problems were in evidence on Rai's trip to Hariala. He was accompanied by a tightknit group of friends from the Frontier Medical College in the nearby city of Abbottabad, who pitched in to help the relief effort since the quake struck on Saturday.
