MANILA, 1 October 2009 (IRIN) - With toilets overflowing, water and power still out and mounds of rubbish rotting after the Philippines' worst flooding in decades, millions across the capital Manila and suburbs are under threat from disease outbreaks, officials warn.

At the Concepcion Uno Integrated School in Marikina District, east of Manila, one of the areas worst hit, only three battered portable toilets were installed for more than 3,000 flood survivors.

School officials say they had to padlock six bathrooms because the toilets had clogged, and the waste was beginning to seep into the grounds were the survivors slept with only cardboard as matting.

With much of Manila's health infrastructure destroyed, the government has appealed to private doctors and health workers, including psychologists, to help survivors, especially children, cope with post traumatic stress.

Meanwhile, hungry survivors, frustrated by the slow pace of aid delivery, have been fighting over food and, in at least one instance, pelted an empty delivery truck that had just made its rounds, officials said.

"People are very, very hungry. Look at us, we are still covered in mud," said Jose Vidal, who heads camp management at Concepcion Uno, pointing to a group of half-naked boys picking through a pile of debris on the road.

"The level of frustration has been running high. People are emotionally unstable, hot-headed."

Mornings were especially challenging, as crowds jostle to fetch water delivered by fire trucks while others scrambled to use the toilets.

"This storm has wrecked too many lives. We don't know whether we can recover," Vidal told IRIN.

At another elementary school serving as an evacuation centre, Virgilio Mamalias tried to stop a group of men fighting over a box of clothes donated by private individuals.

Babies were lying on cold concrete floors, and no one from the national government had arrived to help organize the evacuees, who number about 2,000, residents claimed.

"I decided to take the initiative and try to keep the people here organized. We don't want to appear as if all norms of decency have gone away with the floods, but in this situation, when people are extremely hungry, fighting is bound to erupt. You need to have maximum tolerance," he said.

Nearby, his wife and two young children were huddled in a corner, sharing a small bowl of porridge distributed by a restaurant owner whose shop had been decimated. But the food was limited, and many children went without.

Call for international aid

Ketsana slammed into the Philippines [http://www.irinnews.org/Report.aspx?ReportId=86324] on 26 September, dumping the heaviest rains on Manila and nearby provinces in more than 40 years and causing floods that wiped out entire villages, particularly impoverished low-lying communities along river banks and tributaries.

According to the National Disaster Reporting Council (NDCC) [http://ndcc.gov.ph/home/] , more than 2.5 million people were affected; nearly 700,000 of whom are in 700 evacuation centres scattered around the capital, with the rest staying with family or friends.

As of 1 October, 277 people are confirmed dead and 42 missing, the NDCC said.

"Logistical problems are making relief [http://www.irinnews.org/Report.aspx?ReportId=86331] efforts slow," said Gwendolyn Pang, secretary-general of the Philippine National Red Cross [http://www.redcross.org.ph/] .

"We need more international help. This is not the time to be proud and tell the world we can handle this crisis on our own," she said.

Aldrin San Pedro, mayor of suburban Muntinlupa, south of Manila, said much of the area remained waterlogged. The city government has been rendered helpless, he said, and needed urgent medical help.

"We need medicines, and we fear a disease outbreak, especially skin fungus, because many people have been constantly drenched since the storm," he said.

New storm threat

Compounding the crisis are two tropical storms bearing down on the Philippines from the Pacific Ocean [see map: http://pictures.irinnews.org/images/2009/originals/200910010928420438.jpg].

Typhoon Parma has been gathering strength, with sustained winds of more than 195km an hour.

Another weather disturbance was on the tail of Parma, the state weather bureau said, as it forecast Parma to hit northern Luzon island any time between 1 and 2 October, bringing heavy rains that could result in more flooding and more suffering to those already displaced.

"I am appealing for those in the way of the coming storm to evacuate now," Pang said.

"We don't know yet how big this typhoon will be, but it is always better to be prepared. We don't need more casualties now," she said.

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