ISLAMABAD: The grisly murder of a Red Cross worker and a video showing an American hostage pleading for his life highlight a perilous security situation in Pakistan that aid groups say is endangering their work.

Humanitarian organisations are reviewing operations in Pakistan after the killing of Khalil Dale, whose decapitated body was found on April 29, four months after he was abducted in Quetta.

The savage murder of the 60-year-old British convert to Islam sent shockwaves through the aid community, particularly as his employer, the International Committee of the Red Cross (ICRC), has a reputation for neutrality that allows it to work safely even in the most hostile situations.

Aid groups spend millions of dollars on helping millions of Pakistanis, yet attacks on their staff are increasing, according to the Pakistan Humanitarian Forum (PHF), which represents nearly 50 international organisations.

Since 2009, at least 19 aid workers have been murdered and more than 20 abducted across Pakistan by militants and criminals, the PHF said.

“This trend of increased targeting of humanitarian aid organisations and personnel will further impede the ability of humanitarian agencies to provide life-saving and life-enhancing support to the most vulnerable population,” the PHF warned.

According to the PHF, at the end of 2011 there were more than 200 foreigners and 10,000 locals working in Pakistan for international aid organisations under its aegis. The ICRC is not part of the PHF.

On Sunday a video emerged of kidnapped US development worker Warren Weinstein urging President Barack Obama to save his life by agreeing to his abductors' demands.

The 70-year-old was snatched after gunmen tricked their way into his Lahore home in August last year, and Pakistani officials believe he is being held by al Qaeda and Taliban extremists in Pakistan's lawless northwest.

The kidnapping of Weinstein in Lahore, and an Italian and a German in Multan -- both cities previously regarded as relatively safe -- has further rattled NGO nerves.

“A few people have pulled out of coming for monitoring visits -- we've had auditors coming from Europe and at the last minute they've decided not to come,” an official with one major Western aid group told AFP. “We've really tightened up our security. For Islamabad our security guy says the risk is still low, but kidnappings are increasing, and from places like Multan -- we never would have expected that.”

Many in the aid community have been deeply critical of the CIA's decision to run a fake vaccination programme in a bid to identify Osama bin Laden before he was killed last May, saying the link with espionage has endangered aid workers.

Pakistan arrested the doctor recruited by the CIA to run the programme.

Bin Laden's killing in Pakistan ignited a wave of restrictions on foreigners across the country, limiting their movements and restricting visas.

A staff member with another international NGO said that while most aid workers accepted that a certain level of danger is part of the job, the ICRC's reputation made the Dale case all the more shocking.

“The ICRC is considered to be globally one of the most non-partisan, objective organisations.

It does its utmost to tread the centre ground, so that is a concern to individuals like me,” the staff member said.

Senior ICRC officials from Geneva travelled to Pakistan after Dale's murder to meet authorities and review the organisation's presence in the country.

A few days before Dale's abduction, the ICRC had already said it was planning to scale back its presence in Pakistan.

An internal source said this was to do with tensions with the authorities and problems getting visas for foreign staff, but the process could be sped up following the murder.

One option being considered, the source said, is to cut ICRC operations back to their level before a 2005 earthquake in Kashmir that killed more than 75,000 people.

That would leave just five expatriate staff in Islamabad and a hospital in Peshawar, down from about 100 foreigners at the start of the year.