With tens of thousands of bodies still trapped in earthquake-damaged buildings and rain falling on Turkey, health officials are concerned that epidemic diseases could spread. After a background report, Elizabeth Farnsworth talks with two international health officials.

ELIZABETH FARNSWORTH: And joining us now to discuss the health challenges facing Turkey are: Joelle Tanguy, executive director of Doctors Without Borders U.S.A., which has four medical teams in Turkey; and Dr. Claude de Ville de Goyet, director for emergency preparedness and disaster relief at the Pan American Health Organization, which is part of the U.N.'s World Health Organization. He has coordinated international health relief assistance following numerous hurricanes and earthquakes.

Joelle Tanguy, what are your teams concentrating on now?

JOELLE TANGUY: Well, at this stage, the first, as you know, we were mostly involved within about 24 hours after the earthquake. We are a small part of a very large relief effort. And we hope to make quite a dent into the public health challenges in the region. We focused immediately on providing assistance to the people that were homeless and had no access by setting up clinics. But also making sure that we have adequate treatment for the victims of the earthquake and surveying the needs of hospitals and assisting them, particularly, with the renal failure facilities.

ELIZABETH FARNSWORTH: Explain that. Why renal failure?

JOELLE TANGUY: Well, it is our experience, and it was even my personal experience ten years ago in a neighboring Armenian earthquake, which was of large proportion as well, is that the major cause of death in the patients that we pull out from the rubble and that survive are actually crush syndrome. The crush syndrome is basically the consequence of massive quantity of toxins released by the muscles that have been crushed, released into the bloodstream and, as a consequence, creating renal failure. Quite often, the hospitals are under-equipped with such dialysis facilities that need to be from. They are understaffed with nephrologists and other specialized nurses. That's what we've been able to provide, especially, the University hospital of Marmara and surveying the needs throughout the region.

ELIZABETH FARNSWORTH: And, Dr. Claude de Ville de Goyet, what about the danger of and epidemic which one hears a lot about in this country?

DR. CLAUDE DE VILLE DE GOYET: Yes. We can hear quite a lot about it. But it is grossly exaggerated because people are afraid of cholera, typhoid. But those diseases don't come from the sky. In fact, we can say, if there is a carrier of cholera, this person is much more dangerous alive than being dead buried under the rubble. So cholera, in our experience of 30 years, is not a major problem following earthquakes, nor typhoid.

ELIZABETH FARNSWORTH: So, doctor, explain the move by the Turkish government bury all these bodies very quickly because of danger of epidemic. That's based on misinformation?

DR. CLAUDE DE VILLE DE GOYET: It's misinformation. It's lack of training of the medical doctors locally on what is a major disaster. It is almost a violation of human rights and it's another, let's say, major psychological blow to the victims to bury the relatives without the proper social requirements. It is not justified on public health basis.

ELIZABETH FARNSWORTH: And what about putting lime down? What's that about? We saw pictures of that.

DR. CLAUDE DE VILLE DE GOYET: It's very symbolic. But it doesn't make any difference. It doesn't sterilize a body. No incineration does, by the way.

ELIZABETH FARNSWORTH: So doctor, you're not worried about an epidemic that the point?

DR. CLAUDE DE VILLE DE GOYET: No. We're not worried about a major epidemic in Turkey.

ELIZABETH FARNSWORTH: So tell us, what do you think the main needs right now are? What are the main health challenges?

DR. CLAUDE DE VILLE DE GOYET: Apart from what our colleague from - said, yes, renal failure and crush syndromes are a problem. But secondary treatments of all those multiple traumas is going to have -- you have to reestablish a water supply. You have to resume the normal routine health care. There may be more people with diabetes, with heart disease, failing to have medical care than there would be cases of cholera or typhoid or any other exotic medical tropical disease.

ELIZABETH FARNSWORTH: Joelle Tanguy, your reaction to that, the lack of danger of epidemics.

JOELLE TANGUY: I think I would actually practically agree, that our experience in the last ten years is that there were no massive epidemics. There, of course, needs epidemic-related issues with regards to access, adequate clean water. And that's why that's the number one priority in public health after a disaster. And at this stage, I would agree with the doctor from PAHO that somehow, the whole issue in this disaster is access to health care, the ability of people to have somehow access to health care, whether it be to get insulin for their diabetes or to have a baby delivered, given the fact that hospitals are overwhelmed. It's important to set up right away facility, and strengthen the facilities that the public health system in Turkey already has.

