Search and rescue efforts in Turkey and Syria have been stretched to the limit ever since a huge, deadly earthquake struck on Monday and yet another crisis could be around the corner, according to experts.
The 7.8 magnitude quake triggered the collapse of thousands of buildings, trapping people inside.
As of Thursday morning GMT, the death count had exceeded 16,000. By afternoon, it had reached 19,800 – and was still climbing.
But, there have been still miraculous stories about people surviving within the debris of collapsed buildings, prompting hope that there may be more still alive.
Search teams from around the world have travelled to the disaster-torn countries to help in any way they can, trying to both rescue trapped people and meet the immediate needs – shelter, food, and water.
As Sky News explained, aid workers had a huge task on their hands. They needed coordination between teams and analysis of local areas so there was more of a focus on places where they might be more likely to find survivors (which also depends on local knowledge).
The area also needs to be stabilised – so it is safe to search for anyone who may still be trapped – with heavy machinery deployed to cut through buildings.
In the first 24 hours, the survival rate is 74%, according to the World Health Organisation (WHO). This goes down to 22% in the first 72 hours, decreasing to 6% after that.
Even so, the efforts tend to last between five and seven days. After that, rescue missions have to make the difficult decision to stop and focus on those already pulled from the rubble.
However, experts have warned that a second, humanitarian crisis, might already be on the horizon as everyone who is now homeless in the wake of the earthquake is particularly vulnerable.
Extremely cold weather – including snow – has hit the region, and with the collapse of significant infrastructure, many are without food or power, and susceptible to disease.
Saleh Saeed, the chief executive of the Disaster Emergency Committee (DEC) told BBC Radio 4′s Today programme that 17 million people have already been affected.
Speaking on Thursday, he said while the focus was on meeting the immediate needs of everyone who has been displaced, he added: “Moving on is also about rebuilding people’s lives.”
The WHO’s regional director for Europe, Dr Hans Kulge, also told the programme: ”Basically it’s a second disaster looming unless we act very, very fast – meaning shelter, food, water and medicine, because it’s freezing cold.
“Our own staff in Gaziantep [the epicentre] had to sleep in their cars because there are still hundreds and hundreds of aftershocks, which has a toll on the mental health of the people.
“And then if we speak about Syria, for example, we know that in Syria most communities depend on water reservoirs that are elevated, and those were the first to fall during the earthquake.
“They need urgent replacement because, even before the earthquake, there was a big issue of cholera outbreak.”
Syria is a particularly large concern for rescue efforts, because civil war has torn the country apart over the last 11 years, making transport and communication difficult.
Reuters news agency reported a UN aid convoy managed to reach the affected areas of the country for the first time on Thursday.
UN envoy to Syria, Geir Pedersen, told reporters: “It’s desperately needed by civilians wherever they are, irrespective of borders and boundaries. We need it urgently through the fastest, most direct and most effective routes. They need more of absolutely everything.”
In total there are about 25 million people in need of humanitarian assistance right now.
Kulge also said that he expected the death toll and the number of injuries to rise, particularly as medical facilities are so stretched.
He called for a particular focus to go towards women and girls, to protect their reproductive health.
The WHO representative added: “For the time being, we need to scale up the resource mobilisation because it’s difficult to assess the immediate and long-term public health impact.”
It is also worth noting, as grassroots organisation, the Earthquake Country Alliance, warns on its website, that “your recovery period can take several weeks to months or longer”.