DHAKA/KUTUPALONG, Bangladesh (Reuters) - How do you feed and shelter nearly half a million traumatized people who have made their way, over the course of just one month, to a spit of monsoon-soaked land where 300,000 refugees are already living in squalor? That is the challenge for aid workers scrambling to help the Rohingya Muslims now crowded into the Cox s Bazar region of southern Bangladesh after a spasm of violence in Myanmar s Rakhine state sent them fleeing across the border.  Nothing comparable, in terms of the number of people arriving in such a short space of time, has happened since 1994 in Rwanda,  said Christopher Lom, Asia-Pacific spokesman for the International Organization for Migration (IOM). About 480,000 men, women and children have arrived in Cox s Bazar since the end of August, according to United Nations estimates. Most came with nothing more than the clothes they wore. Nearly 200 of the women have given birth since they arrived and another 20,000 are pregnant. Meeting the needs of such a vast number - indefinitely, because there is nowhere else for them to go - in one of the poorest regions of a poor country is a logistical nightmare for the Bangladesh government, U.N. agencies and aid organizations. There was a taste of what was to come in October and November last year, when a smaller outbreak of violence brought and influx of 80,000 Rohingya. That prompted improvements in infrastructure and coordination in Cox s Bazar, said the United Nations  local chief coordinator, Robert Watkins.  It was working extremely well,  he said.  And then we got this wave of humanity, and we were overwhelmed.  U.N. High Commissioner for Refugees Filippo Grandi said after a visit to Cox s Bazar this week that the most urgent needs were shelter, clean water and sanitation.  Really the first order of business, the first challenge, is to get people out of the mud and the despair in which they are finding themselves into a place where organized relief can be provided,  he told a news conference in Geneva.  The combination of limited health facilities, poor sanitary and hygiene conditions and overcrowded sites ... is a recipe for disaster in terms of possible epidemics.  So far 475 tonnes of aid have arrived at Chittagong airport north of Cox s Bazar, much of it from Muslim-majority countries shocked by the killings and torching of villages in northwestern Rakhine, which U.N. officials have branded ethnic cleansing. While the initial response was chaotic, say aid experts, due to the sheer volume of people arriving, Bangladesh has since won some praise for improvements in organization. At a Sept. 14 meeting in the prime minister s office in Dhaka, the authorities made 22 decisions to remove logistical hurdles. According to a document reviewed by Reuters, these included building 14 storage warehouses, regulating aid distribution,   protecting orphans, building roads and power infrastructure, and setting up shelters for more than 500,000 people. Mohammad Shah Kamal, Bangladesh s secretary of disaster management and relief and the main coordinator of the aid effort, said the armed forces were scanning shipments of aid and transporting them from airports and ports to Cox s Bazar, where local officials take charge of distribution.  I think everyone has been surprised at the Bangladeshi government,  said Karim Elguindi, a senior World Food Program official in Cox s Bazar, noting that it was  fast-tracking everything , had offered police support and helped with customs delays. But the Inter-Sector Coordination Group, which is leading the humanitarian response to the influx of Rohingya, said in a recent update that basic coordination was still lacking because staff and agencies had not been assigned to specific camps. Bangladesh hopes to make room for new arrivals by building a 2,000-acre camp in the Ukhia area of Cox s Bazar. The U.N. says much of this area is not suitable for habitation because it lacks water, sewerage and roads, but many refugees are already settling there anyway. Complicating aid efforts are private civic and religious groups that throw food and clothes off the back of trucks, which experts say is no way to get relief to the neediest. Thousands of tarpaulin shelters that refugees have built in recent weeks stretching across dozens of small hills and rice paddies are only accessible by long walks across flimsy bamboo bridges.   Families in one of the most remote parts of the sprawling Kutupalong refugee camp, a 40-minute walk from the nearest official distribution point, said they mostly rely on handouts from relatives to survive.   Mushtaq Ahmed, 66, a religious teacher, sheltering from the rain under a tarpaulin, said he has resorted to begging to buy rice for his children and grandchildren.   He has tried to throw himself into the scramble for aid thrown from trucks but comes away with nothing.  There are too many people rushing,  he said.  I am too weak to get it.   
'Wave of humanity' puts aid agencies to the test in Bangladesh