Rebuilding shattered health system an urgent priority in next phase of Typhoon Haiyan response

6 December 2013 | Manila, Philippines - One month after Typhoon Haiyan hit the Philippines, WHO identifies as top priorities expanding essential health services, reviving clinics and hospitals, preventing disease and scaling up mental health services as the relief effort shifts from emergency to early recovery programmes.

The typhoon, one of the strongest ever recorded, tore through the central Philippines on 8 November, sweeping away villages, killing over 5700 people, wreaking havoc on the lives of more than 11 million others and damaging the majority of medical facilities.

From the outset of the disaster, WHO has been working side-by-side with the Philippines Department of Health to assess and address the life-saving needs of survivors and coordinate the emergency health response.

“Our immediate goal was to help plug critical gaps in medical services and to get the right experts and supplies into the right places swiftly and efficiently,” says Dr Julie Hall, WHO Representative in the Philippines.

One month into the crisis, 181 medical teams (65 foreign, 116 local) are delivering critical care in affected areas. WHO has coordinated the distribution of more than 72 tonnes of medicines and supplies to support the relief effort. A mass campaign to vaccinate children under 5 against measles and polio is underway in storm-hit communities and evacuation centres. WHO and partners have also worked with the government to reactivate disease monitoring and reporting to ensure cases of infectious diseases are quickly identified and responded to.

The risk of infectious diseases remains high, particularly in the crowded and unsanitary environments where hundreds of thousands of homeless people are now sheltering. Infectious diseases like measles, water-borne diseases such as typhoid fever and vector-borne diseases like dengue, can thrive in such conditions.

However, the primary reasons people in affected areas are seeking medical care right now are acute respiratory infections, fever, diarrhoea, high blood pressure, skin diseases, new injuries from clearing debris and follow-up care for injuries and wounds sustained in the typhoon.

The medical teams are also tending to on-going health needs, including maternal and child health care. An average of 865 women give birth every day in affected areas, of whom an estimated 15% will experience complications, some of them life-threatening.

With many foreign medical teams preparing to leave within the next month or two and others arriving, WHO is working with the Department of Health to ensure a smooth transition. Dr Hall says it is critically important that gaps in services do not emerge and that international attention and support to the health sector does not wane.

“We must ensure that essential health services are not interrupted and that in the months to come, the Philippine Government as well as humanitarian aid organizations and other key partners have adequate resources to restore health services across the affected regions,” says Dr Hall.

At the one-month mark in the crisis, priorities for the health sector include:

• Extending and expanding treatment: Providing free primary and emergency health care as Philippine medical services are re-established. Special attention is required for obstetric and neonatal care and treatment of chronic diseases and infections like tuberculosis.
• Preventing disease: Strengthening disease surveillance and response systems to inform health care needs and prevent the spread of disease. Other essential preventive measures include increasing coverage with recommended vaccines, pre-positioning supplies for possible outbreaks and improving waste management and water supply.
• Restoring health infrastructure and systems: Supporting the Philippine Government as it repairs and rebuilds medical facilities and restores the drug supply and routine health programmes. Health authorities are still tallying total costs, but say they need an initial P 1.4 billion (around US$ 32 million) for basic repairs and replacement of equipment and medicines.
• Integrating healthcare with other key services: Linking health care with social support programmes, especially mental health assistance. WHO and the Department of Health have trained Filipino health professionals who will in turn train field workers to deliver psychological first aid to typhoon survivors.

“Rebuilding the health system is going to be part and parcel of rebuilding lives and livelihoods in central Philippines,” says Hall. “Given the scale of this disaster, it’s going to take a healthy population to fuel the region’s recovery.”

