The 6.4 magnitude quake struck the Ziarat valley in the southwestern province of Baluchistan at dawn on October 29, leveling about 1,500 mud-walled houses, triggering landslides and leaving nearly 15,000 people homeless.
Efforts shifted from rescue to relief as hundreds of injured people were taken to hospitals. But a senior military official said searches were being conducted in the mountains above the valley for any stranded villagers.
Most of the valley's 50,000 people slept out in freezing temperatures, either because their homes were destroyed or damaged, or because about 20 aftershocks, the biggest of 6.2 magnitude, left them too scared to sleep indoors.
Maqbool Ahmed, 25, standing beside the rubble of his collapsed home in the badly hit village of Wam, said 14 members of his 18-member family were killed.
"My father, my mother, all of them are dead," said Ahmed, his dusty face streaked with tears.
"I buried my entire family with these hands. We lost everything, not in minutes but in seconds," said Ahmed as the morning sun brought relief from the biting night-time cold.
The quake struck just over three years after 73,000 people were killed when a 7.6 magnitude quake hit Pakistan's northern mountains. Last year, the worst floods on record in Baluchistan killed hundreds.
The epicenter of the quake was in Ziarat district, a picturesque valley and one of the province's main tourist spots.
Administration officials said the death toll was more than 200 while 500 people were injured. The quake triggered landslides that destroyed some houses and blocked roads, complicating search and relief operations.
A national disaster management team said it had sent rescue workers, tents, blankets, and clothing but officials said only a trickle of help was getting through.
"Only one truck of tents and blankets has reached the affected areas as we were told that helicopters could not land because of the aftershocks," said Ziarat district chief Dilawar Khan.
"It's very disappointing, we are badly in need of tents. It's extremely cold out in the open."
The International Committee of the Red Cross (ICRC) sent two teams to the area. "Aftershocks have continued which we think will force the population to stay outside, and the weather is cold," ICRC spokeswoman Carla Haddad said on October 29.
The World Health Organization said it was sending two truckloads of essential medicines and supplies for 50,000 people for three months to Ziarat and Pishin, a neighboring district where at least five people were killed.
In 1935, about 30,000 people were killed and the provincial capital, Quetta, was largely destroyed by a severe earthquake.
Baluchistan is Pakistan's largest province but its most thinly populated. It has the country's biggest reserves of natural gas but there were no reports of damage to gas facilities.
Back in Wam, Mohammad Salman, 12, was poking through the debris of his home and had collected a small pile of broken plates and cups.
"I couldn't find anything else," he said.