A lack of sanitation causing contagious diseases and incidences of post-traumatic stress disorder (PTSD) and panic attacks are increasingly big concerns for doctors dealing with the gargantuan task of providing care for the masses of homeless survivors of Turkey and Syria’s double-earthquake disaster.

On February 15—the day before the combined quake death toll across southern Turkey and northern Syria climbed past the 40,000 threshold to 42,000 (with 36,187 of the deaths recorded by Turkey), and the two countries yet to say how many people are missing—ReliefWeb said in a Turkey Situation Report: “As of 14 February, the largest service gap observed by STL [the NGO Support to Life] is Water, Sanitation and Hygiene (WASH), which poses a risk of contagious diseases. Turkish Medical Association (TTB) and International responders report that cases of diarrhea, nausea and scabies are observed in affected region.

“In addition, the debris pollution, and presence of compounds such as asbestos creates serious health risks. In addition, access to sanitary pads is limited in all provinces, but is refrained from being expressed publicly. In addition, Shelter, heating, NFIs [non-food items[, food items and health are the short-term priority needs.

“There are safety risks for children, women and LGBTIs in the majority of accommodation areas. Shelter conditions of families staying close to damaged buildings are especially risky for child safety and disabled people. The Ministry of Family and Social Services (MoFSS) announced that the treatment of 162 unaccompanied children who were pulled out of the wreckage continues in hospitals. 101 children were taken under protection after their treatment. Over 95,000 foster family applications have been filed in the last two days.”

Reporting from Antakya, the capital of southern Turkish province Hatay, AFP said shattered regions were devoid of basics including toilets and showers. Sedef, an 18-year-old in Antakya—an ancient city of nearly 500,000 people, entire blocks of which were razed to the ground—told the news outlet that the lack of sanitation was becoming desperate, saying: "Maybe we didn't die from the earthquake, but we will certainly die from diseases."

The number of people still alive being rescued from the earthquake rubble was by February 16 almost down to nil, though TRT Haber reported that the day saw a 17-year-old girl extracted from the ruins of a collapsed apartment block in Turkey's southeastern Kahramanmaras province, 248 hours since the first earthquake, with a 7.8-magnitude, struck in the dead of night on February 6.

Doctors in a Turkish field hospital in the southern Mediterranean port city of Iskenderun were cited by Reuters on February 15 as saying they were treating a rising numbers of earthquake-survivor patients suffering from PTSD and panic attacks.

"Initially the patients ... were those who sustained injuries under the rubble... now more of the patients are coming with post-traumatic stress disorder, following all the shock that they've gone through during the earthquake and what they have seen," one doctor, Indian Army Major Beena Tiwari, said.

Many people were suffering panic attacks, she added.

Some survivors have been pulled from the rubble after hours in the cold and darkness to discover family members have died or are missing, and the busy neighbourhoods where they lived have been reduced to mounds of shattered concrete, the news agency observed.

"People only now are starting to realise what happened to them after this shock period," a Turkish medical official told Reuters.

The United Nations on February 16 appealed for more than $1bn in funds for the Turkish relief operation, just two days after launching a $400mn appeal for Syrians. UN aid chief Martin Griffiths, who visited Turkey last week, said the people have "experienced unspeakable heartache," adding: "We must stand with them in their darkest hour and ensure they receive the support they need."

The catastrophic impact of the earthquakes is still difficult to comprehend for many. Insider reported on how “the Turkey earthquake sliced open an olive grove, creating a chasm right in the middle of it that's deep enough to house a 13-floor building”.

The debate continued, meanwhile, over the level of responsibility the governments of Turkey—for two decades led by President Recep Tayyip Erdogan—and Syria—divided by war since 2011—must bear for the fact that the disaster-impacted zone was home to massive numbers of buildings unable to withstand the impact of a major earthquake. “Turkey earthquake: Experts believe collapse of buildings was preventable,” was the headline over a February 15 article in New Civil Engineer.