And the children will pay with their lives.

MUZAFFARABAD, Pakistan (Reuters) - Earthquake relief efforts in Pakistan will have to be scaled back putting tens of thousands of lives at risk unless donors give another $250 million (140.3 million pounds) immediately, the United Nations said on Friday.

The world body says that with the severe Himalayan winter just weeks away and many survivors of the October 8 quake without food or shelter, only about $111 million of $550 million needed for emergency relief has been provided.

A fresh appeal on Thursday generated only $16 million.

"We need at least $200-250 million now," U.N. emergency coordinator Jan Vandemoortele told a news conference.

"If we don't have that we will fail," he said.

"Frankly, I don't know how to say this any more clearly in plain English: 'It's now or never; we will not have a second chance'."

Vandemoortele said the money was needed "yesterday" and expressed bafflement at the failure of donors to deliver.

Over three million people have been left homeless.

Without more money the United Nations would only be able to keep its vital helicopter fleet running another week, he said.

With many roads blocked by landslides, helicopters are the best means of getting food and shelter to villages and patients to hospital, but they cost around $11,000 an hour to fly.

WFP's logistics chief Matthew Hollingworth said $50 million was needed right away to keep the helicopters flying, while Chris Lom, of the International Organisation for Migration, said there was still a shortage of 200,000 tents.

What the survivors face, beyond their own injuries, illness, starvation, dehydration and the devastation around them, is an unusually harsh winter expected in the Himilayas:

The U.N.'s World Meteorological Organization in Geneva said initial reports suggested winter was going to be unseasonably bitter in the stricken areas.

"Snowfall is expected to considerably exceed the normal range, both in frequency and quantity", and temperatures from December through February were likely to be "well below normal", WMO spokesman Mark Oliver told a Geneva news conference.

"That means even day temperatures are likely to stay several degrees below freezing, especially in the mountainous areas," he said, adding that night temperatures in January could plunge to minus 20 Celsius (minus 68 Fahrenheit).

Exacerbating the problem is that Pakistan has refused India's offer of help:

Pakistan president Pervez Musharraf has defended his handling of the October 8 earthquake and his refusal to permit Indian helicopters to fly relief sorties in Pakistan-administered Kashmir. “The world should understand that we cannot allow Indian soldiers to operate in Kashmir. Our whole defence system is there, our whole military is there,� he said in an interview with the British daily Financial Times.

Meanwhile, international aid that has been promised has not been delivered:

The United States and 59 other countries pledged $580 million for earthquake relief at a Geneva conference Wednesday, but only $15.8 million of that was promised for immediate delivery. That's 20 percent of the money the United Nations says it needs now to provide emergency shelter, food and other relief before the brutal Himalayan winter cuts off thousands of devastated mountain villages.

And countries often pledge aid that is never delivered, officials pointed out.

"Let us all think: What if that child that will catch pneumonia tomorrow was my child?'' Vandemoortele said. "What if that leg that is going to be amputated tomorrow is going to be my mother's leg?''

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