BEIRUT (AP) — Syria could face dangerous outbreaks of disease in the wake of last week’s devastating earthquake if hundreds of thousands of displaced people do not get permanent housing soon, the Red Cross’ global chief said Thursday, as Syrians struggle to receive humanitarian aid amid the mounting crisis.

Jagan Chapagain, who is Secretary-General of the International Federation of Red Cross and Red Crescent Societies, said families staying in makeshift shelters without adequate heating urgently need permanent housing.

“They are still living in very basic conditions in very, very cold school rooms,” he told The Associated Press in an interview. “If this continues for a long period of time, then there will be health consequences.”

He spoke after returning from Aleppo, Syria’s largest city that for years witnessed some of the worst fighting of the country’s ongoing civil war.

Aleppo was hit with a cholera outbreak in late 2022. The earthquake’s impact on access to housing, water, fuel, and other infrastructure could make another outbreak “possible,” he said, adding that the disaster also has been ruinous for Syrians’ mental health.

“If the conflict had broken their backs, I think this earthquake is breaking their spirit now,” Chapagain said.

The deadly 7.8 magnitude earthquake that rocked Turkey and Syria over a week ago shattered parts of the war-torn country, both in the northwestern rebel-held enclave and nearby government-held areas. An estimated 3,688 people died on both sides of the frontline in Syria, about 1,400 of them in government-held cities and towns.

Entire neighbourhoods of Aleppo have been abandoned, Chapagain added, with some residents opting to move to rural areas after the quake. Many Syrians were displaced for a second time following the natural disaster, already leaving their homes to escape the airstrikes and shelling.

The UNHCR estimated that 5.3 million Syrians across the earthquake-hit country could be homeless if viable shelter and aid is not secured.

In the long term, Chapagain said rebuilding Syria’s infrastructure, already crippled by the war, ought to be a priority. However, the civil war and economic crisis in Syria makes a swift post-earthquake recovery more complicated.

The IFRC has raised 200 million Swiss francs ($216.8 million) and hopes to support 2.4 million people across the country over the next two years. Dozens of planes and trucks loaded with humanitarian aid have reached government-held Syria. The UN appealed for $397 million to support almost 5 million people in rebel-held northwestern Syria, almost all living in poverty.

During his tour of Aleppo, Chapagain said that aid, which has decreased over the years, was now arriving in larger quantities.

One woman told him that she had suffered from the dwindling assistance in recent years but “in some way this earthquake brought back humanitarian assistance so (she) could eat food again,” he recalled.

Still, he said, major gaps in essential goods remain.

“Even some of the ambulances are struggling to get fuel, and even some of our own cars are struggling to get fuel,” said Chapagain.