For more information, interviews, or to arrange field visits, please contact:

Paulo Lyra in Manila
Mobile: +63 915 896 6345,
E-mail: lyrapaul@who.int

Aphaluck Bhatiasevi in Tacloban
mobile: +63 917 490 9757 and +63 947 170 7512,
E-mail: bhatiaseviap@who.int

Melissa Winkler in Geneva
Mobile: +41 79 445 2518
E-mail: winklerm@who.int

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Breastfeeding is life-saving for babies in Philippines typhoon emergency

28 November 2013 | Manila, Philippines - UNICEF and WHO today called on those involved in the response to the Philippines’ Typhoon Haiyan (Yolanda) disaster to promote and protect breastfeeding to avoid unnecessary illness and deaths of children.

Exclusive breastfeeding in first 6 months vital

The estimated 12 000 babies to be born in the worst-affected areas this month need to be exclusively breastfed, meaning that they get nothing but breast milk, which protects them from potentially deadly infections. Around one third of babies in the area born before the disaster who are less than 6 months old are already exclusively breastfed, and 9 out of 10 were at least partially breastfed before the emergency. The mothers who were doing at least some breastfeeding need to be supported to transition to exclusive breastfeeding.

“The uncontrolled distribution and use of infant formula in emergency situations like this – where there are serious water and sanitation challenges and other disease risks – is extremely dangerous. Supporting breastfeeding is one of the most important things we can do to protect babies in areas of the Philippines hit by the typhoon,” said Dr Julie Hall, WHO Representative in the Philippines.

"Supporting breastfeeding is one of the most important things we can do to protect babies in areas of the Philippines hit by the typhoon."

Dr Julie Hall, WHO Representative in the Philippines

UNICEF and WHO prioritise the protection, promotion and support of breastfeeding as a life-saving measure for babies everywhere, and especially in emergencies.

“With the right support – from a health worker, a counsellor or another mother – a woman who is already doing some breastfeeding can increase her milk production within days just by feeding her baby more frequently,” said Tomoo Hozumi, UNICEF Representative in the Philippines.

Babies under 6 months the most vulnerable in emergency situations

During emergency situations, disease and death rates among babies and children are higher than for any other age group; and the younger the child, the higher the risk, leaving babies under 6 months most vulnerable. Babies who drink formula made with water that is contaminated with germs or given with an unsterile bottle or teat, can become very sick with diarrhoea and die within a matter of hours.

Feeding babies with formula in emergencies must only be considered as a last resort, when other safer options – such as helping non-breastfeeding mothers to reinitiate breastfeeding, finding a wet nurse or pasteurized breast milk from a breast milk bank – have first been fully explored.

Only a relatively small number of infants under 6 months affected by this disaster – estimated to number around 6 600 – are not breastfed at all. These babies should be urgently identified, their feeding situation assessed, and be provided with skilled support and the safest feeding option.

UNICEF and WHO strongly urge all who are involved in funding, planning and implementing the emergency response in the Philippines to avoid unnecessary illness and death by protecting, promoting, and supporting breastfeeding. Community leaders are called upon to monitor and report any donations that may undermine breastfeeding.

For further information, please contact:

Liv Lawe-Davies
Communications Officer
WHO, Manila
Telephone: +63 915 896 6345
E-mail: lawedavieso@who.int

Gregory Hartl
Coordinator, News and Social Media
WHO, Geneva
Telephone: +41 79 203 6715
E-mail: hartlg@who.int

Zafrin Chowdhury
UNICEF, Tacloban
Telephone: + 63 917 867 8366
E-mail: zchowdhury@unicef.org

Kate Donovan
UNICEF, Tacloban
Telephone: + 1 212 303 7984,
Mobile: + 1 917 3781 2128
E-mail: kdonovan@unicef.org

Denise Shepherd-Johnson
UNICEF, Manila
Telephone: + 63 917 464 7028
E-mail: dshepherdjohnson@unicef.org

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WHO and partners begin reaching people in need on many Philippine islands hit by typhoon

15 November 2013 | MANILA, Philippines - WHO is working with the Government of the Philippines and international partners to reach survivors of Typhoon Haiyan who need medical care. The full extent of the disaster is becoming increasingly clear, with dozens of separate sites needing assistance.

