As the death toll continues to mount in cyclone-stricken Myanmar, health experts worry that a second wave of fatalities -- from disease and malnutrition -- could threaten the region in the weeks and months to come.
According to the U.S. State Department, the country has already sustained a staggering death toll, with more than 100,000 dead. Clean water shortages and corpses floating in flooded areas have already been reported.
Now, according to United Nations officials, about 1 million survivors find themselves in need of shelter and emergency care, and disaster medicine experts say thousands more will likely perish unless proper aid reaches them quickly.
"[Myanmar] was already stretching to meet minimal health care and sanitization standards before the cyclone," says Maurice A. Ramirez, co-founder of Disaster Life Support of North America Inc., a national provider of disaster preparation and recovery education based in Kissimmee, Fla.
"Now anything that has been a health problem in [Myanmar] in the past five years will be seen in a larger proportion," he says. "Even if they have all the [country's] health care available, that couldn't meet the needs to begin with."
Dr. Martin J. Blaser, chairman of the department of medicine and professor of microbiology at the New York University School of Medicine, says the number of additional deaths may rise another 5 or 10 percent. "This seems like a small percentage, but you're dealing with a lot of people."
A shortage of clean water is perhaps the biggest health threat that now faces the survivors of Cyclone Nargis.
"If a safe water supply is not provided, there will be a large rise in gastrointestinal problems such as cholera and typhoid fever," says Dr. Pascal James Imperato, dean of the graduate program in public health and distinguished service professor at SUNY Downstate Medical Center in Brooklyn.
"The big problems are diarrheal diseases, and in developing countries those are highly fatal," Ramirez says. "It's not the bacteria that kill you, it's dehydration that comes from diarrhea. That will be the first big health crisis."
The formation of refugee camps could compound this problem, bringing survivors even closer together in areas with substandard sanitation.
But the problems are not limited only to the water that people can drink.
"Another problem could arise if large amounts of water remain on land surfaces in which mosquitoes could breed at rates much higher than normal, and this can lead to an increase in malaria and viral infections," Imperato says.
And Blaser notes that those who suffered acute injuries when the cyclone hit may now be at risk.
"Many people, unfortunately, drowned, while some people nearly drowned -- they were submerged," he says. "Some of these people are at risk of getting pneumonia, and they could succumb to that."
Even broken bones and fractures, Blaser says, could lead to death if not properly treated.
The other major threat is starvation. Some aid organizations have already begun to address this issue; the World Food Program has 800 tons of food in the region, which it says it is distributing in the city of Yangon.
But while such aid may address immediate food needs, the long-term stability of Myanmar's food supply could be in question, as it remains to be seen how much of the nation's crucial farmland was ravaged by the cyclone.