The numbers in the camps are now increasing again. Forty-eight villages in the Muzaffarabad area have been identified as being at risk of seismic activity following the earthquake, and are especially vulnerable to landslides due to the imminent monsoon season. People in these villages have been instructed to evacuate their homes immediately. To date, over 3,000 of an estimated additional 6,000 have streamed down into the camps.

Kashmir suffered a huge earthquake on October 8, 2005 - that fact is well known. Many will remember the trauma of the immediate aftermath, the huge death toll, the enormous number of injured, as well as displaced from their homes and the rapid humanitarian response. Less publicized are the needs that remain for families still living in camps in tents and with no option to return home.

The earthquake brought about a major shift in circumstances for the majority of the population of Muzaffarabad district. Many of those who previously had husbands and wives are now single parents. Many of those who previously had parents are now orphans.

During a visit to a family in Mera Tanolian camp just outside Muzaffarabad, fathers, mothers and sons gathered around us. When we asked, "Where are the girls?" they replied that the girls had died during the earthquake, under their school building which had collapsed.

In addition to the emotional loss, many faced the reality of being made homeless overnight; families who previously had land and homes had no option but to relocate into camps, setting up temporary homes from tents and materials distributed by aid agencies. Following the earthquake, approximately 100,000 people were forced to relocate down to the regional capital, Muzaffarabad. In the initial stage, numerous agencies came to their aid with medicines, water, food and shelter.

Winter ended at the end of March, and the majority of displaced people were able to return to their place of origin, wanting to reconstruct their homes and resume their livelihoods. However, roughly 20,000 remained unable to leave the camps because their houses in Muzaffarabad had been destroyed, their land in the mountains literally disappeared with the earthquake, or because they were households headed by women with no way to support themselves financially if they returned. These remaining displaced people are living in 41 camps, spread out in the mountains.

With the returning population, many aid agencies stopped their work in the camps in Muzaffarabad to focus their resources on the reconstruction and rehabilitation of the areas to which these people would return home. This meant that attention and much-needed resources shifted away from the basic needs of those remaining in the camps.

The numbers in the camps are now increasing again. Forty-eight villages in the Muzaffarabad area have been identified as being at risk of seismic activity following the earthquake, and are especially vulnerable to landslides due to the imminent monsoon season. People in these villages have been instructed to evacuate their homes immediately. To date, over 3,000 of an estimated additional 6,000 have streamed down into the camps.

One family in Mera Tanolian camp reported that government officials had come to them warning them that their land was not safe: "We didn't want to move because we owned our own land, but they said 'Wouldn't it be awful if something happened to you.' So we came here. We don't know when we can go back, maybe not for a long time, as they say the land is unsafe."

Those coming to the camps are promised tents, water, latrines, beds, electricity, stoves and food. Some have been provided with transport but the majority comes by public transport, rented cars or on foot. Some bring their livestock. In reality, these families will not be able to leave the camps any time soon. They face the prospect of spending at least until after next winter under canvas, waiting for the government to allocate land on which they can live.

The haste with which the government is currently trying to relocate these people into the camps has caught most of the actors off guard and preparations have not yet been adequately made to receive them, especially with another Kashmiri winter on the way.

The problems in the camps are manifold. The water supply in the camps is not adequate. In most camps water trucking has been replaced by linking up connections to the city's water supply. However, the water supply has gaps and camps are now and then without water for days.

The first rains have damaged latrines, which are now sinking in the soil and are flooding. The full ones need to be emptied and the rain has damaged existing tents. Some have been replaced but not adequately for winter.

Families say that food distribution has been reduced from every two weeks to once a month, and they are not provided with rice so they use their limited savings to supplement their diet. People can find health care but often have to use their savings for the costs of travel and medicines. When they arrive, the hospitals are overcrowded, and it often arises that people may return home at the end of the day without having seen a doctor.

"Although the immediate relief after the earthquake was impressive, it's hard to see that still so many people have nowhere to go," says Joe Belliveau, head of MSF programmes in Pakistan. "The relief effort seems to have sputtered in the rush to switch to the longer-term reconstruction effort, leaving thousands of people in the camps to slip through the cracks in assistance."

MSF was in Kashmir before the earthquake and, as soon as it struck, responded with a massive relief effort. As the emergency has lessened, this commitment has been scaled back, but MSF remains committed to assisting those in the camps in Muzaffarabad.

MSF runs two basic health units in two camps, Mera Tanolian and Ambore, where it provides consultations and medicines for all manner of illnesses. The agency also provides water and sanitation facilities in 11 camps, in some cases trucking in water, in others building latrines and shower blocks. MSF is also coordinating with government authorities and other international agencies to ensure that the broader needs of this population are being met, especially with the monsoon already started and winter coming soon.

Further up the Jhelum valley, MSF is active in Hattian, where the local hospital was destroyed in the earthquake. MSF has already built a temporary hospital to last the next few years until a new one can be built. MSF doctors and nurses run the paediatrics ward in the hospital. The team has also provided latrines in the displaced camps around Hattian and runs an outreach program to promote better health seeking behaviour and hygiene.

Of late, there are promising signs that other national and international actors are waking up to the reality that tens of thousands of people will remain dependent on outside help at least through the coming winter and perhaps beyond, but until there are clear commitments to meet at least their basic needs, MSF's assistance is still needed.