At least seven provinces have been hit by the disaster (Samar, Leyte, Cebu, Iloilo, Capiz, Aklan and Palawan) and a humanitarian hub is being established in each. But the scope of the disaster could be larger still. There are concerns that some 20 smaller islands with remote communities may have been impacted by the typhoon as well. This makes delivering relief exceedingly complicated.

“Because of the geography of the Philippines – an archipelago of many islands – and the fact that so many have been hit by the typhoon, it is essentially like mounting at least seven separate, simultaneous relief efforts. This multiplies the logistical challenges associated with the response,” says Dr Julie Hall, WHO’s Representative in the Philippines.

Health infrastructure – including the “cold chain” which is vital for safe storage and transportation of vaccines – has been severely damaged by the typhoon. Initial assessments have found that 18 of the 38 health facilities in affected regions are not functional.

Aid is beginning to reach those in need. A total of 22 Filipino medical teams have been deployed to typhoon-affected areas. For example, the Eastern Visayas Regional Medical Center – the only local health facility remaining operational in Tacloban – is being manned by teams from Metro Manila Hospitals. In addition, 11 foreign medical teams are operational in areas including Tacloban, Ormoc City, Panay, Guiuan and Palo, and another 14 foreign teams are on their way. WHO has teams on location in Tacloban and Cebu, coordinating the actions of foreign medical teams. Around 50 WHO experts have come to the Philippines to support government efforts, in excess of the staff who were already in the country prior to the typhoon.

There are estimated to be more than 200?000 pregnant women and 130?000 breastfeeding women in affected areas in need of specialized prenatal, postnatal, child health, health promotion and family planning services.

Guiuan is one of the hardest-hit areas, with every health facility destroyed, including the only facility in Eastern Samar province with capacity to help women with complications of child birth. However, reproductive health kits have been sent to Guiuan to treat patients with obstetric complications. A generator, a refrigerator to store medicines, a delivery bed, midwifery kits and hygiene kits have also been sent.

Some 1350 hygiene and dignity kits (containing items such as soap, sanitary napkins, toilet paper and underpants) have arrived in Tacloban City for distribution to pregnant and breastfeeding women.

For more information or interview requests, please contact:

Nyka Alexander (Manila)
Communications Officer
Telephone: +63 906 493 5097
E-mail: alexandern@wpro.who.int

Christy Feig
Director of Communications
Telephone: +41 79 251 7055
E-mail: feigc@who.int

Gregory Hartl
Coordinator, News and Social Media
Telephone: +41 79 203 6715
E-mail: hartlg@who.int

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Patchy aid reaches typhoon survivors as Philippines struggles to rebuild

By Aubrey Belford

TACLOBAN, Philippines (Reuters) - Survivors began rebuilding homes destroyed by one of the world's most powerful typhoons and emergency supplies flowed into ravaged Philippine islands, as the United Nations more than doubled its estimate of people made homeless to nearly two million.

But the aid effort was still patchy, and bodies still lay uncollected as rescuers tried to evacuate stricken communities on Saturday, more than a week after Typhoon Haiyan killed at least 3,633 with tree-snapping winds and tsunami-like waves.

"We are very, very worried about millions of children," U.N. Children's Fund spokesman Marixie Mercado told reporters in Geneva. There are officially 1,179 people missing, according to the national count.

Survivors and officials in Tacloban, which bore the brunt of the storm, have said the death toll could be many thousands just in the city as more bodies are discovered every hour.

After long delays, hundreds of international aid workers set up makeshift hospitals and trucked in supplies on Saturday, while helicopters from a U.S. aircraft carrier ferried medicine and water to remote, battered areas where some families have gone without food and clean water for days.

Aid flown in to Tacloban's congested airport finally trickled into ravaged neighborhoods. Work crews and heavy equipment cleared debris from roadsides, but side streets remained piled with the sodden, tangled remains of homes.

