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For the tens of thousands of people now living in makeshift shelters following last week’s devastating earthquake, surviving the temblor was just the first hurdle. Now, the challenge is to survive the potential pandemics that can wreak havoc in the makeshift camps sheltering more than 80,000 homeless people.

Dr. Wan Alkadri, director of environmental health at the Ministry of Health, said limited access to clean water for earthquake victims would cause many kinds of water-borne diseases, including diarrhea, rashes, skin problems and dehydration.

“Water is essential for keeping people healthy, unfortunately many local wells have been damaged or contaminated by bacteria because of the earthquake,” he said.

Wan said when water was an issue, personal hygiene was frequently ignored and, as a result, many diseases were likely to affect the displaced.

Jakarta Globe monitoring at some locations, including Cisalayong village, Tasikmalaya, showed the displaced were not only having problems with limited clean-water resources but also with the emergency toilets, which were not built to proper standards and were causing hygiene problems. Some people living in the emergency tents are also contracting coughs due to the humid air in the shelters.

Wan said the Ministry had been trying to overcome the water problem by providing mobile water-treatment resources where the displaced could get clean water.

“But they can only service areas that are accessible. In the areas where infrastructure has been damaged we are trying a different approach,” he said.

For the shelters that are difficult to reach by car, the ministry has been providing water purification tablets and sachets to filter the water.

“If the water is still dirty, we encourage people to boil it before they drink it,” he said.

As well as these physical issues, the displaced also had to contend with possible psychological problems caused by trauma.

Teddy Hidayat, head of the psychiatric unit at Hasan Sadikin Hospital in Bandung, is in charge of the refugees’ mental rehabilitation.

He said that survivors could suffer from various mental problems due to trauma. “It is very common for disaster survivors to suffer from mental issues ranging from simple post-traumatic stress disorder to acute schizophrenia,” he said, adding that in some cases post-traumatic stress could lead to the abuse of the affected person’s children or partner.

Therefore, he said, early intervention was essential in order to minimize trauma-related risks. Hidayat said that he and his team planned to conduct the intervention within the most critical period of two weeks to a month after the disaster.

“We need to talk with the victims and provide them with guidance on how to free themselves from their fear and trauma,” he said, adding that children and the elderly were often prone to these kinds of health issues.

Hidayat said that the team would provide mental health centers and counseling to assist the earthquake victims in overcoming their trauma as well as organizing various play activities for children and teenagers.

Hidayat added that although there were many nongovernmental organizations that conducted such activities, careful control was essential in order to ensure that these play groups would help people to release their fears and not the other way around.

“These kinds of problems do not have immediate solutions, they need to be evaluated and monitored for an appropriate period of time,” he said.