Monday's 7.8-magnitude tremor has killed more than 11,700 people in Turkey and Syria, flattening thousands of buildings and trapping an unknown number of people.
The World Health Organization said there was a race against time to save lives -- and then ensure survivors stay alive in the dire circumstances.
Robert Holden, the WHO's earthquake response incident manager, said the immediate focus was on saving lives but insisted it was "imperative to make sure that those who survived the initial disaster... continue to survive".
"We've got a lot of people who have survived now out in the open, in worsening and horrific conditions," he explained, with disrupted access to water, fuel, electricity and communications.
"We are in real danger of seeing a secondary disaster which may cause harm to more people than the initial disaster if we don't move with the same pace and intensity as we are doing on the search and rescue," he told a press conference in Geneva.
"This is no easy task... The scale of the operation is massive."
- Medical aid flights -
A winter storm has compounded the misery by rendering many roads -- some of them damaged by the quake -- almost impassable.
Adelheid Marschang, the WHO's senior emergency officer, explained the risks that survivors are were now likely to face.
She said there was a "clear concern" that "underlying health risks will likely be exacerbated" by the aftermath.
In Syria, ravaged by years of civil war, these would include diarrhoea, cholera, respiratory illnesses, leishmaniasis, disability and secondary wound infections.
The quake will also likely worsen chronic conditions and non-communicable diseases due to the disruption to healthcare, with such capacities already "gravely affected" by the civil war.
WHO chief Tedros Adhanom Ghebreyesus anticipated that the death toll would keep climbing, saying: "With the weather conditions and ongoing aftershocks, we're in a race against time to save lives."
"People need shelter, food, clean water and medical care, for injuries resulting from the earthquake, but also for other health needs."
He said one flight of medical aid was heading for Istanbul from the WHO's logistics hub in Dubai, while another bound for Damascus is preparing to depart, with another flight to the Syrian capital planned.
Tedros said 77 national and 13 international emergency medical teams were deploying to the affected areas.
He warned that the situation in Syria was compounded by outbreaks of measles and cholera. Since late August, Syria has reported about 85,000 cholera cases, he said.
WHO emergencies director Michael Ryan added that there would need to be long-lasting mental health support to cope with the ongoing trauma.
"It's a huge issue," he said.
"The psychological stress that communities have gone through in the last 60 hours will reverberate for 60 years."
Turkish quake survivors face big freeze in cars, tents
Gaziantep, Turkey (AFP) Feb 9, 2023 -
Temperatures in the quake-stricken Turkish city of Gaziantep plunged to minus five degrees Celsius early Thursday but thousands of families spent the night in cars and makeshift tents -- too scared or banned from returning to their homes.
Parents walked the streets of the city -- close to the epicentre of Monday's earthquake that has left more than 12,000 dead -- carrying their children in blankets because it was warmer than sitting in a tent.
"When we sit down, it is painful, and I fear for anyone who is trapped under the rubble in this," said Melek Halici, who wrapped her two-year-old daughter in a blanket as they watched rescuers working late into the night.
"Eventually we will have to go to the tent, but I don't want to," she added. "I can't bear the cold, but nor can I think about going back to our apartment."
City authorities have barred thousands of residents from going back to apartment blocks that are considered at risk from aftershocks shaking the region each day.
- 'Our children are freezing' -
Around the Halicis, smoke from dozens of fires filled the night air. Supermarkets and other businesses gave wooden pallets to families to burn.
Some people have found sanctuary with neighbours or relatives. Some have left the region. But many have nowhere to go.
Gyms, mosques, schools and some stores have opened up at night. But beds are still at a premium and thousands spend the nights in cars with engines running to provide heat.
"I have no choice," said Suleyman Yanik, as he sat with one child playing with his car steering wheel and his wife and another child asleep on the back seat.
"The smell is horrible, but we cannot go home," he said.
Restaurant manager Burhan Cagdas said he had been sleeping in a car since Monday's quake because of his family's "psychological" opposition to returning home.
He was unsure how long they could hold out.
Many families have complained about the government's handling of the quake relief operation.
President Recep Tayyip Erdogan admitted during a trip to the region Wednesday that there had been "shortcomings" but insisted that the scope of the disaster was too big for any government to handle.
Poor families who have been camping around Gaziantep's 6th-century castle, badly damaged by the quake, said authorities have done nothing for them.
The families have built makeshift homes with tarpaulin and wood thrown away by others. "They could at least have given us some tents," said Ahmet Huseyin.
"Our children are freezing," added the 40-year-old father of five whose nearby house was virtually destroyed by the 7.8 magnitude tremor.
"We have had to burn the park benches and even some of the children's clothes. There was nothing else," he said.
Some of the shelters did not even have the luxury of a tarpaulin to cover the entrance.
Emel Osman, a 14-year-old whose family fled Syria for Turkey seven years ago, said the authorities should have put up a tent, "at least for the children".
Stones from the castle risk falling onto the park where the families have taken refuge. But they say they have no choice as they have no car and no alternative shelter.
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