High on the wall of an isolated valley, Atiqullah, his wife and eight children are struggling to stay alive. They huddle for warmth in a makeshift shelter of plastic and wood, ration meager supplies of rice and turnips and dread the onset of winter snows that will soon blanket their destroyed village in drifts as tall as a man.

A schoolteacher and farmer who uses just one name, Atiqullah, 43, said he knows that one option available to the family is evacuation. They could pack up their paltry belongings and hike 12 miles down the valley to the nearest town, where they presumably could find shelter in one of the relief camps springing up at lower elevations.

But so far, he said, he is not willing to trade the family's self-reliant life in the mountains for a future as destitute refugees, despite the risks inherent in that choice. "I will stay here with my cattle," said Atiqullah, a whip-thin Pashtun tribesman with hawk-like features and a piercing gaze. "I will die here."

Therein lies the dilemma for the government and foreign aid agencies as they struggle with the aftermath of the massive Oct. 8 earthquake in northern Pakistan, which killed at least 55,000 people, injured tens of thousands more and left several million people homeless, many of them in rugged mountains that are difficult to access in the best of times.

While many survivors have hiked out of the mountains in search of help, tens of thousands are electing to stay behind, spurning pleas from the army, in particular, to evacuate flattened villages -- many cut off by landslides -- for burgeoning relief camps where victims can more easily be provided with shelter, food and medical care.

Here in the Allai Valley in North-West Frontier Province, the army last week announced plans to evacuate as many as 80,000 people -- by helicopter, on foot and by mule -- from isolated villages in higher parts of the valley that will soon be draped in snow. But the evacuation was suspended after just one day when many villagers balked at leaving homes and croplands their families have occupied for generations, according to army officials involved in the operation.

In the face of such resistance, aid groups are developing plans to provide families with roofing material and other supplies that will allow them to repair damaged homes or build temporary winterized structures that -- especially at higher altitudes -- are considered preferable to tents, which in any case are in short supply.

Provided that such shelters can be built before winter sets in, many relief officials say, the approach is preferable over the long run to housing victims in squalid tent cities where they run the risk of losing touch with communities and livelihoods. Relief camps are still being built at lower elevations to accommodate survivors who feel they have no choice but to leave the mountains, U.N. officials said.

"Camps are the last resort," said Chris Lom, a spokesman for the International Organization for Migration in Islamabad, the capital. "They frequently will become dependent in camps, making it very difficult for them to go back."

Although the disaster is more than three weeks old, U.N. officials complain that the world has still not awakened to its dimensions, warning that thousands of survivors are at potentially lethal risk from disease, hunger and exposure. On Friday, U.N. officials said that donor governments have provided only about 20 percent of the $550 million that the United Nations has requested to fund relief operations for the next six months; they warn that some helicopters could soon be grounded as a result.

Those figures sketch an incomplete picture, however, because they do not take account of other forms of aid that bypass the U.N. relief apparatus. For example, the United States so far has committed about $100 million to the relief effort, most of which will be provided directly to the Pakistani government or private aid agencies rather than routed through the United Nations, or used to fund helicopter flights and other relief activities by the American military, U.S. officials said.

Jan Vandemoortele, the U.N. aid coordinator in Pakistan, said in a brief interview that even with such bilateral assistance, the international response so far has been "thoroughly insufficient" to the scale of the disaster. U.N. officials say the relief effort is in many respects a much bigger challenge than last year's Asian tsunami, given the remoteness of areas affected by the quake.

One such area is the Allai Valley, which is home to about 190,000 people. Many live in tiny villages that cling to steep forested mountainsides overlooking a twisting river with water the color of jade. From its lower reaches near the town of Battagram, about 70 miles north of Islamabad, the valley gains elevation as it runs north toward the rugged Kohistan mountains, now rimmed with early snow.

For more than a week, the army and relief groups have been extending their reach in the valley, whose road network has been largely blocked by landslides. About a week ago, an army platoon set up camp and established a helicopter pad in the village of Bateela about a mile from Proot Kalay, a smaller village that was home to about 500 people.

Lt. Wahab Khan, 21, the platoon commander, said he did not see any alternative to evacuating the area. "Within the next 20 days, the snow will fall down in these mountains," he said. "The people will die without shelter."

But to walk up the stony path to Proot Kalay is to understand the agonizing choice that confronts many earthquake survivors in remote areas.

Because most residents had already left their homes for field work or school at the time of the earthquake, only five people died in the village, which sits at the top of a small cliff at an altitude of about 6,300 feet. But the temblor spared little else, reducing mud-and-straw homes to mounds of earth and cutting off the supply of piped water. Atiqullah, the teacher, was in the high school about a mile away and escaped the building, along with 200 students and staff members, just before it collapsed.

After spending the first night outside in the rain with his wife and children, Atiqullah set off with a nephew on foot for Battagram, which they reached after 14 hours, he said. There they flagged down a van that drove them for three hours to the town of Abbottabad, where they purchased rolls of plastic sheeting before returning by the same route.

Using the plastic and salvaged timbers, Atiqullah fashioned a crude 18-by-15-foot shelter he shares with his wife, eight children and six others. Because it cannot accommodate a fire, the shelter provides scant protection against the night's deepening chill, and "on rainy days, all the water fills the tent," Atiqullah said in broken English. "Therefore I worry all the night and day, and no sleep. Where should I go?"

Making matters even more desperate, the earthquake killed one of his cows and a buffalo, whose bloated carcasses lie at the bottom of the cliff, and he recently slaughtered the family's remaining four chickens, reasoning that they would soon freeze to death anyway. So far, he said, the army camp down the hill has provided him with one can of tuna, and the family's food stocks will be gone in another week.

Two surviving buffalo provide his children with milk, but his 3-year-old son, Fida-ulla, already suffers from dysentery and a chest infection, and he fears the others are also growing weak, he said.

Sanitation is dismal. Atiqullah's tent is one of 18 at the base of the cliff, where villagers fill water jugs and wash cooking pots in a stream whose banks are littered with cow dung and human excrement.

Despite the brutal living conditions, Atiqullah and other villagers said they were reluctant to leave, in part because they still are bringing in the fall harvest of rice, corn and maize, which must be processed with heavy timbers pulled by oxen before it can be stored for the winter. They said they might consider moving to a resettlement camp, but only if they were confident that the government would provide them with adequate housing and regular employment, assurances they have yet to receive.

Moreover, said Mohammed Shah, 42, "We have the graves of our grandfathers, and our parents, and all our memories. We would not like to leave from this place." He has already hatched a plan to build covered dugouts on the side of a nearby hill, provided the army or an aid group can get him the necessary materials in time.

"We are employed here," said Shah, a gracious, good-natured man with a red-tinted beard and white prayer cap. "We have our cattle. Just give us some shelter."

Atiqullah, a teacher and farmer, in the tent village that residents built near his quake-ravaged village of Proot Kalay.