The death toll from Nepal's earthquake soared past 3,300 on Monday, two days after the massive quake ripped across this Himalayan nation, leaving tens of thousands shell-shocked and sleeping in streets as aid groups struggled to prevent the spread of disease as doctors and supplies began arriving.
The sick and wounded lay out in the open in the capital, Kathmandu, unable to find beds in the devastated city's hospitals. Surgeons set up an operating theater inside a tent in the grounds of Kathmandu Medical College.
"We are overwhelmed with rescue and assistance requests from all across the country," said Deepak Panda, a member of the country's disaster management.
"The rescue workers are in a really bad shape. We are all about to collapse. We have worked two straight nights," said home ministry official Laxmi Prasad Dhakal.
Saturday's magnitude 7.8 earthquake spread horror from Kathmandu to small villages and to the slopes of Mount Everest, triggering an avalanche that buried part of the base camp packed with foreign climbers preparing to make their summit attempts. Some 1,000 climbers are believed to have been on the mountain when the avalanche hit and rescue operations are continuing.
Deputy Inspector General of Police Komal Singh Bam said Monday that the death toll had risen to 3,218 people but he gave no further details. So far 18 people have also been confirmed dead in an avalanche that swept through the Mount Everest base camp in the wake of the earthquake. Another 61 people were killed in neighboring India. China reported that 20 people had died in Tibet.
1 million children in need
U.N. spokeswoman Orla Fagan said preventing the spread of disease is one of the most important tasks facing aid workers who are arriving.
"There are 14 international medical teams on the way and either 14 or 15 international search-and-rescue teams on the way," she said. "They need to get in as soon as possible. They will use military aircraft to get them into Nepal."
Diarrhea is already a growing problem and a measles outbreak was feared, with vaccines in short supply, the U.N. warned in a report.
UNICEF said Sunday that nearly 1 million children in areas affected by the earthquake are in "urgent need" of humanitarian assistance.
U.N. humanitarian chief Valerie Amos said in a statement Sunday evening that the full picture of destruction and suffering would only appear worse "as humanitarian workers reach the more remote areas near the epicenter of the earthquake." She said "entire areas have been flattened" and that time is of the essence in search and rescue efforts.
Kathmandu district chief administrator Ek Narayan Aryal said tents and water were being handed out Monday at 10 locations in Kathmandu, but that aftershocks were leaving everyone jittery.
"There have been nearly 100 earthquakes and aftershocks, which is making rescue work difficult. Even the rescuers are scared and running because of them," he said.
Tens of thousands spent the night sleeping in parks or on a golf course. Others camped in open squares lined by cracked buildings and piles of rubble.
"We don't feel safe at all. There have been so many aftershocks. It doesn't stop," said Rajendra Dhungana, 34, who spent the day with his niece's family for her cremation at the Pashuputi Nath Temple in Katmandu. "I've watched hundreds of bodies burn."
Anger at the government
In Kathmandu, people expressed anger at the chronically chaotic government’s response to the disaster. Hospitals were running out of emergency medical supplies and places to store corpses. Electrical power is intermittent. And, to add to the misery, forecasters warned that rain was on the way, promising more misery for displaced survivors, and more difficulties for those mounting rescues and search efforts.
The disarray in the government’s response reflects the ongoing inability of Nepali lawmakers to write a constitution, despite many attempts since 2006, when a Maoist-insurgency ended.
The disaster has underlined the woeful state of Nepal's medical facilities.
Nepal has only 2.1 physicians and 50 hospital beds for every 10,000 people, according to a 2011 World Health Organization report.
"The earthquake has exposed that Nepal's best public hospital infrastructure has crumbled at a time when it should serve more people in a hurry," said Sarvendra Moongla, a senior surgeon at Bir Hospital's Trauma Center in Kathmandu, which opened in February.
Earlier this month, more than 5,000 doctors stayed away from work at clinics and hospitals in support of a colleague who went on a hunger strike to demand reforms in medical education and services. The action left most people in Nepal without access to doctors.
And according to an Open Society Foundations report on migrant workers, Nepal now sends the most workers abroad per capita of any country in Asia, with about 1,500 leaving each day in 2014. While official remittances account for over 29 percent of Nepal’s total GDP, the flip side is that there may be a shortage of workers for rebuilding, once the search and rescue operations wind down.
The rescue workers are in a really bad shape. We are all about to collapse. We have worked two straight nights.
Laxmi Prasad Dhakal
Nepal's home ministry
On Monday, aid workers were warning that the situation could be far worse near the epicenter. The U.S. Geological Survey said the quake was centered near Lamjung, about 50 miles northwest of Kathmandu.
Rescuers aided by international teams spent Sunday digging through rubble of buildings — concrete slabs, bricks, iron beams, wood — to look for survivors. Because the air was filled with chalky concrete dust, many people wore breathing masks or held shawls over their faces.
Most shops in Kathmandu were closed after the government declared a weeklong period of recovery. Only fruit vendors and pharmacies seemed to be doing business.
"More people are coming now," fruit seller Shyam Jaiswal said. "They cannot cook so they need to buy something they can eat raw."
The first nations to respond were Nepal's neighbors — India, China and Pakistan, all of which have been jockeying for influence over the landlocked nation. Nepal remains closest to India, with which it shares deep political, cultural and religious ties.
Other countries sending support Sunday included the United States, Canada, the United Arab Emirates, Britain, Germany, France, Poland, Italy, Israel and Singapore.
Remote areas a worry
Early word from from remote mountain villages suggested many communities perched on mountainsides were devastated or struggling to cope, according to aid groups.
Landslides hindered rescue teams that tried to use mountain trails to reach those in need, said Prakash Subedi, chief district official in the Gorkha region, where the quake was centered.
"Villages like this are routinely affected by landslides, and it's not uncommon for entire villages of 200, 300, up to 1,000 people to be completely buried by rock falls," said Matt Darvas, a member of the aid group World Vision. "It will likely be helicopter access only."
Some aid vehicles were able to travel overland from Indian to the stricken Nepalese city of Pokhara.
"That means supplies could potentially come in overland from India. That is a positive sign," said Ben Pickering, Save the Children's humanitarian adviser in Britain. "The airport opening is a small miracle."
He cautioned that chaotic conditions may create a bottleneck at the airport as governments and aid agencies try to bring in personnel and supplies in the coming days.
"Going forward it's about access to the epicenter, and helicopters are the key, but it's not clear whether they can be sourced and whether the high altitude is a problem," he said.
Al Jazeera and wire services