The Red Cross says nearly a week after the devastating earthquake in central Indonesia, many survivors are still in need of basic assistance, including medical care, food and water.

The International Federation of the Red Cross and Red Crescent Societies says damaged roads and disrupted communications are creating big challenges for the aid operation.

Also Friday, the United Nations said its relief operations could take up to six months. It said it will need $103 million to provide emergency shelter, medical assistance, food, clean water and sanitation for survivors.

The Asia Development Bank says it has initially offered Indonesia $10 million in immediate grant assistance and another $50 million in loans.

More than 6,000 people were killed last Saturday when the earthquake struck Java island. About 200,000 people were made homeless.

World Health Organization officials say they are worried about a possible outbreak of tetanus in the area. They say hospital personnel reported shortages of tetanus vaccine earlier in the week, and that overflowing medical facilities and poor sanitation are aggravating the problem.

Thursday night, representatives of more than 40 local and international groups met for the first time to jump-start coordination among health agencies.

Despite the health concerns, W.H.O. officials say Indonesia's response time and coordination following the quake are far better than efforts after the 2004 tsunami.

The W.H.O. estimates that more than 22,000 patients have been treated in hospitals over the past week.