Despite a flood of international aid, health conditions in the hurricane devastated Honduran capital of Tegucigalpa are quickly deteriorating on the eve of scheduled visits by Mrs Hillary Clinton and President Jacques Chirac of France, both of whom are due to arrive today.
Nowhere is the breeding ground for disease more visible than in the neighbourhood called Granja, a place that used to have 8,000 houses. Now it is rubble. It is difficult to describe this place as a neighbourhood. It is difficult, standing atop a hill of tin, broken pieces of lumber and household belongings, to even look out over this city and visualise that it was once a community.
The hilly streets are covered in mud and garbage. Sticks with orange ribbons flying from them mark spots where bodies are buried beneath. There is also no mistaking the smell of decomposing bodies. It is a sour and inexplicably nauseating odour that causes the throat to tighten. Now it is mixed with the smell of faeces, relieved only slightly by the aroma of fire and smoke, as people cook their dinners beside the rubble.
Some 48,000 houses, more than 20 per cent of the homes in the capital, were destroyed by the mudslides and rising rivers that swallowed this city two weeks ago. While about 120,000 people are crowded into 180 shelters, the majority of the homeless are huddled in tin-covered hovels at the sites of their former houses, trying to dig out scraps of their belongings from the mud and protect what little is left from looters.
The critical problem is that most of the city is still without water. Even in the best neighbour hoods a flushing toilet is a memory. The entire water-supply system will have to be rebuilt at an estimated cost of $300 million, and there are no projections as to when that project will be completed, or begun. Roads are being cleared and shops are opening, but water is still entirely absent.
In the neighbourhood of El Prado, just beside the Choluteca river, the streets are still filled with mud that rises to the ankles in some places. One-half of a supermarket was sheared away by the waters, with the result that the remains of the large store now hangs precariously from a cliff. Beneath, in mounds of mud, people are crawling and digging with shovels for food. They are finding canned goods thrown from the shop shelves, jars of baby food, packages of pasta.
The problem is that as they scavenge for food, many of them are standing up to their knees in muck and water that is thick and brown with sewage. Health officials say the water has also been contaminated with bacteria and viruses from rotting corpses.
Cholera has already broken out in some areas, and there are reports of haemorrhagic dengue fever, which is almost always fatal. Respiratory infections are increasing at an alarming rate.
While Honduras and Nicaragua rebuild and struggle to devise a long-term recovery plan that most effectively will be based on forgiveness of debt by the World Bank and the International Monetary Fund, the most immediate crisis for both countries is disease.
Mr Carlos Huezo, director of Hospital Escuela, the country's largest, with 1,300 beds, says he is worried that the two-week incubation period for many diseases will start to produce a flood of patients. His already overwhelmed hospital still does not have a water supply to the top two floors of its five-storey building.
"People who don't have water are drinking from the river. They're bathing in it and washing their clothes and looking for food they find in the river," he said.
About 8,000 people are still missing, meaning their bodies are buried or decomposing in the rivers. Mr Harry Oakes, a dog-handler with International K Search and Rescue Disaster Services, has been here since Wednesday with his dog, Valerie, a four-year-old black cross of border collie and kelpie.
Valerie, whose resume of calamities includes the Oklahoma City bombing, holds the world record for most rescue missions of any dog. So far she has found 22 bodies, including one in a pancaked Chinese restaurant, and several in crushed houses.
Mr Oakes, a 6ft 2" man who lives in Oregon, says he is exhausted. But Valerie, he says, is sad. "This is hard on the dogs. I can tell she gets depressed by the smell of death, and it is everywhere here. It is so much better to find people alive." Mr Oakes and three volunteers are here without pay.
Back at Granja, people had spoken of Valerie. She would dart across the hillside, they said, smelling and digging. When she located a body beneath the mud, she would suddenly sit down.
"The dogs were so good," said Ms Elsa Morino Rios (28), standing beside the pile of wood that was once home to her husband and seven children. A skinny brown dog is vomiting nearby. Elsa is one of the people bathing in the dirty water of the river. She says she has no choice.
At night her family is sleeping in a shelter in a school, but they come back here during the day to try to scavenge for their belongings. She has no idea where they will go or where they will live.
President Jacques Chirac announced in Guatemala City yesterday that his country had annulled the debts of the four Central American countries hit hardest by Hurricane Mitch. The debt owed to France by Guatemala, Honduras, Nicaragua and El Salvador amounts to 730 million francs, or $133 million, he said.