Survivors stare at disease and death

Many more Haitians could lose their lives in the coming days and weeks through diseases such as typhoid and dysentery.

As the death toll from Haiti's earthquake increases, with teams working against the clock to rescue survivors trapped beneath the rubble, the spectre of further fatalities is rising over the devastated city of Port-au-Prince. Many more Haitians could lose their lives in the coming days and weeks, say health experts, not from falling masonry but from disease.

Although treating injuries from the earthquake is still the foremost medical priority, the destruction of the capital's infrastructure and sanitation facilities means that there is now a "major threat" of an outbreak of communicable diseases, according to Paul Garwood, a spokesman for the World Health Organisation (WHO). The chief concern is an outbreak of diarrhoeal diseases such as typhoid and dysentery from the contaminated water supply. Diarrhoea is the second biggest killer of children worldwide.

Only 50 per cent of Haitians had access to clean drinking water before the earthquake. Christian Aid estimated yesterday that Port-au-Prince now has only about three days of clean drinking water supply left. "Access to sanitation was a huge public health threat in urban Haiti before the earthquake hit, now that threat is exacerbated beyond imagination," said Beth Scott, a global sanitation expert. "The death toll from faecal-orally transmitted diseases, caused by the breakdown in sanitation systems, can more than double the death toll from a natural disaster."

While infectious disease outbreaks in the aftermath of earthquakes are rare, Port-au-Prince may be different because of overcrowding, said Franceso Checchi, a specialist in disease control in crisis situations at the London School of Hygiene and Tropical medicine. "Unless people can be provided clean water and latrine facilities in the next week, there will be a very serious risk of diarrhoeal disease outbreak. Once an epidemic starts, it's hard to stop," Mr Checchi said.

Although international agencies and non-governmental groups are working to bring clean water and chlorine tablets to people, their aid, like the rest of the relief effort, is hampered by damaged roads. "The supply of equipment is an incredible logistical challenge," said Hans van Deweerd, the director of the Holland branch of Medécins Sans Frontierès. Another cause for concern is a possibile outbreak of respiratory diseases such as measles, pneumonia and tuberculosis.

"People living in crowded conditions are vulnerable to respiratory infections," Mr Garwood said. Given the number of homes destroyed - the destruction is estimated at 80 per cent in parts of Port-au-Prince - overcrowding in displacement camps is likely. In the middle of a body bag shortage, corpses have been piling up on the roads but, contrary to thepopular perception, these do not constitute a public health risk, experts say.

"The presence of dead bodies itself poses no public health problem," said Mr Garwood, "but it is an urgent psychosocial risk." A more long-term concern is how the day-to-day health needs of the population, including life-saving treatments such as kidney dialysis and anti-retroviral drugs are going to be met, given the damage to Haiti's medical facilities, which were struggling to cope even before the earthquake.

It is not known exactly which of Port-au-Prince's health care facilities were destroyed in the earthquake, but those that are still operating are facing a "huge" burden, according to the WHO. It is not only buildings and equipment that have been lost, but doctors and nurses. "The lack of surviving staff is proving to be a huge challenge," said Emma Griffths, a spokeswoman for the UK-based medical charity Merlin, which has an assessment team on the ground.

"Health workers have either been injured, or are suffering their own loss." Aid agencies are setting up emergency clinics in tents around Port-au-Prince. But, because of the scale of the destruction, it is still hard to assess what is needed. "The scale is hard to predict," said Mr van Deweerd. "We don't have an overview." * The National