The storm has left at least 842 people dead in Haiti with tens of thousands homeless and outbreaks of cholera already claiming more lives. Hurricane Matthew is now battering the US southeast.
As information started to come in from outlying villages in remote parts of Haiti, a tally of deaths reported by civil protection and local officials raised the number of dead to at least 842 on Friday.
In addition, there have been outbreaks of cholera, probably because of flood water mixing with sewage.
"Due to massive flooding and its impact on water and sanitation infrastructure, cholera cases are expected to surge after Hurricane Matthew and through the normal rainy season until the start of 2017," the Pan American Health Organization (PAHO) said in a statement.
Rural clinics on the island, which is the poorest country in the Americas, have been overwhelmed by the number of patients. Some people have broken bones which have not been treated since the storm hit with 233 kph (145 mph) winds on Tuesday.
The US National Hurricane Center (NHC) in Florida said on Friday evening that while Hurricane Matthew was expected to weaken in the following 48 hours, it would probably remain a hurricane until it moved away from the southeastern United States on Sunday. It moved near and over the coast of northeast Florida and Georgia through Friday night and was expected near or over the coast of South Carolina on Saturday.
Two women died in Florida as the hurricane hit. One was killed when a tree fell on her house in the Daytona area and the other died when a tree came down on a camper in Putnam County.
Craig Fugate, director of the Federal Emergency Management Agency, said the real danger was storm surge, particularly in northern Florida and southern Georgia. "These are very vulnerable areas," Fugate said. "They've never seen this kind of damage potential since the late 1800s,"
The US National Weather Service said it could be the most powerful storm to strike northeast Florida in 118 years. The NHC issued warnings and updated advisory statements:
The tops of high-rise buildings in the Jacksonville area were at particular risk of strong winds. The Center advised that winds at the top of a 30-story building will average one Saffir-Simpson category higher than the winds near the surface.
The Jacksonville Governor's office said the storm had cut power to about a million customers in Florida.
President Barack Obama urged people to listen to safety instructions: "I just want to emphasize to everybody that this is still a really dangerous hurricane, that the potential for storm surge, loss of life and severe property damage exists," he said.
About half of the 14,000 residents of St Augustine, just south of Jacksonville, had refused to heed evacuation orders, despite the storm surge warnings, Mayor Nancy Shaver said. "There's that whole inability to suspend disbelief that I think really affects people in a time like this," she commented.
"There are houses that will probably not ever be the same again or not even be there," Shaver said as the floodwaters swept through the streets of the 451-year-old city founded by Spanish settlers.
About half a million people have received evacuation orders in the Jacksonville area, and a similar number on the Georgia coast. More than 300,000 people fled their homes in South Carolina.
"If you're hoping it's just going to pass far enough offshore that this isn't a problem anymore, that is a very, very big mistake that you could make that could cost you your life," NHC Director Rick Knabb warned.
jm/bw (Reuters, AP, AFP)