The first deaths from pneumonia, including that of a three-month-old baby have been reported in the South Asia Earthquake disaster zone.
During the day temperatures in Muzaffarabad's tents were nine degrees C at 1am. By 5am that had fallen to three degrees C, one degree higher than the air outside.
Hundreds of women, children and the elderly already were suffering from respiratory illnesses, diarrhoea, scabies, tetanus and other ailments even before the first cold snap.
Bradford doctor Mohsin Shakil has been in the region for more than a month. He said, People are really concerned about getting back to normal but there are so many problems.
People are really desperate and they need shelter. People are trying to work on that.
Wood-burning heaters offer some comfort to the people who are lucky enough to be in camps which have them but they are hard to maintain
Dr Shakil added, We have made them comfortable and they are going to school and taking different jobs.
But for each of these families who are starting to rebuild their shattered lives, hundreds of thousands more face a winter of clinging to life because they do not have a strong enough roof over their heads.
Shelter is the most pressing problem, said Dr Shakil.
Children under ten years old and people over 50 will be affected in the extreme. A lot of people will die because of all these problems.
People in Muzaffarabad living in tents are now developing pneumonia. Snow has started to fall on the mountains. Things are going to get harder.
The situation may be worse in remote areas, where landslides triggered by the precipitation has blocked main roads.
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