JARO, Philippines -- Even as a major international aid effort has begun to take hold around the coastal city of Tacloban, the situation grimly differs just a few miles inland, where large numbers of injured or sick people in interior villages shattered by Typhoon Haiyan more than a week ago have received no assistance.
Well away from the coastal storm surge areas where most of the death toll occurred on the Philippines island of Leyte, the picture is still one of utter devastation -- in this case from Haiyan's record winds. Mile after mile along the inland roads, particularly in the east, practically every home looks as though its roof has been ferociously clawed off.
Coconut palm forests were torn apart, with vast swaths of trees snapped off about 15 feet above the ground. Falling trunks crushed or knocked holes in houses and huts alike.
But while international relief workers in bright blue or red vests and Philippines Department of Health workers in orange vests are now scouring neighborhoods up and down the coast, they are nowhere to be seen in the interior.
Meanwhile, international aid groups said Sunday that conditions in the disaster zone were gradually improving. "I think in the last few days we've managed to overcome some of the obvious structural and logistical issues," said Matthew Cochrane, spokesman for the U.N. Office for Coordination of Humanitarian Affairs.
Major roads have been cleared, cell phone service is getting better and fuel is becoming more widely available, he said.
"We're going to be able to push aid out and get assistance to people who need it," said Mr. Cochrane, who acknowledged that a wider and faster response was still needed. "It's been more than a week, there's a lot of people who haven't received assistance. I guess the message is that progress is being made."
Signs of that progress could be seen in Guiuan, about 50 miles southeast of Tacloban, where an American-built airstrip was busy as the Swedish air force dropped off German relief workers, the Australians delivered food and water and the U.S. Navy landed Ospreys, Seahawks and C-130s laden with supplies.
But even as aid reaches more ravaged towns and cities, it is clear that the Nov. 8 storm destroyed the ability of many local governments to function. "Ninety percent of the police were not able to show up for the first few days, and even today you've got maybe less than 40 percent of them going to work because they themselves are victims," said Ricky Caradang, a spokesman for President Benigno S. Aquino III.
The national government has had to step in, sending police officers and troops, including about 1,000 to Tacloban, although local officials have called the response inadequate.
Doctors, mayors and local council members in six inland towns and villages on Leyte Island all said Sunday that their citizens had received no medical treatment or medical supplies and no food, water or tents from the international assistance program. They also had not received any medical assistance from the Philippines government; although town governments had received sacks of rice, village governments had not.
All of them said that with the exception of a handful of people sent to hospitals in Tacloban with clearly life-threatening injuries, most people with typhoon-related lacerations and other injuries were being sent home with little or no care. The inland areas lack doctors and have few if any antibiotics, antiseptic, gauze, or other medical supplies.
All of them also said that they were seeing increasing rates of fever and diarrhea, which they attributed to large numbers of people drinking contaminated water and living in now-roofless homes that offer scant protection from the periodic heavy rains over the past nine days.
Raul Artoza, a 49-year-old local council member in Macanip village, which is under the administrative authority of the town of Jaro, said he had never seen so many children come down with fever as in the past few days.
Nobody has a thermometer in the village, nobody has taken a child to a health care worker of any sort and no aid has arrived from the Philippines government or any international group since the typhoon, he said.
"We're just putting leaves on their foreheads," said one of his neighbors, Milagros Macanip.
Rosalina Doyola, a 22-year-old who completed a university degree in accounting last year, sat in a clinic in Santa Fe on Sunday morning, missing two chunks of her left calf each long and deep enough to put an index finger in lengthwise. She was hurt nine days ago by flying debris and has only received iodine solution as a topical antiseptic, plus inexpensive oral antibiotics, with no attempt at suturing her wounds.
"We were escaping from our house and I was hit by an iron roof; maybe it was the church's roof," said Ms. Doyola, adding that both her brothers had been injured by stepping on nails since the typhoon, but that her two sisters were fine.
Virginia Anoya Macasaet, the 51-year-old midwife who has run the clinic for many years, said that she had no formal training in wound care. She said that she had initially put gauze on Ms. Doyola's wounds nine days ago but later changed her mind.
"We bandaged it, but it smelled bad, so we left it open," she said.
Ms. Macasaet and Ms. Doyola both expressed surprise when told that German and Belgian medical aid groups had opened free field hospitals just 3 miles away in coastal Palo. An ambulance was parked in front of the Santa Fe clinic and available to take them to Palo, and gasoline has become available again in the past couple days after disappearing from sale for a week after the typhoon.
Ms. Macasaet mentioned that flying debris during the typhoon had also gouged out the left eye of a 9-year-old boy and that he had been sent home with little care. She asked that the mayor, who was standing nearby, be told that the town's ambulance should be used.
Oscar Monteza, the mayor of Santa Fe, a town of 20,000 people, said that "hundreds" of people had been injured by flying debris during the typhoon. He said that his main priority with the renewed availability of gasoline was to locate and start a generator to produce electricity, but he later agreed to authorize use of the ambulance.
Ricky Carandang, a presidential spokesman for the Philippines, said aid shipments had begun to all town governments on Leyte Island, and these governments were responsible for passing on shipments to village governments.
He expressed concern upon being told that village leaders in places like Macanip and Buenavista said that they had not received any relief, not even food, adding that, "We will look into these reports and take appropriate action."
Inland towns and villages tend to have fewer people and far fewer dead than coastal cities hit by the storm surge. Catalina Agda, the mayor of Tunga, an inland town of 7,000, said there had been only one typhoon-related death there, caused by a falling coconut tree, and 75 confirmed injuries. Santa Fe had 10 confirmed dead and Jaro had 13, local officials said.
But the extreme damage to housing, coupled with a tendency of inland residents not to go to a clinic when they are injured or sick because of an awareness of the limited medical supplies available, make it likely that injuries and sickness are more widespread in inland areas than anyone on the coast realizes, local officials said.