The death toll from the Indian Ocean earthquake has jumped to more than 120,000 after the Indonesian health ministry confirmed on Thursday that another 28,000 lives had been lost in the province of Aceh, the area close to the epicentre of the earthquake. Sri Lanka also raised its death toll by just under 3,000 taking the country?s fatalities to to 27,268. The true scale of the disaster across the region may not be known for weeks.

As the death toll climbed questions grew about the best way of co-ordinating relief efforts for millions of survivors across a vast region.

Serious bottlenecks were developing in the delivery of aid in the Aceh region of Sumatra, which is being distributed by the Indonesian military. It appears likely it will be be days before many Acehnese receive food, medicine and clothing.

In Sri Lanka, the government admitted that it was not ready to manage foreign medical teams and emergency supplies arriving in the country while in India aid efforts in the coastal states were disrupted by fears about further tremors.

The United Nations estimated that up to 5m people around the Indian Ocean had been left without food, water or basic sanitation as a result of the tsunamis. Seawater has ruined water supplies in the region, and the lack of clean water and sanitation is putting people at risk of diseases such as cholera, typhoid, hepatitis and dysentery.

Speaking on Thursday, Kofi Annan, UN secretary-general, said that the disaster had been an ?unprecedented global catastrophe?, which ?required an unprecedented global response?.

More than 4,000 foreign tourists were missing, including 2,000 from the Nordic countries. In Thailand alone, the dead included 54 from Sweden, 49 from Germany, 43 from Britain and 20 Americans.

President George W. Bush on Wednesday reacted angrily to comments by Jan Egeland, the UN's undersecretary-general for humanitarian affairs, that wealthy countries were ?stingy? towards impoverished nations.

He said that the US pledge to send $35m to help victims of the tsunami was just a start. The US, Japan, Australia and India had formed a core group to help victims, he added, saying that he was confident that other countries would join ?in short order?. Mr Bush also said he would consider a proposal by Gerhard Schr?der, the German chancellor, for a temporary moratorium on debt payments for some affected countries such as Somalia and Indonesia.

Michael Elmquist, head of the Indonesia office of UN Ocha, the office of co-ordination for humanitarian affairs, said the UN had been told by a government official that a third of the 120,000 residents of the stricken Aceh town of Meulaboh ?has been wiped out?.

UN Ocha is co-ordinating international assistance for Aceh.

Aid officials said the International Organisation for Migration (IOM) had delivered 5,000 body bags to the Indonesian military that were to be dropped by plane over Meulaboh. Indonesian officials have been unable to reach Meulaboh. While the exact death toll wrought by the tsunami remains unclear, experts said assessing the economic impact was equally difficult, partly due to a lack of catastrophe models upon which to bases their estimates.

The UN is now drawing up plans for a basic tsunami early warning system for the Indian Ocean. ?I want to see that every coastal country around South Asia and Southeast Asia has at least a basic but effective tsunami warning system in place by this time next year,? said S?lvano Brice?o, director of the UN's international strategy for disaster reduction.

Reporting by Fiona Harvey and Robert Orr in London, Frances Williams in Geneva, Christopher Swann in Washington, Amy Kazmin in Bangkok and Shawn Donnan in Banda Aceh

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