The devastation in Haiti from Hurricane Matthew and the loss of life are quickly being compounded by an outbreak of cholera, as flood waters mix with sewage.

The death toll as of Saturday morning stands at 877, but that number is expected to rise as emergency workers reach communities razed by the storm. Tens of thousands of people have been left homeless. Rural clinics are overflowing with patients whose wounds — including broken bones — had not been treated since the storm hit on Tuesday. Food is scarce.

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“We flew over parts of the Grand’Anse region. It’s a humanitarian catastrophe,” said Frenel Kedner, a government official in the town of Jeremie in southwest Haiti. “The people urgently need food, water, medicine,” Reuters reported.

At least three towns reported dozens of fatalities, including the hilly farming village of Chantal, whose mayor said 86 people were killed, mostly when trees crushed houses. He said 20 more people were missing.

Haiti, the poorest country in the Americas, was hit on Tuesday with 145 mph winds and torrential rain. With cellphone networks down and the infrastructure compromised, aid has been slow to reach hard-hit areas. The Mesa Verde, a U.S. Navy amphibious transport dock ship, was en route to Haiti to support relief efforts. The ship has heavy-lift helicopters, bulldozers,  fresh-water delivery vehicles and two surgical operating rooms.

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On Saturday morning Hurricane Matthew made landfall in South Carolina, bringing floods and strong winds.