PORT-A-PIMENT, Haiti — Cholera cases were breaking out by the dozens across a hurricane-devastated swath of coastal Haiti on Sunday, forcing families in isolated villages to carry their ailing relatives out on grueling backcountry treks to reach understaffed hospitals, where patients were collapsed on the floor.

North of the Dlo Mulet River, an area of southwestern Haiti reachable now only by four-wheel-drive vehicles and motorcycles, mile after mile of shoreline tourist towns and fishing villages have been reduced by Hurricane Matthew to a brutalized landscape of smashed homes, crumbled churches, broken trees, and toppled telephone poles.

The overall death toll in Haiti from Hurricane Matthew is still unclear because several remote communities are still cut off by collapsed roads and bridges.


A tally by Reuters put the nationwide figure at more than 900. In the Grand-Anse department alone, officials said 522 were confirmed dead, the Associated Press reported.

The first two cargo planes of humanitarian aid from the United States arrived Saturday at Toussaint Louverture International Airport in the capital, Port-au-Prince, the AP said. Three more American planes are expected. But distribution remains a problem.

In some of villages, and especially in the more remote and inaccessible mountain towns above them, flooding and contaminated water have ignited an outbreak of cholera that is spreading rapidly, according to hospital staff, aid workers, and residents.

In the Port-a-Piment hospital, dozens of cholera patients spilled out of operating rooms into hallways and courtyards Sunday, mixing with relatives and harried volunteer staff. Children were crying and retching on the tile floor.

Babies were lying catatonic with dark circles under their eyes, sprawled on T-shirts and rags, while their parents held up their bags of intravenous fluids.

“Ninety to 95 percent of these patients have cholera — diarrhea, vomiting,” said Missole Antoine, the medical director at the hospital, standing amid the throng of patients. The hospital had no isolated ward for the highly contagious disease. “If everyone keeps coming here, we’ll all be contaminated. We need a new space as fast as possible.”


Since the storm struck early Tuesday, Antoine said she and a nurse have run the hospital largely alone, without sufficient medicine, staff, or supplies. Staff from Doctors Without Borders were pitching in to help treat the crush of patients, including 45 new cholera cases Sunday morning. Four people have died at the hospital from the disease.

“We almost have no medicine,” Antoine said.

Cholera was introduced to Haiti in 2010 by Nepalese peacekeepers, stationed at a United Nations base, whose latrine drained into one of Haiti’s major rivers. Since then, government officials estimate that more than 800,000 people have contracted cholera and that 10,000 people have died.

Aid workers had feared that the waterborne disease would spike after the hurricane, when access to clean water is limited. That now has begun.

One cholera hot spot is a village called Randel, set in a ravine about a four-hour walk from the Port-a-Piment hospital, where more than 100 cases have been reported since the storm, as well as some 25 dead, residents said.

“We had some cholera cases before the storm, but it has gotten much worse,” said Roosevelt Dume, a 37-year-old painter who made his way here Sunday from Randel. “The only people now in the village are the ones with cholera. The others have left.”


Dume’s house, like many others in the village, was destroyed in the storm, his livestock washed away. His family took shelter under a hastily erected wooden lean-to.

“As we were preparing to escape, the house fell on us,” he said. “I was able to rescue my stepmother’s son from under the rubble, and we made it out.”

His family has had little food since then. The only source of water in the village has been a communal spring. On Saturday night, Dume’s 3-year-old son, Roodley, began to vomit and have diarrhea.

At 4 a.m. Sunday, Dume began the hike out of the mountains carrying his son, with the dirt road to Randel blocked by trees, rocks and water. Four hours later, his son catatonic, Dume walked into the hospital and got an IV drip into Roodley’s right hand.

“He’s doing better now,” Dume said, as his son lay on a Sam Diego’s Surf and Skate T-shirt on the hospital hallway floor.

A few feet away, Pierre Donald, 30, held his 22-month-old daughter, Pierredeline, on his lap, an IV running out of her hand, her eyes closed and head lolling back. “She can’t sit up yet,” he said.

He is a bean and cassava farmer from the outskirts of Randel; the storm swept away his goats and sheep and home.

He also hiked to the hospital with his sick daughter Sunday, leaving behind those too weak to leave Randel. Asked if he worried about contracting cholera himself, he said no.


“I was told if you worry, you have it. If you don’t worry, you won’t get it,” he said.

Along this coastline, where people are stuffing their shirts in their nostrils to avoid the wafting smells of animal carcasses, a sense of order has started to erode. Large-scale relief shipments have yet to arrive. Residents are still cleaning up the wreckage, and few have started to rebuild.