This is an evaluation of CARE’s response to the 2005 Pakistan earthquake. CARE had opened its office only 4 months earlier with a small team. All agencies responding to the earthquake had problems relating to the difficult physical environment; CARE had additional problems caused by its small presence with limited surge capacity and the challenging physical and socio-cultural environment of the Allai Valley in which it worked. These problems related to the extent of damage, winter weather, transport, insecurity, institutions, and the lack of development in a virtually feudal society in which women lived extremely restricted lives. CARE succeeded in quickly developing a sound reputation with the government, other agencies, and beneficiaries, but the rapid growth of CARE-P and the difficulty of recruiting and training national staff created a number of problems in human resources and management systems. The reconstruction programmes were technically successful, but connections to beneficiaries have been less effective, partly because programmes have been implemented separately.