Aid operations are being increased for 100,000 civilians affected by recent fighting in Georgia, as a fragile ceasefire teeters on the edge.
The Swiss-based International Committee of the Red Cross (ICRC) says the humanitarian situation remains very difficult. It hopes to soon gain access to South Ossetia, where 50,000 people are in dire need of clean water and other essential items.
Despite the current lack of access to the breakaway region and the unstable security situation, the ICRC, the Swiss Agency for Development and Cooperation (SDC) and United Nations agencies have been able to get a headstart on providing aid to victims elsewhere in Georgia and to refugees who fled to North Ossetia after the conflict erupted last week.
Efforts increased on Thursday with new commitments from Europe and the United States to boost supplies already being distributed by agencies.
The ICRC has been negotiating with all three parties to the conflict - Georgia, Russia and South Ossetia – to grant it safe access to South Ossetia so that it can start handing out aid and evaluate the situation. The breakaway region is currently off limits to humanitarian agencies.
"Russian, South Ossetian and Georgian authorities in principle are ready to give us access but we're being told there are ongoing security concerns," ICRC spokeswoman Anna Nelson told Reuters. "We hope to be able to go in as soon as possible."
About 70,000 people lived in South Ossetia prior to the conflict. Half of them were in the capital Tskhinvali, which bore the brunt of fighting that began last Thursday when Georgia sought to retake the pro-Russian region.
Moscow responded with a huge counter-offensive but a shaky ceasefire was reached on Tuesday. Russian troops reportedly began pulling out from Gori on Thursday but explosions were still being heard in the key strategic city.
The ICRC estimates that 30-50 per cent of South Ossetia's population has fled the fighting, which caused "widespread destruction of infrastructure", including medical as well as water and sanitation facilities.
The Geneva-based organisation is planning a major humanitarian operation in the region, which should last until at least early 2009.
"Those remaining behind are perhaps anywhere from 35,000 to 50,000 people: that's what we are preparing ourselves for. We are getting desperate phone calls from people who stayed behind," said Dominik Stillhart, ICRC's deputy director of operations.
According to government estimates, there are up to 60,000 people elsewhere in Georgia who have fled their homes and also require emergency assistance.
"We see a need for basic things, such as food, water and hygiene items at the shelter centres we are visiting both in and around Tbilisi and in Zugdidi, in western Georgia," said Dominique Liengme, the ICRC's head of delegation in Georgia.
"These people in temporary shelters are really left without anything," Maia Kardava, the ICRC Tbilisi spokesperson, told swissinfo. "We have already assisted 1,400 people in ten centres around Tbilisi but the authorities say they have registered some 28,000."
Present in the region since 1993, the SDC says it is able to work in the zones where most refugees and displaced people are found - in North Ossetia and around Tbilissi.
"We can work with all the parties to the conflict," SDC spokesman Andreas Stauffer told swissinfo. "The situation is very tough for people fleeing the combat zones, especially as the region is only just recovering after the civil war in 1992."
The SDC's Humanitarian Aid Unit has promised SFr100,000 ($92,000) to the Georgian Ministry of Refugees and to the United Nations High Commissioner for Refugees (UNHCR) to help people who have fled from South Ossetia.
The ICRC has no overall casualty figures but says it has seen some 1,000 war-wounded in hospitals in Georgia, not including South Ossetia.
Their Georgia delegation now totals 50 expatriates and 100 local staff, including 17 new ICRC doctors and medical personnel who have been sent to reinforce local medical facilities and treat the wounded.
"After two days of poor security conditions, one of our teams, which included surgeons, was able to go back to Gori today to evaluate and attend to medical and general needs there. Another is on its way to Zugdidi," said Liengme.
Once access is granted to South Ossetia the priority will be to set up a surgical hospital in Tskhinvali.
In the Russian Federation, the ICRC estimates that at least 12,000 people fled to North Ossetia from South Ossetia, the vast majority of them women, children or elderly, and are being cared for by Russian authorities who have the situation "pretty much under control", said Stillhart.
The SDC's Humanitarian Aid Unit has provided SFr170,000 towards medical supplies for hospitals, clothes and shoes, and psycho-social support for women and children in North Ossetia.
swissinfo, Simon Bradley
The ICRC launched an appeal on Tuesday for SFr8 million ($7.4 million) to meet emergency needs in Georgia and North Ossetia.
The SDC's Humanitarian Aid Unit has promised SFr100,000 to the Georgian Ministry of Refugees and to the United Nations High Commissioner for Refugees (UNHCR) to help people who have fled from South Ossetia. It has also provided SFr170,000 towards medical supplies for hospitals, clothes and shoes, and psycho-social support for women and children in North Ossetia.
Swiss Interchurch Aid, the agency of Protestant churches, and Caritas Switzerland have both promised to increase their emergency aid to victims of the conflict, to the tune of SFr100,000 and SFr50,000, respectively.
The pro-Moscow region of South Ossetia in the Caucuses broke from Georgia as the Soviet Union split apart in the 1990s but has no international status.
Georgia began a new offensive to regain control over South Ossetia on August 7, launching heavy rocket and artillery fire and air strikes.
In response, Russia, which has granted passports to most South Ossetians, launched overwhelming artillery shelling and air attacks on Georgian troops.
Bombing raids have displaced thousands of people on both sides of the border. The number killed is unclear.
Russia and Georgia signed a ceasefire on August 12 under a plan brokered by French President Nicolas Sarkozy on behalf of the European Union requiring forces to return to the positions they held before the conflict started last week. But the truce allows Russian forces to take unspecified "security measures".
A fragile ceasefire appeared even shakier as Russia's foreign minister declared on Thursday that the world "can forget about any talk about Georgia's territorial integrity."
In compliance with the JTI standards