In front of the San Fernando Elementary School, government workers distributed sacks of aid to a restless crowd of hundreds who had spent the last week camped in shattered wooden classrooms or in a main school building with floors covered in wet black sand. Nearby, about a dozen body bags were neatly lined up by the roadside.

Survivors living in the school said they had received little help since the disaster.

Rica Mobilla, an 18-year-old mother of one, said local authorities showed up two days after the disaster, handing out four kilograms of rice and a few packs of noodles for her family of thirteen. The family stretched this out with onions and garlic bought from the market.

"For the first two days after Yolanda, we didn't eat. After getting that packet, we eating once a day," she said, using the Philippine name for Typhoon Haiyan.

"I'm upset. I'm not blaming anyone. If there's aid there to give out we'll receive it."

President Benigno Aquino, caught off guard by the scale of the disaster, is scheduled to visit typhoon-affected areas on Sunday. He has been criticized for the slow pace of aid distribution and unclear estimates of casualties, especially in Tacloban, capital of hardest-hit Leyte province.

In Tacloban the death toll is written on a whiteboard at City Hall and bodies have been buried in mass graves since Thursday. Tacloban mayor Alfred Romualdez said people may have been swept out to sea after a tsunami-like wall of seawater slammed into coastal areas. One neighborhood with a population of between 10,000 and 12,000 was now deserted, he said.

SURVIVORS START TO REBUILD, HOMELESS RISE

Relief officials reported a surge in desperate, hungry survivors trying to leave the coastal city of Ormoc, 105 km (65 miles) west of Tacloban.

"People are fleeing in mass numbers and coming to Ormoc, where they stand in line all day to get on a ferry only to be turned away," said Arnaldo Arcadio, an emergency responder with the Catholic Relief Services group.

"Ormoc is teeming with people who haven't eaten in days. They're hungry, thirsty and tired. They want to get out."

Across Tacloban, survivors have begun to rebuild. The sounds of hammers ring out. Men gather in groups to fix motorbikes or drag debris off splintered homes and wrecked streets. Most have given up searching for lost loved ones.

The number of people made homeless by the storm rose to 1.9 million, up from 900,000, the United Nations' humanitarian agency said. In Tacloban, at least 56,000 people face unsanitary conditions, according to the United Nations' migration agency.

Captain Victoriano Sambale, a military doctor who for the past week has treated patients in a room strewn with dirt and debris in Tacloban, said the pace of aid relief was rising.

"I can see the international support coming here," he said.

But he is still overwhelmed. "Day one we treated 600-plus patients. Day two we had 700-plus patients. Day three we lost our count."

U.S. HELICOPTERS AID RELIEF EFFORT

Massive logistical problems remain. Injured survivors waited in long lines under searing sun for treatment. Local authorities reported shortages of body bags, gasoline and staff to collect the dead.

British Prime Minister David Cameron on Saturday pledged 30 mln pounds for international aid agencies working in the Philippines.

But the patchy initial aid response highlighted the need for international agencies and local governments to prepare for more frequent, more devastating natural disasters, said Kristalina Georgieva, European Commissioner for International Cooperation, Humanitarian Aid and Crisis Response.

"This is a mindset change that must happen if we want to be able to stand up to this trend," she told Reuters in Tacloban.

U.S. military assistance has been pouring into the Philippines since Thursday when the USS George Washington aircraft carrier and accompanying ships arrived off eastern Samar province, carrying 5,000 crew and more than 80 aircraft.

The Philippines is one of Washington's closest allies in Asia and a crucial partner in President Barack Obama's strategy of rebalancing U.S. military forces towards the region to counter the rising clout of China.

The Pentagon said on Friday that U.S. Navy amphibious ships will leave Okinawa in Japan "in the coming hours" carrying an additional 1,000 marines and sailors who will provide engineering equipment, relief supplies, and medical support.

U.S. sailors have brought food and water ashore in Tacloban and the town of Guiuan, whose airport was a U.S. naval air base in World War Two. The carrier is moored near where U.S. General Douglas MacArthur's force landed on October 20, 1944, in one of the biggest Allied victories.

