Aid agencies that are trying to reach survivors of the powerful earthquake that shook southern Peru warned yesterday that the death toll, already at more than 500, could rise sharply because of severe winter temperatures as well as a lack of food, clean water or medical supplies.
The rescue effort has been severely hampered by a breakdown in communications, including damage to bridges and major roads, as well as the loss of electricity, phone lines and other vital services. Great, jolting aftershocks, including one measuring 5.9 on the Richter scale that hit the area yesterday, have also delayed the arrival of rescue crews.
"The conditions on the ground are horrific," said Save The Children's Richard Hartill. "Children are spending nights in extremely cold temperatures, having lost their homes, their clothes, their food - everything.
"The full extent of the damage is not yet known but entire communities have been cut off from urgently needed medical supplies, food and water. There are still people stuck under the rubble, and the longer families are left in the cold without blankets and shelter, the bigger the death toll."
Reports from Peru's main port, Pisco, suggest that the streets were subject to increasing lawlessness and looting. In many cities, the dead were left trapped in the houses where they were crushed, or else were laid out in the street waiting for someone to provide a coffin or take them away.
Hospitals - many of which suffered severe structural damage themselves - were overwhelmed, with patients sleeping out in corridors or in makeshift aid shelters in the streets outside.
Scientists also worried that highly toxic chemicals from nearby silver and limestone mines - including cyanide - might have seeped into the drinking water.
Wednesday's 7.9-magnitude quake devastated Pisco as well as nearby cities such as Ica and Chincha, levelling the region's typical adobe-built houses and causing the collapse of two major churches where worshippers were celebrating the Catholic feast of the Assumption of the Virgin Mary.
In Pisco, rescue workers said they had pulled at least 60 bodies from the ruins of the church of San Clemente, where the roof caved in. In Ica, it was not entirely clear whether a church collapsed or whether a bell tower tumbled into the street and hit people below.
The mayor of Ica, Mariano Nacimiento told Peruvian media on Thursday that at least 70 people had died in his city, and 800 more had been injured. "We need medicines, tents, food and whatever help there is," he said.
Residents in the town echoed his sentiments, saying they did not dare return to their homes for fear of existing structural damage or the effects of further aftershocks. "Sir, we are afraid," one resident, Marina Yupanki, told a reporter for Peru's Canal N television station. "We are sick; we are seeking help for our children."
Clara Obregon, also of Ica, added: "We are not going back in our houses again. We plan to stay out here on the streets. We want tents and something to eat. We haven't eaten."
Peru's president, Alan Garcia, flew to the region on Thursday and pledged to stay there until help arrives. He hopped by helicopter from Pisco to Ica and pleaded with citizens not to resort to violence and looting. "Please wait. Have patience," he said.
Several Latin American countries, as well as the European Union and the United States, have pledged to help and are likely to co-ordinate their response with a plethora of non-governmental organisations such as Save the Children and Oxfam who also have a presence on the ground.
The earthquake was Peru's worst since 1970, when 50,000 people were killed. The country sits on two ever-shifting tectonic plates, the Nazca and the South American, and is frequently subject to sizeable tremors but this latest one hit highly populated areas and caused major devastation and loss of life.