There is no sign of the government-promised new houses that were to shelter millions of victims of Nepal's devastating spring earthquake. The agency that was supposed to oversee billions of dollars in spending no longer exists. And border protests continue to prevent needed supplies from getting in.

Aid groups are warning of a crisis unfolding in Nepal as winter approaches, especially for the many of the estimated 400,000 Nepalis who live at elevations of 1,500 metres or higher.

Some are still living in temporary shelters in camps across the country, though there is no official number. Their tents and huts built with tin sheets protected them from the monsoon rain but will be little match for the snow and below-freezing temperatures expected in mountain villages by the end of November.

"This is a crisis within a crisis. It is very obvious that lot of people are going to get sick. These people are in basic shelters that are not ready for winter," said Harris Nyatsanza, emergency response manager of humanitarian agency Plan International.

"With winter only weeks away, the international donor community is unable to deliver vital relief and shelter supplies to many vulnerable communities," the U.S. Embassy in Nepal said in a statement Thursday. "Lives are at stake, and we are concerned that a humanitarian crisis may result."

Many of those who have been living in temporary housing since the April 25 earthquake and subsequent aftershocks are in villages accessible only by foot. Many of these villages will be unreachable during the winter months.

"It is going to be very difficult, especially for the young and old with respiratory infections. We already see respiratory infections and we are going to see deaths too," said Jeffrey Shannon of Mercy Corps, another aid agency helping Nepalese earthquake survivors.

So far, there have not been any reported disease outbreaks among victims of the earthquake, which killed nearly 9,000 people and damaged nearly a million buildings in this Himalayan country of 31 million. But there is still a great deal of deprivation and worry, along with frustration over a government that has been too consumed with internal conflict to provide adequate help.

Nepal Quake Recovery

In this Oct. 20, 2015 photo, a Nepalese boy flies a kite standing on the debris of houses that collapsed in the April 25 earthquake in Bhaktapur. Tents and huts built with tin sheets protected them from the monsoon rain will be insufficient for the snow and below-freezing temperatures. (Niranjan Shrestha/The Associated Press)

At Bhaktapur, 13 kilometres east of Kathmandu, 70-year-old Kanchi Prajapati has been living in a tin shed with her family of six because her brick house collapsed in the earthquake. The town is below 1,500 metres but still faces temperatures as low as 2 C during winter months.

"All we have received from the government people are assurances. We have been living in this hut for six months now and all we can do is wait. I am angry at the government and the politicians who I hear are busy fighting among themselves for power. We have been forgotten by our own government," said Prajapati, standing next to an open sewage line and a community toilet shared by three dozen families.

"All we have a thin layer of tin to protect us this winter. It is going to be very cold and it is likely we are all going to be sick," she said.

Nuche Ram lost his younger brother and the family home; now he and a dozen relatives share another tin shack just a few meters from Prajapati.

"We got a little money, which has already gone to feeding our family, and now we have no money to rebuild our home. I have no work right now because there just isn't any available now," Ram said.

"We have no government and all we hear is promises made in the news, but in reality there is no government," Ram said as his family ate rice, a little lentil and potatoes. This is the time of Dasain, Nepal's biggest festival, and normally meat would be included in every meal during the two-week event.

Aid efforts have been hindered at virtually every turn.

Political protests hampered aid delivery

Following the quake, soon after the government and rescuers were able to gather emergency help like tents, tarpaulin and tin sheets, monsoon rain prevented them from reaching many affected areas. And when the aid groups were getting ready to get materials shipped in to villages, political turmoil engulfed Nepal. Ethnic groups began protesting against the new constitution in August in southern Nepal, and unrest has left 45 people killed.

Once the constitution was adopted on Sept. 20, protesters blocked border points, choking supplies of fuel and other necessities to the rest of the country. Aid groups hoping to transport aid including blankets, jackets and sweaters to these villages have been left with deliveries stuck at the border and their own vehicles without fuel.

Talks between protesters and government have made little progress and the blockade and shortages may continue for few more weeks. Key border crossings with China, meanwhile, have been closed for months because of earthquake damage.

"Right now we can't drive our vehicles because we don't have fuel. Even if the border opens today, it would take at least two to three weeks to stabilize," Shannon of Mercy Corps said. "This is the worst possible time for this to have happened."

Nepal Quake Recovery

In this Oct. 20, 2015 photo, Nepalese woman Indra Laxmi, dries clothes near temporary makeshift tents for earthquake victims in Bhaktapur. (Niranjan Shrestha/The Associated Press)

With time running out and winter approaching, aid agencies including the International Federation of Red Cross and Red Crescent Societies are sending staff to distribute $70 in cash per family in these villages so they can purchase materials in the local market.

"The window to respond closes in November, so we are changing from providing items to cash now. Our focus is getting them warm clothes and blankets for personal heating," said program coordinator Mike Higginson.

It's unclear, however, whether markets in mountain villages will have needed items in stock, since traders also have been affected by the fuel shortage.

Prospects for the longer-term task of replacing housing are at least as bleak, though international donors have pledged $4.1 billion US in aid and loans.

It took the government months to set up the National Reconstruction Authority to oversee spending, and it collapsed 11 days after it was finally formed because the regulation used to create it expired. A fresh bill was presented in Parliament but has not been approved because politicians have been busy dealing with the protests, constitution-making and electing a new prime minister and president.

"Both the politicians and bureaucracy failed to feel the urgency and lack multitasking," said Govind Pokharel, who was appointed the chief of the agency and likely to continue when it is finally reinstated. "They are busy in crisis management right now."

Pokharel said the government has approved reconstruction spending of only $500 million so far.

The authority is supposed to handle the rebuilding of collapsed houses, office buildings, schools, hospitals and roads, and was empowered to bypass spending rules to get the work done quickly.

So far the government has only given 15,000 rupees ($145) per affected family as emergency aid so they can buy corrugated tin sheets to build sheds during the monsoon rainfall. There was a plan to distribute another 200,000 rupees ($1,923) per family but that has not happened.

The lack of a functioning government reconstruction agency affects nongovernmental aid groups as well.

"We can't reconstruct or work on infrastructure because there is no guideline. We have materials available but to use them we need to have guidelines," said Jason Katz of the aid group World Vision.

The paralysis raises questions of how long it will take Nepal to rebuild. Pokharel said it may end up taking five years — or more.