Aid experts on Wednesday warned of a looming health crisis in Myanmar, where millions of cyclone victims face outbreaks of disease as they struggle to survive without clean water, food or shelter.
Five days after Cyclone Nargis crashed into one of the world's poorest countries, killing more than 22,000 people, medical organizations say they are still trying to assess the impact in the remote worst-hit areas.
With the repressive military regime blocking access to foreign relief workers, and huge logistical hurdles in accessing the inundated disaster zone, precious little supplies have reached victims so far.
Save the Children said it believed millions were homeless and there were worrying reports that Pyinkaya town in the southwest of the delta, home to 150,000 people, had had no supplies of food or clean water since the storm hit.
"Assistance hasn't reached them yet and they are dying, completely isolated," said the group's Myanmar country director, Andrew Kirkwood.
Experts warned that such conditions were ripe for disease and injury.
International SOS, an international healthcare provider with an office in Yangon, has issued warnings over the risk of tetanus, salmonella, typhoid, malaria, diarrhoea, Hepatitis A and a multitude of other illnesses.
Their initial findings show the biggest problem is water.
"What's coming out of the pipes right now is contaminated," said Uwe Stocker, International SOS's director for the Indo-China region. "Even if it looks clear, that doesn't mean it's safe."
Flooding and broken pipes have allowed sewage, toxic chemicals and groundwater into the supply. Polluted water makes cleanliness near impossible, and drinking it increases the risk of catching gastrointestinal diseases, Stocker said.
With much of the southwestern coast inundated, stagnant water is providing a breeding ground for dangerous bacteria and insects that can carry diseases.
Families also risk contracting tetanus and infections from injuries as they rummage through their ripped-up homes, Stocker said.
"People will try to go through their damaged property, looking for valuables and even the remains of their loved ones," he said. "If they're injured, there's no normal hygiene here right now."
Stocker said the destruction of roads and vehicles will prevent wounded people from reaching health clinics and short-staffed medical teams will be unable to venture out to treat patients.
Doctors without Borders spokeswoman Veronique Terrasse said it was still too early to identify critical health needs since the organization is awaiting better communication systems and reinforcements.
Its staff first has had to address the 16,000 HIV/AIDS patients it is responsible for treating in Myanmar, and then deal with the partial collapse of its clinic in Yangon.
The U.N. food agency said that cyclone damage to rice crops and supplies in Myanmar's Irrawaddy delta and other areas may impair its ability to export an expected 600,000 tonnes of milled rice in 2008.
The storm, which battered 5 states accounting for 65 percent of the former Burma's rice output, may trigger "localized food shortages" and require imports from neighbors, it said.
In a preliminary assessment of the damage, the Food and Agriculture Organization (FAO) said lower exports or larger imports "would lead to a further tightening of the world rice market".
"Damage to annual crops is expected, in particular on rice, palm oil and rubber plantation," the report said.
The cyclone may have damaged the 2007 secondary paddy crop, which is normally harvested from April to June, it said.
The FAO's current 2007 production estimate for 30.02 million tonnes of paddy, or an equivalent 18.9 million tonnes of milled rice, may "be downgraded somewhat once the extent of the damage is better known."
It said the impact on rice supplies already harvested might be serious due to poor storage facilities.
"If post-harvest losses turn out being large, localized food shortages in the short term may result," the FAO said.
"Such losses could also impair the country's ability and government decision to export rice in 2008," it said, adding that the military government had authorized exporters to ship 600,000 tonnes of milled rice.