The toll in the province of Aceh on the northern-most tip of the island of Sumatra was creeping towards 5000 by late Monday evening and casualty figures had yet to arrive from several of the worst hit areas.

Earlier in the day Vice-President Jusuf Kalla suggested the toll could top 10,000.

The earthquake 10km below the sea-bed off the coast of Aceh caused widespread destruction across the rugged, mountainous province 1200km north of the Indonesian capital, Jakarta.

The quake sent waves the height of three-storey buildings crashing on to the shoreline, sucking entire villages out to sea.

Foreign presence

In an effort to speed the delivery of critically needed supplies of medicine, food, clothing and water to the afflicted areas in Indonesia, the government on Monday effectively swept aside long-standing prohibitions against the presence of foreigners in Aceh.

The government has asked for
immediate assistance

Western diplomats, aid workers and journalists have been effectively banned from travelling to Aceh since the authorities launched a fullscale military operation against a persistent separatist insurgency in the province 20 months ago.

"The government is saying very simply that they want foreign assistance as soon as possible and that Jakarta is to process the matter without delay," said an aid official who saw the order.

The news was greeted with optimism by the United Nations agency coordinating the emergency response to the humanitarian catastrophe across the region.

Communication problems

"Obviously we are having a great deal of difficulty getting an accurate picture of what is going on on the ground, what the specific needs are because of the extensive damage to the communications systems, telephones and electricity," said Michael Elmquist, emergency services coordinator at the UN's Office for the Coordination of Humanitarian Affairs (OCHA) in Jakarta.

Vise-President Yusuf Kalla says
tolls are likely to double

"We have been unable to establish contact with the nine members of our staff based in Banda Aceh. We expect the somewhat cumbersome approval procedures will now be relaxed."

While the government appears to be taking steps to facilitate the movement of humanitarian aid, the situation on the ground remains chaotic.

Health services in the provincial capitol Banda Aceh, where more than 3000 people are confirmed dead, are stretched to breaking point.

Indonesian military aircraft began flying into the city of 600,000 on Monday where medical supplies in the largest public hospital were said to be close to exhausted.

Hospitals overwhelmed

Local television reported hundreds of critically injured people, many of them young children, are receiving only the most rudimentary treatment from doctors overwhelmed by the scope of the tragedy.

Rescue efforts have been
hampered by the president's visit

President Susilo Bambang Yudhoyono flew in to the city of Lhokseumawe five hours south of the capital to visit a refugee camp and offer condolences to survivors.

More than 700 residents of the area are confirmed dead, close to 400 severely injured and roughly 200 missing, feared drowned. Aid workers said the president's visit hampered efforts to process the thousands of new arrivals whose villages had been sucked out to sea by the force of the tsunami.

"More refugees have been arriving all day. There were 10,000 on Sunday, and since the president came there is no coordination of efforts here so we have no clear idea how many people we have," said volunteer Cut Roestina.

"As soon as the president left, all the local officials left also. The situation is quite bad for the people here. Many are sick and injured. They have no clean water or food."

Coordination failures

There was also evidence that despite efforts to centralise the command structure by establishing an emergency response centre in Medan, the administrative capital of neighbouring North Sumatra province, there is a general lack of communication between different agencies.

"This plane was ready to leave within hours of the earthquake with medical supplies but it is almost two days later and the government still refuses to allow it to land"

Dr Jose Rizal

The director of the Indonesian arm of the Crescent Medical Rescue Team (MER-C) complained bitterly about the government's continuing failure to grant landing privileges to a plane loaded with relief supplies that was chartered by the organisation's Malaysian branch.

"This plane was ready to leave within hours of the earthquake with medical supplies but it is almost two days later and the government still refuses to allow it to land," said Dr Jose Rizal.

"I have worked in some very hard environments but this is different. It is a really hard situation, very frustrating, when our brothers and sisters in Aceh are suffering so much."

Military role

While the nation's ministry for people's welfare is officially the lead agency in coordinating relief efforts the only organisation in Indonesia with the hardware and expertise to carry off this sort of logistical exercise is the military.

The Indonesian military was accused of committing widespread human rights abuses against the civilian population of Aceh during the course of the formal military operations against the rebel Free Aceh Movement, which ended several months ago.

It is one of the ironies of the situation that the estimated 50,000 soldiers in Aceh who have been the source of so much criticism are now the best hope for a successful humanitarian campaign.