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The death toll from the 26 December tsunamis in Southeastern Asia is now more than 100,000 and growing as the bodies of more victims are found. As relief agencies try to cope with the crisis, there are fears that inadequate shelter and sanitation could lead to epidemics in the region as well. The greatest danger is posed by unsanitary drinking water.

Prague, 30 December 2004 (RFE/RL) -- Relief agencies find themselves overwhelmed with the magnitude of the disaster in the Indian Ocean region.

UN emergency-relief coordinator Jan Egeland described the situation this way to reporters yesterday in New York: "It will take maybe 48 to 72 hours more to be able to respond to the tens of thousands of people who would like to have assistance today -- or yesterday, rather," he said. "I believe the frustration will be growing in the days and the weeks [ahead]."

The immediate focus of relief efforts is providing drinking water, food, shelter, and medical care to those who survived the onslaught of giant tidal waves. The tsunamis not only destroyed shoreline communities but flooded low-lying areas many kilometers inland, displacing up to 5 million people according to preliminary UN health agency estimates.

But as the flooding recedes and efforts to care for homeless survivors get under way, health officials say new risks loom. The most serious is the potential outbreak of epidemics.

Oliver Rosenbauer, a spokesman for the UN World Health Organization (WHO) in Geneva, told RFE/RL the greatest danger comes from unsanitary drinking water. "Between 3 and 5 million people are homeless and they will live in overcrowded temporary settlement camps with poor sanitation infrastructures, so that really facilitates the transmission of any potential water-borne diseases," he said.

Drinking unsanitary water can bring diarrhea, hepatitis, and cholera. The diseases, often passed through water contaminated with human feces, are debilitating and, if severe and untreated, fatal.

Health experts say it is impossible to predict how many survivors of the tsunamis may succumb to disease. But relief agencies say they are in a race to get fresh water supplies to the disaster areas immediately. Those outside supplies may have to be maintained for months more until regional water sources like wells now flooded with sea water return to their normal levels of purity.

Other threats from insect-borne diseases like malaria and dengue fever also loom as flooded areas create new breeding grounds for mosquitoes. Relief agencies will try to fight that danger by distributing mosquito netting sprayed with insecticide.

As the dangers of epidemics loom, health experts say there is little reason to fear the diseases will spread to other parts of the world. Such fears are raised by recent experiences with avian flu, which has spread with surprising rapidity across Southeast Asia, ravaging poultry and killing several people.

Rosenbauer said the diseases threatening the tsunami survivors arise from poor sanitation conditions and cannot easily pass to areas where sanitation is good. "If any of those people move to different areas of the world, it is an entirely different sanitation infrastructure at that point," he said. "So, they might, in fact, infect the immediate people that they might come into contact with, but they won't spread the disease through the sanitation systems in those areas. So, probably, there is very little chance of [an] epidemic moving out of that region."

As health experts try to cope with the tsunami tragedy, they say unwarranted fears of disease are causing authorities to take one public health measure that is both unnecessary and psychologically harmful to survivors. That is the immediate mass burial or burning of corpses of those killed in the disaster in the belief this will prevent the outbreak of epidemics.

Rosenbauer said diseases spread through contacts with sick people, not from the presence of the dead. "Dead bodies do not actually pose a public health risk, per se," he said. "Because what happens is that if a body dies, all the pathogens in that body decompose very rapidly as well. Having said that, people who handle the cadavers have to take certain precautions: wear gloves and wear face masks and wash their hands before eating. But to the wider population there is no public health risk."

Those handling cadavers without proper protection face a risk of tuberculosis, hepatitis, and HIV, as well as some gastro-intestinal infections.

Many health workers now say that the traditional practice of immediately burning corpses or burying them in mass graves only robs survivors of the chance to recover the bodies of loved ones. Instead, they urge authorities to collect the corpses for later identification and burial by relatives.