The massive earthquake in Nepal and its frightening aftershocks have unleashed another force almost as overwhelming: an international relief effort that already is involving governments, charity groups and private volunteers from all corners of the globe.
The stricken nation of 27.8 million people faced shortages of shelter, electricity, food and clean drinking water after Saturday's magnitude 7.8 earthquake, which killed more than 3,700 people, and the death toll was expected to rise.
Aid workers were streaming in Sunday, along with cargo jets laden with supplies. But destroyed roads, overwhelmed hospitals and damaged communications networks will hinder the arrival of help. Reliable information is scarce, plaguing aid agencies that must figure out where to send resources.
The extent of the earthquake damage in Nepal has made it difficult to venture outside the stricken capital of Kathmandu to check the surrounding countryside for damage, said Craig Redmond, senior vice president of programs at Mercy Corps, a nonprofit global aid organization based in Portland, Ore., that has about 100 staff members in Nepal.
"In some of the outer cities, the secondary and tertiary cities, the numbers and assessments [for the earthquake damage] haven't happened yet," Redmond said. "Our teams are scrambling to get out there."
Mercy Corps officials said workers were preparing survival kits with clean water, clothes, cooking utensils and hygiene supplies, along with shelter kits that will include tarps for survivors who no longer have safe spaces to sleep.
While images of collapsed buildings in densely populated Kathmandu have dominated news stories, the epicenter was actually about 50 miles to the northwest, where the extent of the crisis remains unknown.
"We are extremely concerned about the fate of communities in towns and villages in rural areas closer to the epicenter," Jagan Chapagain, the International Federation of Red Cross and Red Crescent Societies director for Asia Pacific, said in a statement. "Access roads have been damaged or blocked by landslides and communications lines are down, preventing us from reaching local Red Cross branches to get accurate information. We anticipate that there will be considerable destruction and loss of life."
Chapagain added: "We do not yet know the scope of damage, but no doubt this is the most deadly and devastating earthquake since the 1934 tremor which devastated Nepal and Bihar [a state in India]. People will need considerable support including food, water, medical care and emergency shelter."
Almost a million children living in earthquake-afflicted areas will require "immediate aid," according to UNICEF, the United Nation's relief organization for children. U.N. officials said Sunday that hospitals were overflowing with patients but running out of medicine and places to store bodies.
"Hospitals were trying to accommodate a huge influx of patients, some with amputated limbs, and were running short of supplies like bandages and trauma kits," Jamie McGoldrick, U.N. resident coordinator in Nepal, said in a statement. "Water supplies, a problem under normal circumstances in this fast-growing city [Kathmandu], will almost certainly run short."
The U.S. sent a military plane with a U.S. Agency for International Development disaster assistance response team, a search-and-rescue team and 45 tons of cargo, the Pentagon said. California also was sending a search-and-rescue team, the governor's office said.
But even getting to Nepal, which has just one international airport, is difficult.
"The number of flights has been severely restricted, so that's been a challenge in getting people over there," said Garrett Ingoglia, vice president of emergency response for AmeriCares, a nonprofit that delivers medical and humanitarian aid. "We have a team in India that we're deploying.... They were actually on a flight last night, on the runway, on the plane, when one of the aftershocks occurred, so the flight got canceled."
The workers were carrying "boxes and boxes of medicine," but had to find a hotel before trying again Sunday, Ingoglia said. Even when AmeriCare's aid efforts get going, he said, conditions in Nepal will be tough.
"Nepal's got bad roads, there aren't a lot of helicopters and planes available to move products around, so we think it's going to be a challenge," Ingoglia said. "In-country transport can happen by boat, by helicopter, by plane, trucks, all different ways. That's part of the challenge of responding to these disasters, and it's part of the puzzle of how to move your things around."
As numerous international aid organizations ramped up fundraising efforts, Ben Smilowitz - executive director of the Disaster Accountability Project, a nonprofit watchdog for aid groups - warned donors to be careful.
Watch out for organizations that promise immediate, lifesaving aid but that don't have a history of operating in the country where they're hoping to work, he said.
"This is going to be a very fluid process, and groups need to be called out on inaccurate and misrepresentative appeals," said Smilowitz, whose Maryland-based nonprofit was founded after Hurricane Katrina in 2005. "It's too late after an organization has raised $10, $20, $30 million – that organization already has that money and that money may never end up in Nepal."
Smilowitz added: "Donors can wait a week or two to donate. … They can stay tuned to see which organizations are showing up and which are being very opportunistic."
Mercy Corps is one of the organizations that has staff in Nepal. Redmond said his workers already sounded "very stressed out."
"I've been in emergencies all around the world. These early days are always very stressful, making sure your families are safe, making sure your communities are safe," he said.
But, Redmond added, "They're OK, and they're resolute, and the great thing is, these guys know what they're doing."