Huge swathes of the already impoverished state of Bihar are under water after a major river breached flood defences in neighbouring Nepal, changing course and washing away villages, crops, livestock and people.

Survivors are making a long trek out, a few dragging cows behind them, most carrying little more than flip-flops.

"Mother's gone," wept one man as he emerged from the flood plain. He said his mother had been swept away by the swift current of the river that now flows through hundreds of villages.

Near a bridge, a bloated corpse had washed up and lay tangled in thick reeds.

More than two weeks after the Kosi river -- known as "Bihar's Sorrow" for its frequent deadly floods -- washed away much of the state, tens of thousands of people are finally giving up hope the waters will soon recede.

More than half a million people have already been evacuated by the government. But rescue workers still need to get at least 400,000 more out, state disaster minister Nitish Mishra told AFP.

"They also want to leave the villages now. They have realised this will continue," said Mishra, estimating that it could take up to a week before another 600 or so villages are reached.

The Indian government is sending in more than 1,500 fresh army and navy personnel, but distances are great and rescue workers are short of motorised boats, hugely slowing evacuation efforts.

A log kept by a rescue worker with an Indian security force showed that his battalion made four trips on Sunday and brought back no more than 30 people before running out of fuel.

Hundreds of those who finally made it out Monday crowded around relief camps in the Bihar town of Madhepura, clamouring for food, or lined outside the top district official's headquarters wearily pleading for help.

Around 80 people are confirmed to have died in the flooding, said officials in Patna, the state capital, but the real toll is expected to be higher.

Many of the river refugees spoke of relatives still missing, last seen trying to fight the current.

As the rescue efforts drag on, officials have expressed fears about disease -- both among those stuck with little or no food or clean water on rooftops, and those crowded in shelters, where some 200,000 are now living.

In one makeshift shelter in Madhepura town, 150 kilometres (90 miles) east of Patna and one of the worst-hit areas, the women said they had clean drinking water from a handpump in the water-filled courtyard.

But they said they were washing their dishes in the stagnant flood waters.

Water marks also showed the floods had probably contaminated drinking water in many of the hand pump wells here, a visiting health worker with the United Nations children's fund UNICEF.

The shelters are also short of medical teams.

"There are people in various small groups in shelters where they found space, but there are no facilities apart from food," said Malini Morzaria from the European Community Humanitarian Office (ECHO), the EU's emergency aid organisation which is working in the disaster area.

"The important thing now is for there to be some camp management, where the people have access to latrines, clean drinking water and some basic health care."

With the river's defences unlikely to be completely fixed for several months, Bihar is now looking at feeding and housing as many as a million people for the next six months, officials say.

Many villagers are still grappling with that news. Few know what they will do now.

"If we go home what will we eat? My home collapsed. We have nothing. Where will we go?" said Munni Khatun, who was staying with her five children and husband in Madhepura student housing, now surrounded by a metre of water.

"Everything drowned except us."

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