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The official number of 12 confirmed deaths and more than 200 people injured was expected to rise.

Not all of those killed or hurt had been brought to a hospital and would not be included in the figures, aid agencies said. Some residents were scared to visit badly-damaged Vila Central Hospital, the main treatment facility.

More than 1,000 people were displaced, according to the UNICEF, the world body's humanitarian agency. Aid workers estimated about 20,000 people were likely without water.

Water shortage threatens a fresh crisis

The biggest threat was the spread of illness from people drinking contaminated water, said Brecht Mommen, a UNICEF water, sanitation and hygiene specialist based in Vanuatu.

“It’s a rush against time to get water trucks organized for those areas so that we prevent a second disaster, which is a diarrhea outbreak,� he said.

It was still unclear where broken pipes were located in the immense network servicing Port Vila and it was unknown how long it would take to find and fix them all, Mommen added.

Rain and landslides slow relief efforts

Relief efforts were hampered by blocked roads, traffic jams and patchy communications.

Rain forecast in the next few days threatens to worsen landslides prompted by the quake. They included a major slip that has blocked Vanuatu’s sea port. The airport, currently open only for humanitarian flights, will resume commercial airline operations on Sunday, according to local news outlets.

It prompted quiet hope for a return to normal among residents accustomed to life in one of the world’s most natural disaster-prone countries. But analysts said the problems that afflicted Vanuatu before Tuesday’s quake were likely to hinder recovery.

A perilous island paradise

Vanuatu is an scenic, sprawling archipelago covering a vast expanse of South Pacific Ocean that lies between Australia and Fiji. More than 80 coral and volcanic islands are home to 330,000 people.

Perched on the Pacific ring of fire – a belt of tectonic plates and volcanoes – Vanuatu is regularly jolted by earthquakes, though none in living memory as large as Tuesday’s.

The country is also among the world’s most imperiled by climate change. Earlier this month Vanuatu in a landmark case on the matter in the top United Nations court.

The country's envoys argued that as rising seas threaten the existence of Vanuatu and other nations, major polluting countries should be ordered to take more responsibility for curbing their emissions.

A struggle to lure tourists back

Lush tropical forests and azure seas make the country a popular destination for holidaymakers from Australia and New Zealand, and tourism accounts for about 40% of the economy. The other major contributor is agriculture, with products exported or sold to tourist resorts.

Disasters of recent years have frustrated its growth. Visitor numbers dwindled during the coronavirus pandemic and had barely started to recover before three major cyclones in 2023 dealt another blow. In May, the country’s national airline collapsed.

Political uncertainty could stall recovery

Vanuatu is currently led by a caretaker government after President Nikenike Vurobaravu dissolved Parliament in November as Prime Minister Charlot Salwai faced a no-confidence vote.

Salwai, now the caretaker leader, is Vanuatu’s fourth Prime Minister in four years, with his predecessor toppled in a confidence vote in 2023 after a month in office. A snap election is due in January.

“This is one of the most turbulent political systems in this part of the world,� said Riley Duke, a Pacific analyst at the Lowy Institute, an Australian think tank. The political chaos has bred a “permanent short-term focus�, he said, and has deterred some funders of badly-needed development projects.

Part of a bigger geopolitical contest

Vanuatu has become part of a wider strategic battle for the Pacific in recent years as western countries seek to counter China’s growing influence. Australia is still Vanuatu’s biggest donor, but the government has increasingly looked to China to fund infrastructure and building projects including work this year on a presidential palace.

In the process, it has amassed sizeable loans and was rated at high risk of debt distress by the International Monetary Fund before this week’s quake.

“There’s going to be a drive by the next government to secure additional financing, which opens the door to more interest in external financing,� said Duke. “That obviously has secondary effects for geopolitics.