"What we need is something like no other emergency relief effort," Undersecretary General Jan Egeland, head of the U.N. Office for the Coordination for Humanitarian Affairs, told reporters in Geneva Thursday, calling for the equivalent of the Berlin airlift that kept the German city alive in the late 1940s after Soviet forces cut all land access.

"If they could do that in the end of the 1940s, set up in no time a lifeline to millions, we should be able to do that in 2005," he said.

Why such an effort, now nearly two weeks after the 7.6 magnitude quake Oct. 8?

The topography, U.N. officials answered in so many words, over and over again.

"In terms of logistics, the difficult terrain makes this one of most challenging relief operations ever undertaken," U.N. Secretary-General Kofi Annan told reporters at U.N. World Headquarters in New York Wednesday. "Winter is approaching fast, and temperatures are dropping."

In issuing an unusual personal appeal for additional help, he warned, "A second, massive wave of deaths will happen if we do not step up our efforts now."

The U.N. effort dwarfs that following last December's Indian Ocean tsunami. It comes at a critical time of the year. That means there is a dire need to rush in hundreds of thousands of winterized tents, medicine, and food and other urgently needed supplies before the situation worsens even further with the arrival of the harsh Himalayan winter.

Egeland said 48,000 people were confirmed dead.

However, he said the final toll could be twice as high. Perhaps worse was the proportionate number of wounded, with 67,000 people severely injured.

If the United Nations assumed this figure would also be doubled or tripled, it would mean thousands could die in the coming days if they were not reached in time.

Half a million people had still not been reached and a total of 3 million people have been affected, left with damaged homes.

"We are putting in all our combined U.N. resources at the moment. It is not enough. We have never had this kind of logistical nightmare ever. We thought the tsunami was as worse as it could get. This is worse," the U.N. relief-chief said.

"The race against the clock is like no other one. There is like a terrible cut-off for us in the beginning of December, could be even before, when there will be massive snowfalls in the Himalayan mountains," he said.

In the tsunami, which killed more than 200,000 in a dozen Indian Ocean nations, there was a much higher death toll, but the earthquake is the reverse, with more wounded than dead, Egeland said, adding there was an exponential growth of infections, gangrene, tetanus and other diseases.

The $312 million U.N. Flash Appeal, issued a few days after the temblor, has received $86 million, roughly one quarter of what is needed, officials said. It is expected to be increased at a donors' conference in Geneva next week.

Egeland said the world organization had probably never been as overstretched as it was right now, as it still had to deal with old emergencies such as Sudan's Darfur crisis, the Democratic Republic of the Congo and southern Africa, where 12 million people urgently need food aid.

"The world must be able to respond to several emergencies in parallel and at the same time," he said.

With Annan's appeal for international organizations to embark on an "immediate and exceptional escalation" of Pakistan's relief operations, the U.N. refugee agency has begun its first ever joint, large-scale airlift with the North Atlantic Treaty Organization, said the Geneva-based U.N. High Commissioner for Refugees.

The first three flights in the operation, supported by the Turkish government, took off from Incirlik airbase in southern Turkey with more than 25 tons of urgently needed supplies, the start of an air bridge that will ferry some 860 tons of aid from the UNHCR regional warehouse in nearby Iskenderun.

In his appeal, Annan called for helicopters, trucks and heavy lifting equipment, 450,000 winterized tents and temporary shelters, 2 million blankets and sleeping bags, tarpaulins, ground sheets, stoves, water, sanitation equipment and food.

Many of the tents arriving in Pakistan are not winter-friendly, making additional blankets, tarpaulins and ground sheeting necessary, OCHA said. Also, many of the tents can't be easily pitched due to the mountainous terrain.

The U.N. World Food Program said thousands of people had started fleeing their remote and hard-to-reach villages, seeking medical attention, food and water, as landslides and bad weather continued to impede delivery of desperately needed relief supplies.

WFP food assistance is being transported by truck where roads are open and by helicopter and even pack mules in more remote mountain areas, the Rome-based agency said.

The U.N. World Health Organization warned that with the onset of winter, coupled with a lack of shelter, there is a serious health concern which needs to be resolved quickly to avoid health problems such as hypothermia, shock, and ultimately, death.

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