BASEY, Philippines (Thomson Reuters Foundation) - Lilia Fonteres had been coughing for a long time, even before Typhoon Haiyan destroyed her ramshackle home on the coast in a village in central Philippines. The cough worsened after the storm, as her family of four rebuilt their house from pieces of debris and tarpaulin.
Lilia felt pain all over her body and noticed traces of blood when she coughed. But she waited several weeks before she went to hospital.
"I was too weak to travel," she said, sitting on a bed in a field hospital set up by the International Committee of the Red Cross (ICRC) in Basey, a town in Samar Province.
The doctors diagnosed pneumonia. Lilia’s two daughters believe the rough living conditions in the aftermath of the storm worsened their mother’s health.
The initial surge of emergency cases that followed the November storm have slowed. But health problems indirectly caused by the typhoon, like that of Lilia, are still prevalent three months on, say doctors working in some of the worst-affected areas. They also remain concerned about the outbreak of epidemics.
There have been no major outbreaks of disease in Samar and Eastern Samar provinces, but between Jan. 1 and 20 , there were 84 suspected dengue cases in Ormoc City in Leyte Province, leading to the medical evacuation of at least four international aid workers.
Continuing bad weather - a tropical depression in January and another storm in February - caused flooding in typhoon-affected areas in Eastern Samar and Leyte, leaving stagnant pools of water – a breeding ground for any kind of mosquito, including those carrying dengue.
The ICRC and medical charity Médecins Sans Frontières (MSF) said they had also been treating large numbers of respiratory tract infections and skin infections.
And those suffering from chronic conditions, such as diabetes and hypertension, who had to stop regular treatment due to the storm, have seen their health deteriorate, said Alexander Buchmann, MSF’s emergency coordinator in Guiuan, Eastern Samar, where the charity is running a 60-bed tent hospital.
"The baseline is that people do not stop being sick because their lives are turned upside down by a natural catastrophe," he told Thomson Reuters Foundation.
When Haiyan, known locally as Yolanda, tore through the central Philippines on Nov. 8, it killed over 6,000 people and displaced more than 4 million. Healthcare facilities took a major hit, with one early U.N. assessment in November showing 47 out of 115 were not functioning. Many are still under repair.
ICRC and MSF are rehabilitating at least 11 rural health units and three district hospitals. Both organisations stress their presence is temporary and local health services need to resume.
ICRC said it would continue to provide medical care until the health facilities have been completely rehabilitated, but its activities in Basey are winding down. It had closed its emergency and operating rooms by the end of January.
In Guiuan, the district hospital was damaged beyond repair and substantial investment and construction is needed to restore services, said MSF’s Buchmann. MSF is now building a temporary hospital, made with prefabricated materials to speed up construction.
"If all goes according to plan, this hospital will be ready to use by early June," he said. MSF will remain until then, he said.
"The MSF emergency setup is not meant to last forever. A more sustainable solution, namely the construction of a new, permanent District Hospital is needed," Buchmann said.
Many of the rural health units are now up and running, either operating out of tents or using the least-damaged rooms.
At the one in Giporlos, Eastern Samar, all the equipment, drugs and medical records were destroyed and only one room survived relatively unscathed. The entrance now doubles up as the waiting room.
The lone doctor at Giporlos is Marlyn Capanang, herself a storm survivor. She reported for duty at the clinic three days after the storm, as soon as the roads were cleared.
“It’s now taking about an hour to get to work because the roads are bad. It used to be 30 to 45 minutes,” she said, raising her voice above the din of construction.
She is also an indirect casualty of the storm. A few days ago, she had a motorbike accident on the way to work.
"The roads have been so bad since the storm I couldn’t control the bike," she said. "It was only scratches but I still have pain in my shoulder."