Humanitarian agencies are struggling to cope as tens of thousands of Burundian refugees stranded on Kagunga Island in Tanzania face worsening medical conditions.

UNICEF officials told Al Jazeera on Thursday that conditions at Kagunga were “tough” and that a cholera outbreak had made conditions even more dire.

At least 33 people have died, with 27 deaths believed to have been cholera related.

The World Health Organization declared cholera a level 1 emergency in the region on Wednesday.

“It is very, very tough in Kagunga, and our focus now is to try and save those living in these very poor conditions,” said Thomas Lyimo, a health officer at UNICEF.

More than 100,000 people have crossed into Tanzania since political unrest began in Burundi on April 26.

At last count, some 70,000 refugees were still in Kagunga, waiting to be transferred to the Nyarugusu camp outside Kigoma.

Christopher Kamugusha, programme officer for WHO in Tanzania, said it was now a matter of case management and establishing a treatment centre in Kagunga.

“We have enough drugs and we are putting our resources into this and ensuring this does not spread”.

Authorities say there are just 94 latrines for use by the 70,000 people currently in the fishing village of Kagunga.

The arrival of so many refugees in a village with a population of no more than 11,000 has overburdened every health and social service facility.

“It is better than earlier, and it is in a manageable state, but there is so much to be done,” Lyimo said.

With just two boats operational, only 2,000 refugees are transferred each day to Kigoma, where they are processed at the Lake Tanganyika stadium in the town.

“Assuming the numbers don’t change in Kagunga, it will take a month to transfer all of them to safety at the camp,” Lyimo said.

But the refugees continue to arrive; at least 150-200 people continue to arrive every day in Kagunga, which is not the only entry point for them.

There are at least five other points but Kagunga is by far the busiest.

Many families have been separated from each other, with some cases of unaccompanied children making their way in to Tanzania. Al Jazeera