The U.S. military estimates that it delivered some 623,000 pounds (283,000 kg) of U.S. relief supplies to the Philippines so far. The American military also estimated that it had moved nearly 1,200 relief workers into Tacloban and airlifted nearly 2,900 displaced people from affected areas so far.

(Additional reporting by Rosemarie Francisco and Eric dela Cruz and Manuel Mogato in Manila, Michelle Nichols at the United Nations and Stephanie Nebehay in Geneva, Ranga Sirilal in Colombo; Writing by Jason Szep; Editing by John Mair and Michael Perry)

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Water a pressing concern for typhoon survivors

TACLOBAN, Philippines (AP) — Since the typhoon hit, Danny Estember has been hiking three hours round-trip into the mountains each day to obtain what he can only hope is clean water for his five daughters and two sons.

The exhausting journey is necessary because safe water is desperately scarce in this storm-ravaged portion of the Philippines. Without it, people struggling to rebuild and even survive risk catching intestinal and other diseases that can spread if they're unable to wash properly.

While aid agencies work to provide a steady supply, survivors have resorted to scooping from streams, catching rainwater in buckets and smashing open pipes to obtain what is left from disabled pumping stations. With at least 600,000 people homeless, the demand is massive.

"I'm thirsty and hungry. I'm worried — no food, no house, no water, no money," said Estember, a 50-year-old ambulance driver.

Thousands of other people who sought shelter under the solid roof of the Tacloban City Astrodome also must improvise, taking water from wherever they can — a broken water pipe or a crumpled tarp. The water is salty and foul tasting but it is all many have had for days.

The U.S. Institute of Medicine defines an adequate daily intake of fluids as roughly 3 liters (100 ounces) for men and about 2.2 liters (75 ounces) for women. Given the shortages and hot climate, it's certain that most in the disaster zone aren't getting anything like those amounts, leaving them prone to energy-sapping dehydration.

Providing clean, safe drinking water is key to preventing the toll of dead and injured from rising in the weeks after a major natural disaster. Not only do survivors need to stay hydrated, they also need to be protected from waterborne diseases such as cholera and typhoid.

Haiti's devastating 2010 earthquake was followed by a cholera outbreak that health officials say has killed more than 8,000 people and sickened nearly 600,000. Some studies have shown that cholera may have been introduced in Haiti by U.N. troops from Nepal, where the disease is endemic.

Washing regularly, using latrines and boiling drinking water are the best ways to avoid contracting diarrhea and other ailments that could burden already stressed health services.

It took several days for aid groups to bring large quantities of water to Tacloban, the eastern Philippine city where the typhoon wreaked its worst destruction. By Friday, tankers were arriving. Philippine Red Cross workers sluiced water into enormous plastic bladders attached to faucets from which people fill jerry cans, buckets, bottles and whatever other containers they might have.

"I'm thirsty," said Lydia Advincula, 54, who for the last few days had been placing buckets out doors to catch some of the torrential downpours that have added to the misery of homeless storm survivors.

Water provisioning should get a big boost with the recent arrival of the U.S. Navy aircraft carrier USS George Washington, a virtual floating city with a distillation plant that can produce 1.5 million liters (400,000 gallons) of fresh water per day — enough to supply 2,000 homes, according to the ship's website.

Britain also is sending an aircraft carrier, the HMS Illustrious, with seven helicopters and facilities to produce fresh water, Britain's Ministry of Defense said. It said the ship is expected to reach the area about Nov. 25.

Filtration systems are now operating in Tacloban, the center of the relief effort, and two other towns in Leyte province, the hardest-hit area. Helicopters are dropping bottled water along with other relief supplies to more isolated areas.

Other more high-tech water purification solutions are also available, such as water purification bottles developed since the 2004 Indian Ocean tsunami that devastated parts of Thailand, Indonesia, India and Sri Lanka. Those contain systems that filter out parasites, bacteria and other dangerous substances from virtually any water source, making it safe to drink and alleviating the high cost and logistical difficulties that shipping in bottled water entails.

