In Lay Htat Monastery, an area perhaps a hundred yards square, 8,000 people eat, sleep and struggle to keep clean, so at first it is easy to miss the marks of the storm. But after a while, stepping among the clusters of refugees, so dense in places that there is not a foot of space between them, you begin to notice them — on elbows, arms and naked backs.

Some have crusted over, but others are raw and red as burns. These are the scars of Cyclone Nargis, a storm of wind, water and debris so intense that it rubbed the skin off the flesh. This is just one of a list of health menaces that threaten to make a catastrophe of disease and hunger out of the physical devastation of the wind and flood.

To walk through the monastery is an overwhelming experience — all the more so when you learn that it is just one of 58 improvised “camps,” most of them in schools and Buddhist temples, in the town of Laputa, one of the worst hit of the towns of the Irrawaddy Delta. Smoke from wood fires billows through the meditation halls, where the equivalent of several villages of people cluster to shelter from driving monsoon rain.

They fill the covered approaches to the prayer hall, and crouch under blue tarpaulins stretched over frames of bamboo. Hundreds of people queue at a small medical post set up beneath the gilt image of the Buddha; scores more live on the dirt in the narrow crawl space beneath the main hall.

The total population fluctuates, but some of the few foreign aid workers in Laputa put it as high as 70,000 refugees. “To be honest, all of us are lost in terms of numbers,' says Julio Sosa Calo, of the German medical charity, Malteser International. “People come here all the time. They know this is the only place they'll get assistance. So they come in huge numbers.”

In the first few days, the refugees who required treatment were those injured in the cyclone itself. There were people who had fallen from trees, and suffered concussions from trees falling on their houses, but the most striking and bizarre injuries of all were the stripped backs of those who had limped into Laputa from the coastal villages to the south.

Many of those who survived did so by shinning up palm trees and clinging on for hours in the equivalent of a giant sand blaster. “The wind blew so fast and it was filled with particles of sand and soil and leaves, making these lacerations on the skin,” says Alexandra Piprek, a doctor with Malteser International. “In this climate they become infected immediately.”

Now new problems are emerging that speak ominously of an impending disaster. At Laputa's single hospital, nine out of ten cases in the first few days were injuries, but these are tailing off to be replaced by a sinister statistic — a quarter of recent cases treated by the doctors are for diarrhoea. This can cause dehydration and death in children, but is easily treated. However, it indicates the great hazard of refugee camps — poor hygiene.

The inhabitants of Lay Htat Monastery drink and bathe in the water from a single murky well. Considering the huge number of people and their stifling proximity, standards of hygiene are remarkably high. But germs and disease-bearing mosquitoes cannot help but breed, and when people live in such stifling closeness to one another epidemics can spread with appalling speed. “You see it when you walk around the town,” says Dr Piprek. “Piles of rubbish, faeces. The epidemics could begin here in about five days.”

And all this is without considering the many more people who have not made it to the town of Laputa itself. Before the cyclone, the broader district had a population of 350,000, of whom perhaps 80,000 are now dead, according to Merlin, a British non-governmental relief agency. If 100,000 are in Laputa town, that leaves a vast number stranded in the villages, several hours' journey away in boats that, in any case, have been destroyed by the storm.

Laputa today is poised in a limbo between one disaster and another. If the second one comes, the health facilities presently in place will be quite inadequate.

“I've had long experience of emergencies, but I've never seen anything like this before,” says Mr Sosa Calo. “We need a huge humanitarian mission. What we have now is too little for the size of what has happened here.”

Explore Asia News

• China News

Times Recommends

• 'Great Schlep' may seal deal for Obama
• Hindu 'storm troopers' flex their muscles
• Ahtisaari: deserved reward for (failed) plan