Lack of food and clean water threatens survivors

It's the disaster after the disaster.

Poverty-stricken areas reeling from a tsunami that struck 11 nations on Sunday now must cope with the sickness and death spawned by contaminated food and water.

In countries where the sanitation and health care systems were wanting even before the quake-driven tidal waves hit, there is potential for widespread disease, experts say. And the danger is highest in temporary shelters with inadequate sewage disposal.

"The issue is the 3 to 5 million survivors who are homeless, have no water, no infrastructure and limited food. We expect to see high rates of infectious disease - diarrhea, dysentery, pneumonia and other respiratory infections, where people are homeless and are gathered together," said Dr. David Nabarro, head of crisis operations for the World Heath Organization, in a written statement from Geneva.

Water and food mixed with human feces provides an incubator for diseases such as cholera, typhoid fever, hepatitis, and potentially fatal stomach ailments, experts say. Mosquitoes attracted to standing water may also carry malaria and dengue fever.

"When you have a shutdown of the sewer system and the water supply is contaminated, it's like the perfect storm for the spread of organisms that would otherwise occur very sporadically. Potentially we could see a widespread epidemic," said Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital in Manhasset, N.Y.

And while such outbreaks might be controllable in more developed countries, the nations struck generally don't have the means to contain such illnesses.

"The fact that this extraordinary catastrophe happened in areas of the world with such poor countries means mortality rates will be much higher," said Dr. Erwin Redlener, director of the National Center for Disaster Preparedness at the Columbia University Mailman School of Public Health in Manhattan.

"Sanitation, health care and fresh water systems are fragile to begin with so their ability to tolerate a crisis like this is very limited," Redlener said.

A further complication is that these countries have hot climates. Diarrhea, a primary symptom of many of these diseases, causes severe dehydration, which can kill if left unchecked and is particularly dangerous for children.