We need £1bn now or millions will die

The world's largest-ever relief effort gathered pace today to help victims of the tsunami disaster as aid agencies warned they are still dangerously short of funds.

With the authorities now faced with the first reports of disease spreading, the focus is on providing basic water supplies, sanitation and food.

The United Nations has estimated the immediate relief effort needs over £1 billion to prevent a substantial number of the five million people now at risk of sickness or starvation losing their lives.

Unicef has said that more than a million children need immediate help in Indonesia alone. So far western governments have pledged over ?181 million, with Britain donating ?15 million.

Simon Missiri, of the Asia Pacific region Red Cross, said: "We are facing a disaster of unprecedented proportions. We are talking about a staggering death toll."

Phil Bloomer of Oxfam added: "It is clear the short and medium-term responses are underfunded.

"The next five to 10 days are crucial. The danger is donors will walk away in two weeks' time as they have in other disasters."

In Sri Lanka there are reports of thousands suffering measles and diarrhoea.

Many areas in the worst-hit province of Aceh, in the north of the Indonesian island of Sumatra, have still to be reached by aid agencies. Disease, starvation and thirst are expected to be rife.

On the streets of Banda Aceh, the provincial capital, fights broke out over packets of instant noodles dropped from the air. But other relief supplies piled up at a regional airport because of a lack of cars, fuel or passable roads to move them.

Health officials in Thailand are also warning that areas ravaged by the tsunami are now running out of fresh water.

With sea water, silt and sand covering swathes of the southern coastline, the health ministry said lack of fresh water could bring outbreaks of dysentery, cholera and typhoid.

David Nabarro, head of crisis operations for the World Health Organisation, said: "I am very scared people are not paying real attention to this.

"Counting deaths is one thing and looking at damaged hotels is another, but the real issue is making sure the human beings affected by this tragedy survive.

"In one humanitarian crisis after another, what we see is people dying of communicable disease because of lack of sanitation and clean water. As many as five million people are not able to access what they need to live. They cannot get water, their sanitation is inadequate or they cannot get food." Christian Aid spokesman Dominic Nutt added: "The ?15 million pledged by the UK Government is useful, but will not do much in the long term. We will be appealing for more."

International aid agencies have reported a huge initial public response to the crisis. The British Disasters Emergency Committee, a coalition of 12 charities, raised more than ?5 million in the first 24 hours of its appeal, taking 23 calls a second.

The British Red Cross appeal has raised ?1 million, while Oxfam's drive to bring in ?3 million has so far garnered ?600,000.

An Oxfam-chartered plane carrying water tanks, pumps and sanitation gear has already taken some aid to Sri Lanka and Indonesia, while another flight has taken bottled water to the Maldives. The Queen has announced her intention to make a "substantial" donation to relief charities.

In addition to the ?18.5 million pledged by the US, President George Bush has ordered the aircraft carrier Abraham Lincoln to sail from Hong Kong to Sumatra with its complement of aircraft and helicopters.

Six US C130 transport planes based in Thailand have also been pledged to help the relief effort, and a fleet of seven US ships is to sail from the Pacific island of Guam to the Bay of Bengal with 25 helicopters and 2,100 Marines.

But UN officials fear President Bush's announcement that a "core group" of countries - the US, India, Australia and Japan - will coordinate relief work may confuse the effort on the ground.

Critics of the scale of the US response to the crisis were also outraged by the revelation that President Bush will spend an extra ?80 billion on operations in Iraq and Afghanistan next year - four million times the amount he is spending on tsunami aid. In his first comment on the disaster, President Bush said the initial US aid package "is only the beginning of our help. It's just beyond our comprehension to think about how many lives have been lost. We will prevail over this destruction."

Relief teams from Australia, Japan, Germany and other countries fanned out across corpse-strewn areas of southern Thailand.