GHALANAI, Pakistan - The United States plans to pour $750 million of aid into Pakistan’s tribal areas over the next five years as part of a “hearts and minds” campaign to win over this lawless region from Qaeda and Taliban militants.

But even before the plan has been fully carried out, documents and officials involved in the planning are warning of the dangers of distributing so much money in an area so hostile that oversight is impossible, even by Pakistan’s own government, which faces rising threats from Islamic militants.

Who will be given the aid has quickly become one of the most contentious questions between local officials and American planners concerned that millions might fall into the wrong hands. The local political agents and tribal chiefs in this hinterland on the Afghan border have for years accommodated the very groups the American and Pakistani governments seek to drive out.

A closely scripted visit to the hospital here, used for a pilot project by the United States Agency for International Development, showed the challenges on full display. The one’story hospital here was virtually empty on a recent day.

Local people had no way to get there. Three of the 110 beds were occupied. Two operating tables had not been used in months. Many doctors had left because the pay was too meager and security too precarious, said Dr. Yusuf Shah, the chief surgeon.

Sher Alam Mahsud, the local political boss who escorted this reporter on a rare visit, said he wanted all the American aid money “delivered to us.” But the precarious security does not allow the Americans to assess the aid priorities firsthand, or to provide oversight for the first installment of $150 million allocated by the Bush administration.

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