Sierra Leone is facing significant health challenges after recent devastating mudslides. The crisis began when heavy rains caused mudslides from the denuded slopes of Mount Sugar Loaf, about five miles from Freetown. Houses that hugged the slopes, many of them little more than wooden shacks with tin roofs, were buried after torrents of mud poured down under the force of the water.

18 more bodies have been discovered this past weekend, bringing the death toll to 499 people, according to Sidie Yahya Tunis, the Tourism and Cultural affairs Minister, more than 150 children were among the dead, he said in a statement. The death toll includes those killed in mudslides on the outskirts of the west African nation’s capital, Freetown, and fatalities from flash floods in other provinces, Deputy Health Minister Madina Rahman told CNN.

About 20,000 people have been displaced by the mudslides, including 5,000 children, presidential spokesman Abdulai Bayraytay said. Rescue workers told CNN they were losing hope of finding whole bodies in the debris, with hundreds of people still unaccounted for. Some body parts have washed up on nearby beaches and the city morgue at Connaught Hospital in Freetown has been overwhelmed by the influx of bodies so far.

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The country also must battle cholera and malaria, Rahman said, in the wake of one of the deadliest natural disasters to hit Africa in recent years.  Some residents have gotten skin infections from the water they have been washing in, and officials are putting in place plans for cholera preparedness and prevention, she said. “We are equipped to a point. We can’t do it alone,” she added.

Rahman has, appealed for international support, saying “The number of people dead is changing every day,We have just done a census recently, and we are working with the statistics office to see how many people are on that site and how many people are unaccounted for and how many people were dead and buried.”

Elhadj As Sy, secretary-general of the International Federation of Red Cross and Red Crescent Societies, also told reporters in Geneva, Switzerland, that other countries must step up, saying that Sierra Leone was facing a crisis “way beyond (its) capacity.”

Many appeared shell-shocked in the wake of the disaster, crying as they walked along or looked for missing loved ones. One woman told CNN she had lost most of her family, including a sister who was heavily pregnant. Another resident, Ishmael Tomboyeke, said he was also looking for his sister’s body. After seeing the mudslide, he said, “I ran there, I saw where the house was, everything was demolished.”

The government of the impoverished West African nation in recent days has warned residents to evacuate a mountainside where a large crack has opened. Thousands of people live in areas at risk and the main focus is making sure they leave before further disaster, authorities have told local media.

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Aid groups have been providing water filters, buckets, water storage tanks, soap and hygiene supplies. “Water sources have been contaminated” and that officials “fear for an outbreak of water-borne diseases,” said Saidu Kanu, country director for World Hope International. Malaria is another concern many of the estimated 3,000 homeless are sleeping without mosquito nets.

Some critics are accusing the government of not learning from past disasters in a city where many poor areas are near sea level and lack good drainage. The capital also is plagued by unregulated construction on its hillsides and has parts without clean drinking water because of damage to pipelines.