Women and girls most at risk from waterborne diseases

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Women and girls may bear the brunt of a "second wave" of the disaster in south Asia if the devastation wreaked by the tsunami is followed by the outbreak of disease, aid agencies warned yesterday.

Women and girls may bear the brunt of a "second wave" of the disaster in south Asia if the devastation wreaked by the tsunami is followed by the outbreak of disease, aid agencies warned yesterday.

Health risks from contaminated drinking water and the destruction of hospitals and clinics could hit the female population of the stricken countries disproportionately, officials said.

"The worst is yet to come, I am afraid, because of the breakdown in sanitation facilities," said Dr Robert Edelman, a professor of medicine and vaccine specialist at the University of Maryland.

Experience from previous disasters such as the earthquake in Bam, Iran, last year and the hurricane that struck the Carribean in September has shown that women and girls suffered most, according to the United Nations Population Fund (UNFPA).

Women were more vulnerable to poor nutrition, at risk from anemia and, as care-givers, had more people dependent on them. "To assume they can compete for food and resources in emergencies is not right," said Sultan Aziz, director of the Asia and Pacific region for UNFPA.

"There are tens of thousands of pregnant and nursing women in the affected countries, who are especially susceptible to waterborne diseases and may require supplementary feeding, pre-natal care and delivery assistance. Even in ideal circumstances, some 15 per cent of pregnant women require emergency care to avoid maternal and infant deaths."

The warning came as the World Health Organisation upgraded its estimate of the number injured in the disaster to 500,000, in line with the rising death rate. A spokesman said the priorities were to restore water supplies and treat the survivors but both objectives were being hampered by the destruction of local government and health facilities.

"Our main concern is Aceh province in Indonesia where we understand there is only one working hospital after 80 per cent of the western coastal area was damaged or destroyed. We have been unable to find out what its condition or capacity is. Some parts of the region were completely inaccessible for two days. It is an area of grave concern," said a spokesman.

There had been no reported outbreaks of disease but officials were monitoring the situation closely. "We are not out of the woods yet by any means," the WHO spokesman said.

UNFPA warned that physical and psychological trauma would mean even more pregnant women in need. In India, more than 524,300 refugees have taken shelter in at least 644 relief camps that have been set up in the three southern states of Tamil Nadu, Pondicherry and Kerala, and on the Andaman and Nicobar islands, said AK Rastogi, of the Ministry of Home Affairs.

At least 3,000 people are still missing in the Andaman and Nicobar islands, an archipelago comprising 572 islands along a narrow, broken arc over a distance of 800km. The islands had a total population of 356,265 at the census in 2001, the government said.

Public health specialists warned that, even before corpses could be counted, diseases could kill more, with children most at risk.

"People [with injuries] need to be treated now so they don't get deep infections," said Peter Sharwood, an Australian surgeon at Banda Aceh airport. "Those who had life-threatening injuries to start with have probably already died."

The main threats to the uninjured are from cholera, bowel disease, typhoid and hepatitis, all of which are carried by contaminated water. Dengue fever, spread by mosquitoes, is also a substantial risk.

Low-tech measures, such as using clothing to filter water, could help prevent some epidemics, but most people were probably too traumatised to remember to take such measures, public health specialists announced.

Getting clean water to the millions of people affected was the priority for most but aid workers faced overwhelming odds, said Dr Gilbert Burnham, the co-director of the Centre for International Emergency, Disaster and Refugee Studies at Johns Hopkins University in Baltimore.

After seeing the scenes of devastation and destruction, he said: "Where are you going to find a million plastic buckets in Sri Lanka right now?"