TAKAJO, Japan - Within the dark and fetid wards of the Senen General Hospital, some 120 patients lie in their beds or slumped in wheelchairs, moaning incoherently.
"There is no food!" cries an old man in a blue gown, to no one in particular.
Last week's powerful earthquake and tsunami heaped untold new misery on those already suffering thousands of elderly, infirm and sick people in hospitals that were laid to waste by the violent shaking and the walls of water that followed. There are no figures yet on how many hospitals were ravaged, but few could have escaped unscathed given the scale of the destruction.
Sam Taylor, the spokesman for Doctors Without Borders, an international group that has sent a team to Japan, said there were longer-term concerns about the elderly, many of whom are fragile and may be living on little food and water without their lifesaving medicines.
"They have some medicines for the immediate future, but in the coming weeks that's when it really could become an issue," he said.
Senen General Hospital in Takajo town, near Miyagi prefecture's capital of Sendai, had about 200 patients when the earthquake hit, tossing its medical equipment around and collapsing part of the ceiling in one wing.
All of its food and medicine was stored on the first floor. Everything was ruined or lost in the 30 minutes when Takajo, a small town of about 12,000, was flooded by the tsunami.
"We're only administering the bare necessities," said administrator Ryoichi Hashiguchi.
So far four patients have died, all older than 90 and severely sick even before the calamity. Another 80 that could be moved were sent to a nearby shelter.
There is no power or running water, and for the first two days the staff and patients shared some frozen noodles and vegetables they salvaged from a toppled freezer.
The nurses have been cutting open soiled intravenous packs and scrubbing down muddy packs of pills with alcohol to cleanse them. A gut-wrenching stench from the bathroom, after several days of waterless use by hundreds of people, was clear from half a building away.
No aid came from the government the first two days, but some rice balls were handed out on Monday. A relative of a worker donated a flooded generator, which two men were trying to get working outside. The local gas company set up a set of burners outside to warm food and water.
From the outside the hospital looks abandoned, with thick mud layered across the parking lot, and a jumble of cars piled up by the tsunami.
"I'm sorry, we have no medicine," the staff repeatedly told a constant flow of people from the town, many of them elderly.
Hashiguchi said he has been in contact with city officials, and told them that the conditions of many patients is worsening.
"I don't think this is going to be resolved any time soon," he said.
With even hospitals deprived of aid, it is no surprise that ordinary survivors are living a hand-to-mouth existence.
Osamu Hayasaka, 61, said the government hasn't provided anything to people who didn't move into the refugee centers. He strapped two cardboard boxes of DyDo drinks on his red bicycle with a bungee cord to take home to his family of six, including his sick mother, and neighbors.
"There are a lot of older people near where I live, so I'll give them some of this," he said.
Hayasaka said the local supermarkets are running out of goods. He lined up 2 1/2 hours Sunday and was allowed to buy just a few items, including a grapefruit and an orange.
In a community center crammed full with hundreds of people, there is slightly more to eat.
"Today I had some cake and an orange," said Yuto Hariyu, 15, whose middle school was destroyed the day before his graduation ceremony.
"I'm hungry, but what I want most is furniture, like a bed, and a TV," said Yuto's classmate, Shio Fujimura.
At a government-run center for the elderly on the outskirts of the city, the food allotment yesterday was two rice balls, one in the morning and one at night, says Takahashi Sata, 43, who works at the center.
"Yesterday I had two rice crackers and a bottle of water," he said. "Today there is nothing for anyone."