Bangladesh refugee camps for Rohingya Muslims are on the brink of a "public health disaster," Doctors Without Borders (MSF) has warned, saying filthy water and faeces flow through shanties bursting with Rohingya Muslims who have fled violence in Myanmar.
Nearly 430,000 Rohingyas have poured into Bangladesh’s Cox’s Bazar in less than a month, seeking refuge from an army-led crackdown across the border in Myanmar's Rakhine state, which the UN has described as "ethnic cleansing".
The weary and wounded arrivals have shocked the world with stories of Myanmar soldiers and Buddhist mobs driving them out of their homes with gunshots and arson attacks that have razed their villages to ash.
While Bangladesh has offered sanctuary from the terror, there are dire shortages of nearly all forms of relief in what has become one of the world's largest refugee settlements in a matter of weeks.
The United Nations on Friday said it will need $200 million over the next six months to face the "catastrophic" influx.
MSF on Thursday warned that a "massive scale-up of humanitarian aid is needed in Bangladesh to avoid a public health disaster".
"We are receiving adults every day on the cusp of dying from dehydration," said Kate White, the group's emergency medical coordinator.
"That's very rare among adults, and signals that a public health emergency could be just around the corner."
There are no official roads into the slum-like settlements that have sprung up outside official camps, complicating aid delivery in the hilly, mud-slicked terrain.
"There is a complete absence of latrines," added White.
"When you walk through the settlement, you have to wade through streams of dirty water and human faces."
One small event could lead to an outbreak that may be the tipping point between a crisis and a catastrophe
and patchy food distribution, many Rohingya are only eating one meal of plain rice per day, she added.
Bangladeshi troops were deployed this week to build more toilets and shelters for thousands still sleeping out in the open despite regular monsoon rains.
On Friday the UN's Refugee Agency said it was speeding up the distribution of plastic sheeting to provide basic protection from the elements as authorities work on erecting a new 2,000-acre shelter.
The camps are "bursting at the seams and yes, there are risks of diseases, so that is why the extension is so crucial," said UNHCR spokesman Andrej Mahecic.
The potential of an infectious disease outbreak is "very high", according to MSF, citing the rapid population increase and low vaccination coverage among the Rohingya, who lived in impoverished conditions in Myanmar.
"One small event could lead to an outbreak that may be the tipping point between a crisis and a catastrophe," said MSF emergency coordinator Robert Onus.
The humanitarian emergency has heaped global pressure on Myanmar's government to halt military operations in Rakhine state, which was once home to a 1.1-million strong Rohingya population.
The stateless minority has languished under years of discrimination in the mainly Buddhist country, where they are denied citizenship and struggle to access health care and other basic services.
The army has defended its operations as a proportionate response to Rohingya militants who raided police posts on August 25.
But accounts from refugees tell a different story, with scores describing army-led attacks on their homes that rights groups say amount to a systematic purge of the minority.
On Tuesday Myanmar leader Aung San Suu Kyi showed a faded willingness to take back the refugees in a nationally-televised speech but she did not spell out a clear plan for when repatriation could begin or who would qualify for return.
Even before the latest exodus, Bangladesh was already sheltering some 300,000 Rohingya refugees who had fled from previous waves of persecution, some dating back decades ago.
Bangladesh's Prime Minister Sheikh Hasina on Thursday proposed creating UN-supervised safe zones inside Myanmar.