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."
Disease and Malnutrition
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.
Lasting Impact for Children
The group most likely to inherit the lasting health impacts from the disaster are the country's youngest survivors.
"Re-establishing health care -- in the U.S. it takes less than a year or six months, but in a place like [Myanmar] it might be a decade," Ramirez says. "If you go a decade with minimal to no health care, the impact on child mortality and longevity is devastating."
Lack of access to adequate food may also have long-lasting impacts for these young victims. "If they don't get food, the biggest problem will be malnutrition," says Dr. Karen Olness, professor of pediatrics at Case Western Reserve University in Cleveland. "Malnutrition in the first two years of life leads to learning disabilities."
But Olness adds that by far the most serious issue facing the children of the disaster will be long-term mental illness.
"The long-term problems for the children will be post-traumatic stress disorder and other mental health problems as a result of the experience -- the frightening experience of losing family members, of losing familiar environments," she says. "It's hard to judge what percentage of children will be adversely affected, but in general, after a major natural disaster, about one-third of children will suffer from mental health problems."
Olness says the key to warding off these adverse effects on mental health is to re-establish family and community connections and resume school sessions and other aspects of day-to-day life.
Saving the Survivors
For everyone, however, the most pressing need is to provide relief as quickly and efficiently as possible.
"There were many good lessons learned from the 2004 tsunami," Imperato says. "The most important was aggressive public health intervention to provide safe water supplies, safe food supplies, safe shelters and protection for children and adults against viral infections."
Such intervention may be easier said than done, Olness says.
"During situations like the 2004 tsunami and the earthquake in Pakistan in 2005, the countries allowed the U.N. agencies to come in very quickly to set up tent hospitals, which are very effective these days," she says. "The trouble with Myanmar is the reluctance to bring in the acute needs that are now relatively easy to do."
This may result in epidemics, she says. "There were no epidemics after the tsunami and earthquake because of the humanitarian programs, which were so effective."
But Blaser says that the capability to offer crucial aid exists -- and this aid has the potential to save hundreds, even thousands, of lives.
"I think the good news in all of this is that we live in a world of rapid communications and travel," Blaser says. "We should try to utilize people in a hurry and get help there as soon as possible, because there are some people who are right on the margin, and they can be saved if they are helped soon enough."