Its not unrealistic but it is a lot of work and requires a lot of people on the ground. If you have those people on the ground, then you are set. But you will need a logistic officer who knows the region well and knows the people who sell the items so you aren’t ripped off. You need a good finance officer and a good set of funds available.
I would highly suggest you read Three Cups of Tea. Its a pretty good book about how an American set up an NGO in the Balistan area of Pakistan with little to no support. It also covers some of the issues you will have if and when you set it up.
Also in Pakistan a lot of the Zakat and Charity are not donated to faceless charities. They are provided to the hired help around the house. Many pay for meals of workers in the cities. Its rather common for workers to be provided food free of cost a daily basis in all the major cities because some family pays for the meals.
Yes a lot needs to be done in Pakistan. I do not disagree But there is a great deal already being done for the local communities and those who are disenfranchised. Pakistani society has a very strong vein of charity in the country.