The potential emergence of waterborne diseases in areas pummeled by a massive cyclone in Myanmar raised worries Friday that more could still die, as reports of diarrhea surfaced and shortages of clean water created concerns of a cholera outbreak.
Because relief has been slow to reach storm victims in much of the low-lying Irrawaddy delta, some victims have been drinking whatever water is available. Many freshwater sources have been contaminated by saltwater or decaying human bodies and animal carcasses.
There have been no reports of cholera, but it spreads quickly in areas with poor sanitation, causing acute diarrhea that can lead to dehydration, kidney failure and death. UNICEF said Thursday early estimates indicate 20 percent of children in the most devastated areas are suffering from diarrhea.
"Most of the area is covered by dirty water," said Osamu Kunii, UNICEF's chief of health and nutrition in Yangon, Myanmar's largest city. "There's a lot of dead bodies and they have very poor access _ sometimes no access _ to clean drinking water or food."
In addition, the World Health Organization was worried about malaria outbreaks, said Poonam Khetrapal Singh, deputy director of WHO's Southeast Asia office in New Delhi. The mosquito-borne disease is endemic to the area, and WHO has sent in 10,000 bed nets.
On Thursday, Singh said she had heard reports of malaria outbreaks, but she said Friday it did not appear to be a problem yet.
She said WHO has been informed about a few cases of diarrhea in two districts, but nothing widespread.
"We have been getting reports that safe water is an issue," Singh said. "We are trying to get more and more chlorine tablets to them."
Powerful Cyclone Nargis lashed Yangon along with the country's major rice-growing region Saturday, killing tens of thousands and leaving many more homeless. Food, water and fuel prices have soared in the aftermath, putting basic necessities beyond reach for many living in the impoverished country.
The secretive military-run government has received harsh criticism from the international community for delaying visas for aid workers and placing restrictions on planes entering the country.
Traumatized survivors left homeless in some areas have gone without food for days, and many risk infection from injuries suffered during the storm that caused high winds and flooding, Kunii said. Children are among the biggest worry because they are typically more vulnerable to disease. Many were orphaned by the cyclone.
A WHO team in Myanmar is working to assess the situation, and a few international technical experts are making their way into the country, Singh said.
"It reminds me of the tsunami when every day the figures kept rising, and that's really the pattern here," she said, referring to the 2004 Asian tsunami, which killed nearly 230,000 people.
Kunii said the situation in Myanmar is worse in some ways because more people suffered severe injuries from strong winds, high tides and flooding. And he noted that after the tsunami, food and water could be obtained from inland areas that were not hit by the killer waves.
"This time it is quite difficult because most of the areas are quite remote and difficult to access," Kunii said. "We are trying our best."
Tens of thousands of people die every year in Myanmar, also known as Burma, from tuberculosis, AIDS and diarrhea. Malaria alone kills about 3,000 people annually in the country.
In 2000, WHO ranked Myanmar's health system as the world's worst after war-ravaged Sierra Leone. There are hospitals, but most people cannot afford treatment because about 90 percent of the population lives on just $1 a day.
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Margie Mason covers medical issues for The Associated Press across the Asia-Pacific. She is based in Hanoi, Vietnam.
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