ELIZABETH FARNSWORTH: Ms. Tanguy, what are you hearing from your people about coordination? We heard Robert Moore's report, the first ITN report, that the lack of coordination is still quite evident. Are you hearing the same thing?

JOELLE TANGUY: Yes, definitely. I think that we all suffered from that. There were initial tremendous logistical problems, which deals also with the coordination issue, including telephone and transportation problems related to the earthquake. But I think altogether, it is a disaster of such proportion that it has overwhelmed any system of preparedness program that could ever have been in place. And at the moment, it will be a very big priority for all of us to be properly coordinated and not only in what we do but in, for example, to appeals for donations. It's important that the kind of medicine that arrive in Turkey are appropriate medicine for that disaster and that the very rare resources that must be allocated to the relief effort be spared the duty of sorting out wrong medicine and so on. So, my recommendation is really to be in touch with the organizations that are working on the ground and make appropriate support based on estimation and good monitoring of the situation on the ground.

ELIZABETH FARNSWORTH: Dr. De Ville de Goyet, do you have anything to add to that?

DR. CLAUDE DE VILLE DE GOYET: Yes. I would like to go longer -- perhaps one of the main sources of lack of coordination is also the external assistance. In quite a few cases, it has been called the secondary disaster. Inappropriate donations, excess of medical volunteers from outside the countries -- when the Turkish doctors are all volunteers to do their own medicines in their own countries, this, we are also the cause the lack of coordination. And a disaster of this size is overwhelming for any organized society.

ELIZABETH FARNSWORTH: Dr. De Ville de Goyet, it sounds like you learned a lot watching and the World Health Organization in general watching all these different disasters and learning from them. Are there quite a few myths involved with an earthquake like this that need to be countered?

DR. CLAUDE DE VILLE DE GOYET: Yes. One of the myths, as in the people locally are incompetent and they need your assistance. Perhaps your assistance is needed before the earthquake, in preparedness, in training, in transfer of skills and sharing resources -- also, donations. There has been a lot of inappropriate donations in the past. It has been the case in Kosovo. It has been the case in any kind of disaster. It's time we learn also to be a good donor.

ELIZABETH FARNSWORTH: And, Joelle Tanguy, what about post-traumatic stress disorder? In one of the ITN pieces, that was mentioned, that many, many people will be suffering from psychological problems because of this. Do your teams deal with any of that?

JOELLE TANGUY: Well, they, of course, are confronted with the trauma, stress related to the earthquake. If you want to look at the operation in three phases, you must think of the first few days, as we have seen, the most important priorities to get people pulled from under the rubble and provided a chance at survival. The second phase is going to be about providing some semblance of stability and access to health care, and of course, hygiene and sanitation. But what we know is that long after the cameras will be gone, we'll probably still be there and a number of organizations... and as you said, doctor, with quite a lot of experience, Turkish doctors working on the mental health care consequences of that earthquake as we did, for example, five years later, we were still working on that in neighboring Armenia.

ELIZABETH FARNSWORTH: And, Ms. Tanguy, what did you find in Armenia, what kind of psychological damage?

JOELLE TANGUY: Well, particularly, at the time, we focused our efforts on the young children, and we found that it was both important to provide both direct care, but also some facilities to coach the local professionals in providing medical care related to mental health care. I think that there will be a large... it's not only the children that suffer. It's every single person. And it can create wounds in a society that are long-lasting. Unfortunately, this is not something you can see in the first medical screening. And it takes more of a specialized team in the end to carry out. But it will be probably in the phase three, a priority for Turkish public health to deal with this.

ELIZABETH FARNSWORTH: And, doctor, we have very little time, but your comments on that.

DR. CLAUDE DE VILLE DE GOYET: This, again, is the training of local physicians and local health services. When you invest in those people, generally, it pays off.

ELIZABETH FARNSWORTH: Thank you both.

DR. CLAUDE DE VILLE DE GOYET: And they can take care of the problems.

ELIZABETH FARNSWORTH: Thank you both very much for being with us.