A cholera epidemic spread in central Haiti on Friday as aid groups rushed doctors and supplies to fight the country's worst health crisis since January's earthquake. Nearly 200 deaths had been confirmed and more than 2,000 people were ill.
The first two cases of the disease outside the rural Artibonite region were confirmed in Arcahaie, a town that is closer to the quake-devastated capital, Port-au-Prince.
Officials are concerned the outbreak could reach the squalid tarp camps where hundreds of thousands of quake survivors live in the capital.
"It will be very, very dangerous," said Claude Surena, president of the Haitian Medical Association. "Port-au-Prince already has more than 2.4 million people, and the way they are living is dangerous enough already."
The Ministry of Health confirmed 194 deaths and 2,364 cases of cholera, said Imogen Wall, a spokeswoman for the U.N. Office for the Coordination of Humanitarian Affairs.
"It's concentrated in Artibonite right now and we're doing our best to keep it that way," Wall said.
Dozens of patients lay on the floor awaiting treatment at the St. Nicholas hospital in the seaside city of St. Marc, some of them brushing away flies on mattresses stained with human feces.
One of them, 55-year-old Jille Sanatus, had been there since his son Jordany brought him Thursday night. A doctor was struggling to stick a needle into his arm.
"He's completely dehydrated, so it's difficult. It's hard to find the vein," said Dr. Roasana Casimir, who had been working nearly without rest since the outbreak began two days earlier.
Casimir finally penetrated the vein and fluid from an IV bag began to trickle in, but half an hour later the father of 10 was dead. Two hospital employees carried the body to the morgue behind the hospital and placed it on the ground for the family to reclaim for a funeral.
Sanatus' son said the family had been drinking water from a river running down from the central plateau region. Health Minister Alex Larsen said Friday that the river tested positive for cholera.
Wall said the sick patients and the contagious remains of the dead were insufficiently quarantined.
"Part of the problem has been people are moving around a lot, and there hasn't been proper isolation in place at the clinics," she said.
The sick come from across the desolate Artibonite Valley, a region that received thousands of refugees following the Jan. 12 earthquake that killed as many as 300,000 people and destroyed the capital 45 miles (70 kilometers) south of St. Marc. Most of the new arrivals have been taken in by host families.
In addition to the two cholera cases confirmed by the health ministry in Arcahaie, the International Medical Corps said it was investigating other possible cases in Croix-des-Bouquet, a suburb of the capital. Radio reports also said there were two dozen cases of diarrhea on Gonave island.
Cholera was not present in Haiti before the earthquake, but experts had warned that conditions were ripe for disease to strike in areas with limited access to clean water.
"You cannot say it is because of the earthquake, but because of the earthquake the situation here requires a high level of attention in case the epidemic extends," said Michel Thieren, a program officer for the Pan-American Health Organization.
Cholera is a bacterial infection spread through contaminated water. It causes severe diarrhea and vomiting that can lead to dehydration and death within hours.
Larsen, the health minister, urged anyone suffering diarrhea to make their own rehydration serum out of salt, sugar and water to drink on the way to a hospital.
Catherine Bragg, the U.N.'s No. 2 humanitarian official, said officials could not yet explain exactly how the outbreak occurred, or when it might end.
"I cannot say that it is under control," Bragg, the U.N.'s assistant secretary-general for humanitarian affairs, told reporters at U.N. headquarters in New York. "Cholera deaths are preventable, and we're doing everything we can. However, clearly a lot more needs to be done."
The number of cases will continue to grow because Haitians do not have any built-up immunity to cholera, said Jon Andrus, deputy director of the Pan American Health Organization's Regional Office for the Americas, which is sending medical teams to the neighboring Dominican Republic as a preventive measure.
"We have all the things in place for something we know will get bigger," Andrus said.
Aid groups and the government were rushing in medical and relief supplies including 10,000 boxes of water purification tablets and 2,500 jerrycans, according to the World Health Organization.
Wall said some 300,000 courses of antibiotics were available in Haiti and were being prepared for use in the Artibonite.
Outside the hospital in St. Marc, 28-year-old Ismode Mesinord was among dozens of relatives clamoring to get in to see their relatives. She complained security guards would not her in to visit her 1-year-old son.
"I'm worried because he's vomiting and has diarrhea and there's no one to take care of him," she said.
Associated Press writers Mike Melia and Danica Coto in San Juan, Puerto Rico, contributed to this report.