Jakarta, Indonesia ? The death toll from the devastating earthquake and tsunamis that hit Asia and Africa soared to about 160,000 early Friday after Indonesia announced almost 20,000 new deaths.

Health officials have warned that the death toll could jump even higher without a continual supply of aid, and world leaders struggled Thursday to figure out the best way to help victims.

Donors concluded an emergency one-day summit as relief workers scrambled to move aid to areas of Sumatra, the Indonesian island hit hardest by the earthquake and giant waves that crashed ashore Dec. 26. Volunteers hurled sacks of rice and instant noodles into trucks as U.S. helicopters loaded with other supplies buzzed overhead en route to isolated communities.

Indonesia said on Friday that its death toll from the 9.0-magnitude earthquake and the tsunamis it spawned was 113,306, up from its previous estimate of 94,200. More than 10,000 are still missing in the Aceh province of Sumatra island, the Ministry of Social Affairs said.

The announcement raised the overall death toll in 11 countries to 159,445.

In the Indonesian capital, Jakarta, world leaders discussed how to transform one of the largest aid packages ever assembled, nearly $4 billion in pledges, into food for the hungry and shelter for the homeless. U.N. Secretary-General Kofi Annan urged nations to come forward immediately with the billions they’d promised and to break with past practices of promising much and delivering little.

An Indian police officer tries to control hungry survivors of the tsunami as rice is handed out at a relief camp in Devanah Pattinam, India. The truck had to leave midway as chaos prevailed Thursday because there was not enough rice to be distributed to all the evacuees.

“The disaster was so brutal, so quick, and so far-reaching, that we are still struggling to comprehend it,” Annan said. “We will never know the exact magnitude of how many men, women and children perished on 26 December.”

Australia leads the world with a total aid pledge of $810 million, followed by Germany, Japan and the United States.

Secretary of State Colin Powell said America would take a wait-and-see attitude before pledging more cash. “These are not insignificant numbers,” Powell told reporters.

Japan hinted it might offer more help for those hit in the disaster that ravaged 11 countries — including Sri Lanka, India and Thailand. Foreign Minister Nobutaka Machimura said the $500 million Japan already pledged “was on the small side.”

The World Health Organization said that if basic needs, particularly access to safe drinking water, were not restored by week’s end, infectious diseases could kill tens of thousands. The confirmed death toll stands at 160,000.