The official death toll there has climbed to 166,000, bringing the total dead in all the countries affected to over 225,000.

Disease remains the main threat to the survivors in the province, which is home to 4.5 million people. Tetanus, a deadly disease that has been all but eradicated through vaccination in much of the world, has hit at least 67 people in Aceh.

“I might have expected to see one case in my entire career,” Charles Chan Johnson, a doctor from Singapore working in the provincial capital Banda Aceh, told the British daily Telegraph. “Now I have 20 patients in one ward.” Chan said most had symptoms too advanced to be treatable. “I am afraid nearly all these patients will die,” he said.

Because the tetanus bacteria incubation period can last for weeks, many more survivors may have contracted it. Many residents of the coastal villages that survived the maelstrom found themselves wounded and lying amidst rubble in filthy water. Doctors Without Borders reports that “vaccination coverage in the region is probably very low,” meaning many could be susceptible to the disease.

A potentially more serious threat is posed by the pools of brackish water that have been created deep inland by the tsunami. This has become a breeding ground for a record mosquito crop, which poses the threat of epidemics of malaria and dengue fever.

“Short-term, we’re trying to prevent an epidemic,” Richard Allan told the Associated Press January 15. “And it may already be too late.” Allan is the director of the Mentor Initiative, an international anti-malaria group based at Johns Hopkins School of Public Health in Baltimore, Maryland. Allan warned that tens of thousands could die from such an epidemic, aggravated by the weakened immune systems from injury and trauma and unsanitary conditions.

Washington announced its intention January 15 to withdraw its military forces within two weeks from all tsunami-hit nations except Indonesia. They have been a significant component of the relief effort. U.S. deputy defense secretary Paul Wolfowitz, speaking to reporters that day during a visit to Indonesia, said the U.S. military’s goal in the region was “to put ourselves out of business as quickly as possible” and “hand over responsibility to others, and especially to the Indonesian government.”  
 
 
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