Longer-term water solutions will come once the crucial issues of shelter and security are settled and will likely have to wait several months, said John Saunders, of the U.S.-based International Association of Emergency Managers. Those water systems are far more complex, requiring expensive, specialized equipment and training for operators, he said.

"I can bring in a $300,000 water system that provides thousands of liters per day of drinking water, but who pays for the system and how is it maintained and distribution managed?" Saunders said.

Long-term solutions are a distant concern for Jaime Llanera, 44, as he stands in a shelter he and his family have fashioned out of broken plywood and a tarpaulin.

A single 500-milliliter (12-ounce) bottle of mineral water delivered by the military three days earlier is all that's available for his parents, sister, brother-in-law and a friend. To stretch their supply, they've been collecting rainwater in buckets and any other containers they can find and boiling it. They're also using rainwater to clean: His mother dunks clothing into a bucket of rainwater and tries to scrub out the filth.

The family plans to wait one more week. If help hasn't come by then, they'll try to find a way out of Tacloban so they can stay with relatives elsewhere. "We have no house. We have no home. But we're still intact," Llanera said.

__

Christopher Bodeen reported from Beijing.

Copyright c 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Desperate Philippine typhoon survivors loot, dig up water pipes

By Andrew R.C. Marshall and Stuart Grudgings

TACLOBAN, Philippines (Reuters) - Desperation gripped Philippine islands devastated by Typhoon Haiyan as looting turned deadly on Wednesday and survivors panicked over shortages of food, water and medicine, some digging up underground water pipes and smashing them open.

Five days after one of the strongest storms ever recorded slammed into cities and towns in the central Philippines, anger and frustration boiled over on Wednesday as essential supplies dwindled. Some survivors scrawled signs reading "Help us".

Controversy also emerged over the death toll. President Benigno Aquino said local officials had overstated the loss of life, saying it was closer to 2,000 or 2,500 than the 10,000 previously estimated. His comments, however, drew skepticism from some aid workers.

Some areas appeared to teeter near anarchy amid widespread looting of shops and warehouses for food, water and supplies.

There were reports of gunfire between security forces and armed men near a mass grave in worst-hit Tacloban in Leyte province, but city administrator Tecson John Lim denied the clash based on information he had received from the army.

Eight people were crushed to death when looters raided rice stockpiles in a government warehouse in the town of Alangalang, causing a wall to collapse, local authorities said.

Other looters still managed to cart away 33,000 bags of rice weighing 50 kg (110 lb) each, said Orlan Calayag, administrator of the state-run grain agency National Food Authority.

Warehouses owned by food and drinks company Universal Robina Corp and drug company United Laboratories were ransacked in the storm-hit town of Palo in Leyte, along with a rice mill in Jaro, said Alfred Li, head of the Leyte Chamber of Commerce and Industry.

Tacloban city administrator Tecson John Lim said 90 percent of the coastal city of 220,000 people had been destroyed, with only 20 percent of residents receiving aid. Houses were now being looted because warehouses were empty, he said.

"The looting is not criminality. It is self-preservation," Lim told Reuters.

Some survivors in Tacloban dug up water pipes in their desperate need for water.

"We don't know if it's safe. We need to boil it. But at least we have something," said Christopher Dorano, 38.

"There have been a lot of people who have died here."

Resident Rachel Garduce said the aid - 3 kg (6 lb) of rice and 1 liter (34 ounces) of water per household a day - was not enough in her ravaged Tacloban neighborhood. Her aunt in Manila, 580 km (360 miles) to the north, was travelling by road and ferry to bring supplies. "We are hoping she won't get hijacked," she said.

Secretary Mar Roxas denied law and order were breaking down. "It is wrong to say there is lawlessness in the city," he told reporters.

