At least four South Koreans - two civilians and two soldiers - were killed when North Korea fired dozens of artillery shells at Yeonpyeong island in one of the heaviest bombardments on the South since the Korean War ended in 1953.
Dozens of houses were burned in Tuesday's shelling of the island, which is just 120 km (75 miles) west of Seoul and home to about 1,600 civilians and 1,000 soldiers.
"The current firing upon South Korea will definitely have an effect on our relief efforts and yes, it will possibly cause a suspension. There is no question that this will have an impact on funding for relief work in DPRK (North Korea)," said Franklin Graham, the president of SamaritanÂ?s Purse, which has worked in North Korea for more than a decade.
"With that said, it is now more important than ever that the United States engage in dialogue with the DPRK," he said in comments emailed to AlertNet.
The charity's activities have included airlifting relief supplies, equipping TB treatment centres and providing mobile clinics.
Other aid groups working in the secretive state say they are monitoring the situation.
"Our programmes in North Korea, including agricultural programmes, will continue as planned unless this thing escalates," World Vision International's director Paul Mikov told AlertNet.
World Vision provides food aid and works with farmers to help them increase food production. It also supplies medical equipment, medication and training.
American Friends Service Committee (AFSC), which helps farmers, said it was "very concerned" about increased tensions in the region. "But we don't anticipate any change to our programme," said spokeswoman Alexis Moore.
MercyCorps spokeswoman Joy Portella said there was "no impact at this point, though it's certainly a fluid situation". She said the group's current activities comprise a relatively small-scale, privately funded agricultural project and a programme to distribute medicines to help combat waterborne diseases following floods earlier this year.
Several analysts see North Korea's attack as an attempt by its leader Kim jong-il to raise his bargaining position ahead of nuclear disarmament talks - the kind of strategy he has used in the past to win concessions and aid from the outside world, in particular the United States.
CHRONIC MALNUTRITION
About 5 million people face food shortages in North Korea, according to the United Nations. One in every three children is chronically malnourished or stunted and a quarter of pregnant and breast-feeding women are malnourished.
The reclusive state traditionally relies on aid from South Korea, China and the U.N. World Food Programme. But wide-ranging sanctions on North Korea due to its nuclear programme hamper efforts to attract funding.
WFP, which has worked in the country since the mid-1990s, already finds it very difficult to encourage large donations.
Its current operation aims to help 2.5 million people, most of them women and children. The organisation has asked for $96.3 million for a two-year programme, but this is so far only 19 percent funded.
WFP's executive director Josette Sheeran, who visited North Korea this month, said the agency was worried about the lack of funding.
"I saw a lot of children already losing the battle against malnutrition," she said after her trip. "Their bodies and minds are stunted and so we really feel the need there."
There was no immediate comment from WFP on whether North Korea's attack on the South would affect its work.
North Korea needs to import 867,000 tonnes of cereal for the year 2010 to 2011, according to WFP and the Food and Agriculture Organisation (FAO). But it only plans to import about 325,000, leaving a shortfall of 542,000 tonnes.
Warehouses visited by a joint WFP/FAO mission in September contained no cereal stocks, according to its report published this month.
Floods in the summer ravaged the north of the country, destroying crops. Even with a good harvest North Korea can barely feed its 23 million people, partly due to its hilly terrain and antiquated farming industry.
A famine in the 1990s killed an estimated 1 million of the North's then population of 22 million people.
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