MANILA, 29 September 2009 (IRIN) - Evacuation centre volunteer Candy Regadillo calls on a long line of hungry and tired flood survivors to be patient as she hands out dwindling relief items, three days after flooding in Manila and surrounding areas left more than half a million displaced and nearly two million affected.

"Please behave. You, get back in the queue," Regadillo shouts at a dishevelled-looking old man trying to get to the food and water first.

"We have to organize ourselves in this crisis," she said.

Other volunteers link hands to keep the impatient crowd from moving, as several men begin shoving and cursing.

A pregnant, barefoot woman nearly faints, and is kept from falling by two elderly women, while overhead the distant sound of helicopters can be heard, indicating possible food drops.

Similar scenarios are being played out in hundreds of shelters around the capital for survivors of tropical storm Ketsana, which dumped the heaviest rainfall on the capital in four decades.

According to the National Disaster Coordinating Council (NDCC), as of 29 September at least 240 people were confirmed dead with more than half a million displaced by the storm, which pummelled the northern island of Luzon three days earlier.

The floods destroyed much of the city's health infrastructure, overwhelmed emergency response capabilities and forced the government of President Gloria Arroyo to appeal for international assistance on 28 September.

Massive needs

For hundreds of thousands of Filipinos displaced, survival is now a daily struggle in squalid, makeshift evacuation centres.

Food and water are inadequate, while keeping basic standards of sanitation remains problematic as receding flood waters leave piles of rubbish and debris everywhere.

For Ryan Leyva, 25, it means more suffering for his four children, who have been subsisting on biscuits and instant noodles for the past three days.

An accident left Ryan limping, forcing his wife Analiza to queue for hours just to receive a blue plastic bag containing meagre relief items.

But today, they were not so lucky. The supplies ran out even before she got halfway along the 200m queue.

"This has been a very difficult three days. While we are lucky to survive the flood, we have to suffer here," Leyva told IRIN, indicating the packed basketball court in the impoverished San Andres village of Cainta, an eastern Manila suburb where many low-lying areas remain partly submerged in water and mud.

Survivors sleep on the cold cement floor, using cardboard boxes as matting, while grimy children run around in various states of undress.

Pets, including dogs and potbellied pigs, are tied to posts, sleeping in the same area.

Sanitation remains a huge problem as water supplies have yet to be restored and up to 3,000 share a single bathroom.

Sanitation issues

"The flood came swiftly early Saturday. It submerged my house, which is on the banks of a river," Leyva recalled.

"We were already poor and whatever little we had was taken away. Asking for rations is worse than begging on the streets. We have to suffer this indignity until after the waters finally dry up and we can reclaim our house."

Meanwhile, many children remain traumatized and cry whenever the rains start up again.

"Our most pressing problem is sanitation. The hardest thing to teach these people is cleanliness," said Vesta Macatangay, principal of the 25-room Kabisig Elementary School in Cainta, housing more than 2,000 displaced, adding that rubbish, including used nappies and old food, were left rotting by the evacuees on the school grounds when they first began arriving on Saturday.

"At first we were not paying mind, but have since instituted strict rules to clean up or they will be asked to leave."

Already three toilets were backed up and overflowing, and heads of families were being asked to take turns to clean them up.

"These people need to take charge if they are to stay here for an extended period," she said, adding that the school may have to remain closed in the next few weeks until the displaced can return to their ruined homes and try to rebuild.

"We need medicines. Many children have coughs, colds and some are feverish," she said, pointing to a young mother bathing her infant in brownish water that she had fetched from a nearby stagnant pool.

"We don't know how long we can keep this school as a temporary shelter," she said.

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