THOUSANDS REPORTED MISSING

The government has been overwhelmed by the force of the typhoon, which destroyed large swathes of Leyte province where local officials have said they feared 10,000 people died, many drowning in a tsunami-like surge of seawater.

Aquino, who has been on the defensive over his handling of the disaster, said the government was still gathering information from various storm-struck areas and the death toll may rise. "Ten thousand, I think, is too much," Aquino told CNN in an interview. "There was emotional drama involved with that particular estimate.

Official confirmed deaths stood at 2,275 on Wednesday, with only 84 missing, a figure aid workers consider off the mark.

"At this time it is definitely not 10,000," Cabinet Secretary Rene Almendras told a news conference. "There has been a body count based on the dead lying in the streets but we can't be accurate because there is still, some people say, there are people buried in certain areas."

Some aid workers cast doubt over Aquino's estimate.

"Probably it will be higher because numbers are just coming in. Many of the areas we cannot access," Gwendolyn Pang, secretary general of the Philippine Red Cross, told Reuters.

The preliminary number of missing, according to the Red Cross, is 22,000. Pang cautioned that figure could include people who have since been located.

Google, which has set up websites to help people share and look for information about missing persons during catastrophes, currently lists some 65,500 people as missing from the typhoon. The Person Finder website allows anyone to list a person missing and to search the database for names.

But Google staff warned against reading too much into the data, pointing out that a similar website set up after the Japanese tsunami in 2011 listed more than 600,000 names, far higher than the final death toll of nearly 20,000.

CHAOTIC EVACUATION

There are not enough flights from Tacloban airport to cope with the exodus from this stricken town. As darkness fell on Wednesday, Philippine Special Forces held back hundreds of people, many of whom had walked for hours to reach the airport and then waited for days with little or no food or water.

When asked how she and her four children endured three days of waiting in searing heat and torrential downpours, Marivic Badilla, 41, held up a small battered umbrella. "We have been sheltering under this," she said, tears streaming down her face.

Many people complained that military families were given priority to board the C-130 cargo planes out of Tacloban. "If you have a friend or relative in the military, you get priority," said Violeta Duzar, 57, who had waited at the airport since Sunday with eight family members, including children.

"They say 'Fall in line! Fall in line!' and we all line up. Then nothing happens," she said of the soldiers presiding over chaotic scenes.

None of the aid passing through the airport had been distributed to the needy crowd at its gates.

Firming the resolve of those at the airport to get on a flight out are reports and rumors of looting and rape in the ruined city.

"It's the criminals who escaped from the prison. They're raping the women," said Duzar. "Tacloban is a dead city."

Tacloban city administrator Lim said that "less than ten" prisoners escaped from jail after the typhoon struck.

More the 670,000 people have been displaced by the storm and nearly 12 percent of the population directly affected, the United Nations said.

The World Health Organization said teams from Belgium, Japan, Israel and Norway had arrived in the Philippines to set up field hospitals.

The nuclear-powered aircraft carrier USS George Washington will arrive later this week, carrying about 5,000 sailors and more than 80 aircraft. It has been joined by four other U.S. Navy ships.

The United States, a close ally and former colonial ruler of the Philippines, has also provided eight C-130 cargo planes for delivering aid, said Cabinet Secretary Almendras.

Rescuers have reached some previously cut off regions, such as Guiuan, a wind-swept city of 40,000 people that was spared the storm surge that washed over Tacloban. Local officials say 85 people were killed in Guiuan, with 24 missing.

The typhoon also leveled Basey, a seaside town in Samar province about 10 km (6 miles) across a bay from Tacloban. Local officials say 80 people were killed there.

The overall financial cost of the destruction was hard to assess. Initial estimates varied widely, with a report from German-based CEDIM Forensic Disaster Analysis putting the total at $8 billion to $19 billion.

(Additional reporting by Rosemarie Francisco in Manila, Jeremy Wagstaff in Singapore and Phil Stewart and Susan Heavey in Washington. Writing by Jason Szep. Editing by Dean Yates and Nick Macfie)

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