At least 54,000 people fled their homes, either because they were destroyed or in fear of another tsunami, adding to difficulties to add up causality figures, other officials said Tuesday.

At the main regional emergency center, the Banjar Public Hospital, doctors and nurses scrambled to treat a steady stream of patients - most from the Pangandaran coast. Some slept on dirty mattresses on the floor, while others were treated in the admissions hall amid a bustle of family members searching for loved ones.

Among a handful of foreign patients was Hamed Abukhamiss, a 40-year-old Saudi who lost his wife and 4-year-old son.

Enormous waves separated the family as they enjoyed an afternoon of surfing, shopping and eating at a Pangandaran waterfront cafe.

Abukhamiss, who suffered minor injuries, said he told himself as he was repeatedly sucked under the current and battered by debris: "I'm not going to give up. I'm not going to die."

His other son, Yousif, 12, saw the wave approaching with a pair of binoculars, but no one believed him when he yelled, "Tsunami!"

Indonesia was hardest hit by a 2004 tsunami that killed at least 216,000 people in a dozen nations along the Indian Ocean rim - more than a half of them on Sumatra island's Aceh province.

Though the country started to install an early warning system after that disaster, it is still in the early stages, covering only Sumatra. The government had been planning to extend the warning system to Java by 2007.

The island was hit seven weeks ago by a 5.9-magnitude earthquake that killed more than 5,800 people, though the 110 miles of coastline hit by Monday's tsunami was not affected by that temblor.

Vice President Jusuf Kalla said no local warning was issued Monday because most people fled inland after they felt the earthquake, fearing a tsunami.

"After the quake occurred, people ran to the hills ... so in actual fact there was a kind of natural early warning system," he told reporters in Jakarta.

Monday's quake struck at 3:24 p.m. about 150 miles beneath the ocean floor, causing tall buildings to sway hundreds of miles away in the capital, Jakarta. The region was rattled by a series of strong aftershocks.

After the quake, the Pacific Tsunami Warning Center and Japan's Meteorological Agency issued warnings of a possible tsunami. It struck Java about an hour later and its effects could be felt as far away as Bali island and near Australia's Coco Islands.

Indonesia is on the so-called Pacific "Ring of Fire," an arc of volcanoes and fault lines encircling the Pacific Basin.