Race against time

Aid workers are racing against time to get vital supplies through to millions of refugees from the Asian tsunami disaster.

Despite western countries pledging more than ?500million, authorities on the ground have found themselves helpless in the face of the extraordinary damage to infrastructure.

Thousands of tons of aid have already arrived at airports throughout the devastated countries, only to sit on the runway awaiting distribution as governments and charities struggle to cope with the scale of the tragedy.

As the estimated death toll from Sunday's disaster exceeded 165,000, it was revealed at least five million people have been left destitute. Roads and bridges have been swept away and severe fuel shortages have hampered the effort to reach areas by land.

Fleets of naval vessels dispatched to the area are making slow progress and a huge shortfall in the number of helicopters available has further frustrated the relief effort.

The US aircraft carrier Abraham Lincoln, which set sail from Hong Kong, is still days away from being within range of the region and there is little prospect of the situation improving quickly.

With many living under plastic sheets in the middle of the road and children forced to stave off hunger by eating leaves, air drops from fixedwing aircraft have also met with limited success. Much of the aid dropped so far has fallen into standing water or on to inaccessible pieces of land.

In many areas the fundamental structures of government needed to organise the distribution have been washed away alongside hospitals, fire stations and ambulance depots.

The aid effort is now a race against time, with experts expecting an outbreak of cholera at any time.

The first cases of severe diarrhoea, which often emerges before cholera epidemics, are being reported and 30,000 tsunami survivors could die from the disease "within weeks" unless the situation on the ground improves dramatically. Although cholera is easily cured using very cheap rehydration salts, the thousands of life-saving sachets containing the treatment have yet to be distributed widely.

"Cases of diarrhoea are exactly what we would expect to see at the start of a cholera epidemic," said Oliver Morgan of the London School of Hygiene and Tropical Medicine.

"Because there is so much dirty water lying on the ground, something like cholera could spread incredibly quickly. The key is to try to get enough clean water into the worst affected areas and to make sure people have good personal hygiene.

"But that's very difficult to do, and in most of the poorer areas serious aid is still a week or two away."

The situation is understood to be worst in the Indonesian province of Aceh, where the region's infrastructure-already weakened by a 27-year civil war, has now been utterly ruined. Relief workers are also facing serious problems in Sri Lanka, with disagreements on strategy further hampering the natural obstacles in their path.

One convoy of 75 aid lorries dispatched to Galle, where locals are having to drink water from broken pipes, was stuck on the city's outskirts by an unidentified problem.

Some of the more remote islands, including the Andaman and Nicobar clusters where the fate of tens of thousands is unknown, have barely been visited at all.

Purnomo Sidik, head of Indonesia's social affairs disaster control directorate, said: "There is enough relief aid - so much so that it is a problem to park aircraft carrying it at the airport."

A doctor on the ground in Aceh, Doti Indrasanto, added: "We've got piles of food and medicine and we can't get it through to these places."

Electricity supplies are still only sporadic in many areas and most of the troops in Aceh are having to concentrate all their efforts on clearing bodies from the streets.

In Aceh's provincial capital, Banda Aceh, even ambulances have been forced to ration their use of petrol while hundreds of locals, watched by armed police, have formed queues half a mile long around the city's few working petrol pumps.

"The police are there, otherwise there would be violence," said Zezi Afrizal, 26, a food vendor. "Tell the world we need more fuel."

Such is the shortage of resources to distribute aid that when one vehicle was dispatched into Banda Aceh to distribute high-energy biscuits, it was besieged by desperate refugees and drivers were forced to flee before they could hand out their load.

One man made homeless by the tsunami said: "Some cars come by and throw food. The fastest get the food, the strong one wins. The elderly and the injured don't get anything. We feel like dogs."

Refugee camps have formed in a thick line along either side of the road to the city's airport in the hope passing relief trucks will toss out some aid.

"It will take at least two weeks for us to have the people and equipment we need here," said Aigor Lacomba, from a consortium of European aid groups. "It means nothing to bring a whole lot of staff if you have nowhere for them to live."

One of the few nurses, Ade Bachtiar, a volunteer from Jakarta, has helped set up an impromptu clinic, albeit without electricity, in an abandoned souvenir shop along one of Banda Aceh's main roads. "Yesterday we could only stay open for about two hours due to the lack of electricity," he said.

Nevertheless, he added, they treated 60 to 80 people, mainly closing and cleaning wounds. "Medicine is running out, especiallyantiseptics," he said. In the town nearest the earthquake's epicentre, Meulaboh, a detachment of troops sent to assess the situation found survivors scavenging for food in mud and sea water.

Brigadier- General Achmad Hiayat, surgeon general of Indonesia's armed forces, said: " Everything here has collapsed. Even the government has collapsed.

"The hospitals, medical services are in disarray."