MUZAFFARABAD, Pakistan — Shortly after a cold rain had finally quit, German relief volunteer Waggas Sajid walked the muddy paths of this city's most disease-ridden tent camp for earthquake survivors. Picking his way through mounds of rotting garbage and excrement, he felt like a character in Dante's "Inferno."
"This place is like hell," said the 26-year-old paramedic from Frankfurt. "People are living together in squalor. Everyone is coughing, and the babies get sicker every day.
"I cannot imagine how they will survive. Hell cannot be any worse than this."
Situated on the site of a destroyed government college, it's known as the Old Government Camp. The name is misleading because neither the government nor any other relief group had anything to do with the impromptu compound until a team of German doctors stumbled upon it last week.
What the team found was an unsightly collection of 350 tents and more than 2,000 people that sprang up on a dirt-caked cricket field days after last month's magnitude 7.6 earthquake.
Although scores of camps housing tens of thousands of refugees in the city are run by the Pakistani government and domestic or foreign relief groups, Old Government Camp had no sponsor. People just began showing up there and erecting their hovels.
Without help from Pakistani soldiers and international aid officials, conditions at the unsanctioned site quickly deteriorated -- worsened by cold nights and days of rain.
Doctors blame the outbreak of infectious disease, including hundreds of cases of diarrhea and acute respiratory infections, on a shortage of toilets, foul drinking water and the occupants' close quarters.
The German medical team, from the group Humanity First, discovered the camp after arriving in Muzaffarabad a week ago.
Its members reported the situation to foreign health officials, who said they did not even know that the camp existed. Since then, several groups have rushed to the camp and have been shocked by the squalor.
"These are deplorable, appalling sanitation conditions -- absolutely and completely inadequate," said Dr. John Watson, a communicable disease monitor for the World Health Organization in Muzaffarabad.
"There has been no access to latrines. People are relieving themselves indiscriminately. This is a recipe for an epidemic."
For weeks, health officials have warned of the possibility of widespread death from cold and exposure if residents of isolated mountain villages did not move into tent camps in the lower valleys for shelter, food and healthcare.
Experts including Salahud Din, a Humanity First physician from the Netherlands who has helped set up a medical clinic at Old Government Camp, wonder whether such a move is wise.
"People might be better off back up in the mountains, taking their chances against the elements in their own villages, than to endure conditions like this," Din said.
At this teeming camp, even some of the smaller tents house 18 people. Infants crawl on dirt floors and through puddles, ignoring the carpets their mothers have spread on the ground.
Dozens of goats scavenge from garbage mounds as chickens and feral cats wander among open campfires where women cook their daily meals, shooing away ever-present flies.
Many of the tents are made of a single layer of burlap, and rain drips inside as steadily as a hospital IV machine. Some residents have dug trenches to divert the rainwater, but others have no tools to do so.
Worst off are families with slapdash shacks made from sheets of corrugated metal that lean against a center pole, with no way to stop the wind and rain.
There was only one tank for drinking water, which soon became contaminated. Without latrines, residents relieved themselves just outside their tents, Din and other doctors said.
Volunteers from the aid group Oxfam have constructed a second water tower and installed sets of latrines around the camp's perimeter. They are emphasizing better sanitation.
But doctors still worry that the worst is yet to come.
On his first visit last week, Watson diagnosed 170 cases of acute diarrhea -- "sick men, women and children -- lots of them," he said.
Officials say treatment has helped reduce cases of diarrhea, which could lead to worse illnesses such as cholera.
Doctors also found cases of gastrointestinal infections, vomiting, meningitis, pneumonia, measles, scabies, chickenpox and hepatitis -- illnesses that can spread easily in the absence of proper sanitation and clean water.
Among adults in the quake-stricken area, respiratory illnesses are the second most-pressing medical problem after quake-related injuries, according to the World Health Organization.
But for children younger than 5, respiratory infections are the No. 1 concern, a trend that worries Din, the Humanity First doctor.
"Once children come down with respiratory illnesses," he warned, "it can spread through the camps like wildfire."