Aid agencies raise alert over sanitation and lack of safe drinking water as risk of disease outbreaks grows.

Humanitarian agencies have raised alerts over hygiene and safe drinking water needs eight days after Cyclone Idai lashed central Mozambique, with cholera cases reported in the devastated port city of Beira.

The warnings on Saturday came as the Mozambican government raised the death toll to at least 417, with an unspecified number of people missing.

The number of dead was put at 259 in neighbouring Zimbabwe, which Idai tore through after Mozambique before moving to Malawi, which recorded 56 deaths.

Henrietta Fore, the chief of United Nations’ children’s agency (UNICEF), told AFP news agency in Beira that stagnant water and decomposing bodies, as well lack of hygiene and sanitation, have created a risk of outbreaks of malaria and cholera.

“We are running out of time, it is at a critical point here,” Fore said.

The International Federation of Red Cross said in a statement on Friday that some cholera cases have already been reported in Beira, along with an increasing number of malaria infections.

Diaz Simango, the mayor of Beira who has been helping clean up the city by driving an excavator, also told AFP that cases of diarrhoeal infections had already been reported.

UN’s World Food Programme declared the flood crisis a level-three emergency [Tsvangirayi Mukwazhi/AP]

Meanwhile, four cases of typhoid were reported on Saturday in the small provincial district of Dombe, some 280km west of Beira, sparking fears that the disease could spread across the flood-prone area.

Local health worker Adelbert Da Silva told Al Jazeera that after authorities became aware of a cholera outbreak in some parts of the country, several people who had complained of illness were attended to by a mobile voluntary medical team stationed in Manica Province.

The four were found to have typhoid, and put on treatment.

Da Silva said he expected more cases to emerge in the coming days, adding, however, that government and humanitarian aid organisations were “working around the clock” to contain an outbreak of acute diseases.

“Dombe was covered in water after the heavy downpour, and this place is prone to flooding and diseases such as cholera and typhoid,” Da Silva said.

“But whilst we are still trying to come to terms and deal with the after-effects of this deadly cyclone, I can assure you that another crisis a disease outbreak will not be allowed to worsen an already bad situation.”

People slowly made their way from devastated inland areas to Beira [Tsvangirayi Mukwazhi/AP]

Da Silva said most of those that perished were crushed at night in their huts by falling trees and weighty rocks rolling off hills under the sheer force of the violent flow.

Food distribution and shelter have been reinforced in Dombe, with such organisations as Mozambique’s relief agency INGC and UK Aid Direct coming to the rescue.

Survivors whose homes were swept away are now housed in taints, with those that have fallen ill accessing medical attention from there.

Meanwhile, aid group Doctors Without Borders said people were also at risk of respiratory infections such as pneumonia.

UN Secretary-General Antonio Guterres appealed for stepped up support for victims of Idai saying the UN and its humanitarian partners are scaling up the response but “far greater international support is needed”.

He said in a statement that “with crops destroyed in the breadbasket of Mozambique more people are at risk of food insecurity in all three countries”.

UN’s World Food Programme (WFP) declared the flood crisis a level-three emergency, putting it on a par with Yemen, Syria and South Sudan.

The homeless, hungry and injured slowly made their way from devastated inland areas of Mozambique to Beira, which was heavily damaged itself but has emerged as the nerve centre for rescue efforts.

“Some were wounded. Some were bleeding,” said Julia Castigo, a Beira resident who watched them arrive. “Some had feet white like flour for being in the water for so long.”

Aid workers are seeing many children who have been separated from their parents in the chaos or orphaned.

More than 65,000 people are already in shelters in central Mozambique and other sites are being opened.

Elhadj As Sy, secretary-general of the International Federation of Red Cross and Red Crescent Societies, said the relief efforts so far “are nowhere near the scale and magnitude of the problem”, and the humanitarian needs are likely to grow in the coming weeks and months.

“We should brace ourselves,” he said.

Cyclone Idai moved to Zimbabwe after tearing through Mozambique [Philimon Bulawayo/Reuters]

In Zimbabwe, where roads began to open and some basic communications were set up, a fuller picture of the extent of the damage began to emerge.

The victims included a mother buried in the same grave with her child; headteachers missing together with dozens of students; illegal gold and diamond miners swept away by raging rivers; and police officers washed away with their prisoners.

In the city of Mutare, Maina Chisiriirwa said she buried her son-in-law, who had gone to the diamond fields to mine illegally.

“There are no jobs and all he wanted was to feed his family. He was with his colleagues. They thought it would be easier to mine since the rains would keep the guards and the police away from patrolling,” Chisiriirwa said.

His colleagues survived, but her son-in-law was swept away, she said.

Enock Muchinjo contributed to this report from Dombe, Mozambique