Who do you save first?

As more aftershocks hit the Haitian capital, Port-au-Prince, UN teams switched from search and rescue to relief efforts, such as providing drinking water. Photograph: Roberto Schmidt/AFP/Getty Images

Thousands of lives could have been saved in Haiti if aid efforts had focused more on injured survivors rather than rescuing trapped people, it has been claimed, amid a sharp criticism of aid agency "jostling".

Michael Schuster, a volunteer US doctor running a ward at Port-au-Prince's general hospital, said tens of thousands were likely to die because they had received no medical treatment while emergency teams scoured rubble for signs of life.

"We end up chasing our tails. By the time we have the supplies for the masses it is almost too late. I think if we mobilised for the masses and put less media emphasis [on those under the rubble] many lives could have been saved," he said.

The claim today coincided with a report by the British medical journal the Lancet that accused international aid agencies of corporate preening and self-interest in their response to the magnitude 7.0 tremor which killed up to 200,000 and left more than 2 million homeless.

The enormity of the humanitarian needs became clearer in clinics overwhelmed by an estimated 250,000 wounded. Shortages of surgeons, nurses, medicine and supplies seemed ubiquitous. Food and water were reaching more of the 500 makeshift camps, which are home to about 500,000 people, but lack of sanitation produced more reports of diarrhoea and other ailments.

Some of the rescue crews began to leave after hope faded of finding more survivors. International teams pulled out more than 80 people alive, including several after more than eight days.

Two barely alive survivors were rescued yesterday. An 84-year-old woman was pulled from under a wrecked building, said Dr Vladimir Larouche, who treated her. Elsewhere in the shattered capital, an Israeli rescue team freed a 22-year-old man from the rubble. Rescuers and local residents hugged and celebrated after pulling out the man, who was limp and suffering from dehydration.

Schuster, who heads the general hospital's post-operation ward, said rescues dominated media and world attention.

"Think about the millions who were not under the rubble. Nobody wants to lose lives but I think you have to value the lives of tens of thousands who may be dying now every day from infections. The world may want to rethink the way it delivers emergency relief services."

As the number of voices from beneath the rubble dwindled, each alert drew multiple rescue teams. A female voice heard beneath debris on the roof of the Olympic Market on Tuesday, for instance, drew teams from Haiti, France, Turkey and the US. By the time the 25-year-old was pulled out 12 hours later there were more than 100 firefighters, dog handlers, paramedics and other emergency workers.

"This could be one of the last rescues so everyone wants in on it," said one US airman. With at least a dozen media organisations present the US team wanted to use a helicopter to airlift the woman to hospital but dropped the idea after the Haitians and French said that was needless and would hog the limelight.

Just a block away there were scenes of squalor where survivors were drinking ditch water. They did not seem to begrudge the resources lavished on their trapped compatriot and cheered when she was driven away in an ambulance.

Michael McCarry, a nurse from Northern Ireland, said he was seeing more injuries that had become infected. "What we are talking about here is what you find in a war zone," he said.

In a separate criticism of the aid response the Lancet said aid agencies had contributed to the post-earthquake bedlam. "International organisations, national governments and non-governmental organisations are rightly mobilising, but also jostling for position, each claiming that they are doing the best for earthquake survivors," it said in an editorial.

"Some agencies even claim that they are 'spearheading' the relief effort. In fact, the situation in Haiti is chaotic, devastating, and anything but co-ordinated."The Lancet said the aid sector was an industry in its own right and needed scrutiny of motives and performance.

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