Adding to the problem is the fact that in many places, thousands are stranded on the highway -- their houses destroyed -- in abysmal conditions of sanitation and hygiene.

With almost all civic infrastructure destroyed, the medical fraternity is concerned about the imminent outbreak of water-borne diseases like hepatitis, cholera and typhoid, and more commonly dysentery and diarrhoea.

But the scale of the devastation in Orissa, with help yet to reach some of the most inaccessible areas, has the doctors worried. The news can only get worse in the days to come, they fear.

Already, 18 diarrhoea deaths have been reported from various parts of Bhubaneswar since Sunday, most of the victims being children. Three more have been reportedfrom Choudwar, Cuttack, Balianta and some parts of Pipli, according to department sources. About 100 doctors and medical officers from Andhra Pradesh, Calcutta and New Delhi have been deputed in Bhadrak, Balianta, Cuttack, Choudwaar, Jagatsinghpur and Jajpur.

Though the State Health department has started its operations on a war footing, the victims are so scattered it's difficult to reach them.

Voluntary health workers, officials of the Bhubaneswar Municipal Corporation (BMC) and primary health centre staff are assisting the health department in their work.

Project Director of Orissa Health Systems Project Arati Ahuja said the department's prime concern now is to prevent the spread of an epidemic.

Health workers are distributing chlorine tablets, bleaching powder and oral rehydration solutions. The department has opened 16 community latrines in different parts of the city, she said. Six mobile teams deployed in the city have identified 20 spots prone to disease.

But after a meeting at the HealthMinistry in New Delhi, public health specialists on Wednesday endorsed the decision that cholera and typhoid vaccines should not be given since it had proved to be counterproductive.

Instead, emphasis should be on prevention of the spread of both water-borne and vector-borne diseases.

And for the first time since the cyclone struck, the Health Ministry today got an SOS call from state health officials in Bhubaneswar for an urgent consignment of chloroquin tablets. The anti-malarial drugs have already been sent.

The Ministry of Health and Family Welfare has got into the cyclone-relief act in a limited way, primarily because of the communication paralysis in Orissa. ``We rushed a team of 20 doctors to the coastal districts in Orissa on October 31 itself. We've also sent four epidemiologists to monitor the relief efforts and to advise the state health authorities on measures to prevent any outbreak of diseases in the state,'' said S P Aggarwal, Director General of Health Services. One small blessing whichgives the medical teams some respite is that malaria cases will strike only after a break of some two weeks. This, as Shiv Lal, Director, National Anti Malaria Programme, explains, is because the cyclone blew away the dense mosquito population from the area and fresh vectors would only breed in about two weeks time.

``But this is a malaria endemic area, so the problem would surface soon enough. What we're doing is trying to stamp out any possibility of malaria coming back in a big way,'' said Lal.

State doctors already have stocks of chloroquin and primaquin which were safe from the cyclone, but additional supplies are being rushed. DDT is being sprayed widely on the stagnant water bodies and malathion fogging being done in the urban centres to prevent a malaria outbreak.

The Health Ministry has also flown large stocks of bleaching powder, chlorine tablets, intravenous drip kits, IV drip bottles and life-saving drugs to the state, though there has been no feedback whether the drugs and medical suppliesare reaching the worst-affected areas.

``This is our foremost problem. We have practically no information, even from the medical teams we sent on the situation, whether the supplies are reaching the affected people and what else they require,'' said Aggarwal.

However, the DGHS is optimistic that in the next few days the crisis situation would come under control once communication links are restored, even as he emphasised the possibility of diseases breaking out.

The decision not to conduct a mass vaccination campaign against cholera and typhoid follows the latest World Health Organisation guidelines, said G R Khatri, DDG (TB) in the Union Health Ministry. ``The new concept is that vaccinations do not stop the spread of infection. Instead they give a false sense of security to the people which is best avoided in such situations,'' Khatri said.

The heads of the Indian Council of Medical Research and the National Institute of Communicable Diseases, public health experts from AIIMS, Ram Manohar Lohiaand Safdarjung hospitals, community health experts of the WHO and UNICEF, and a number of epidemiologists and entomologists attended the meeting.