Thousands of homeless people used open spaces as toilets along India's ravaged southeastern coast Tuesday as health and aid workers worried about the growing danger of epidemic from a lack of hygiene and the rotting of unburied bodies.
All around the Indian Ocean (search), the aftermath of Sunday's mammoth earthquake and tsunami waves is a spectacle of filth, leading the World Health Organization (search) to warn that disease could kill as many people as the actual disasters.
"The initial terror associated with the tsunamis and the earthquake itself may be dwarfed by the longer term suffering of the affected communities," Dr. David Nabarro, head of crisis operations for WHO, said at the U.N. agency's headquarters in Geneva.
Governments in 12 nations were still trying to determine Tuesday how many were killed in the devastation wreaked by Sunday's quake and the tsunamis it caused. The death toll now stands at around 55,000 and is expected to rise.
Local hospitals and health services are already overwhelmed by the initial impact of the earthquake, and so are less able to cope with people who may fall ill, Nabarro said.
"So our focus, with the governments and with civil society organizations throughout the region, will be on saving lives, preventing disease and promoting recovery of the essential infrastructure for public health and well-being," he explained. "The assessments are underway."
Relief organizations are distributing supplies over 11 countries in Asia and Africa, and the United Nations has said it will likely make its largest ever appeal for humanitarian funding in response to the disaster.
The hardest-hit countries are Indonesia, whose Aceh region was closest to the epicenter of Sunday's earthquake, Sri Lanka, Thailand and India.
"Some areas are still hard to get to, but we're now moving into Aceh and finding early signs of a really terrible humanitarian tragedy in that part of Indonesia, and we're much more aware now of the needs in Sri Lanka, and Maldives and in the other countries," Nabarro said.
In Tamil Nadu, India's hardest-hit state, health officials said it was crucial to clean up quickly, particularly in getting the dead buried.
"There is a very high risk of epidemics breaking out in all these places," said Dr. Sathish Amarnath, a microbiologist who heads the infection control department at Manipal Hospital in Bangalore. "Decaying bodies are bacteria factories. The bodies must be quickly disposed of."
That hasn't happened in any of the towns in Tamil Nadu, where civic authorities were focused on trying to provide shelter for an estimated 100,000 people left homeless along a coastal stretch 130 miles long.
In Velankanni, one of India's most important pilgrimage centers, with the 400-year-old Basilica of the Virgin Mary, hundreds of bodies still lay in the streets and on a beach.
"We have recovered and identified 700 bodies, but another 700 may still be there," said the church's rector, the Rev. P. Xavier, who is helping coordinate relief operations.
Little attention was paid to hygiene. Volunteers handled corpses with bare hands, doctors left unidentified dead in the open and people carted off the bodies of relatives in open carriages. The dead were being heaped in mass graves without the usual precautions.
"The situation is extremely dangerous. Authorities must understand the seriousness and magnitude of the problem," Amarnath said.
He said improperly buried corpses could contaminate ground water, spreading diseases such as cholera (search), typhoid (search), hepatitis-A (search) and dysentery (search). He urged people to sprinkle bleaching powder on corpses as well as in water.
"There is much more we should do. Vaccination for survivors will be very important, once bodies have been dealt with," Amarnath said.
Authorities said that they were doing what they could and that it was impossible to teach hygiene to grieving survivors.
"I cannot ask a man who has lost his family and home to boil his water before drinking," said a medical officer at the government hospital in Nagappattinam, refusing to give his name.
A government official, Veera Shanmuga Moni, said authorities had been overwhelmed by Sunday's devastation, but were getting relief operations under control and would begin to address health concerns.
"It was all sudden and unexpected. There were just too many bodies to recover," he said. "Now that we are close to finishing that job, we will now take care of sanitation and supply of clean water."
Moni said authorities would build makeshift toilets for people being housed in marriage halls, college hostels, tents and government offices.
At one marriage hall, a woman who lost her 5-year-old daughter to the waves, said the people being sheltered there had no sanitary facilities. "We have to use open fields," said Nagalakshmi, 30, who uses only one name.
But she said she was at least getting enough food and potable water.