The death toll from Hurricane Matthew in Haiti has soared past 1,000

While Hurricane Matthew caused modest damage in the United States, the devastation in Haiti has been absolutely horrifying.

At least 1,000 Haitians have died, according to a survey of local officials by Reuters, and tens of thousands have been left homeless after the storm flattened entire towns last week. The official death toll is still uncertain, and it could rise further in the days ahead, particularly with cholera now breaking out in some areas.

Matthew was a Category 4 hurricane when it hit the western cities of Les Cayes and Jeremie on October 4. Here are some wrenching photos of the aftermath from the United Nations Stabilization Mission in Haiti:

The UN says that 1.4 million people are in dire need of assistance. Aid workers and rescue teams struggled early on to reach many of the hardest-hit areas, as floods made roads inaccessible and severe winds cut communication lines.

Making things worse, cholera outbreaks have killed at least 7 people after flood water mixed with sewage (cholera causes diarrhea and severe dehydration and can kill within hours). The storm also destroyed up to 80 percent of crops in some areas.

Haiti is the poorest country in the Western Hemisphere, which only increases its vulnerability to hurricanes and other disasters. The country’s already flimsy building codes are rarely enforced. Thousands of houses toppled during the storm, particularly those not made of concrete blocks.

Poor preparation also hurt: Whereas neighboring Cuba has mandatory hurricane drills every spring, Haiti tends to be far less ready. Before Matthew arrived, Haitian officials struggled to evacuate areas in the hurricane’s path. As Reuters reported, “Poor Haitians are often reluctant to leave home in the face of storms, fearing their few belongings will be stolen.”

Since the hurricane has passed, Haiti’s government has struggled to provide food and water to those affected. By some accounts, corpses have been dumped in mass graves to prevent decomposing, and doctors were slow to return to hospitals.

One key question now is how recovery efforts will unfold. When a major earthquake hit Haiti’s capital in 2010, leaving 250,000 dead, international aid groups swooped in. But critics say those groups did little to help build Haiti’s capacity to respond to future disasters. What money they did spend was often ineffective or poorly directed, with less than 1 percent bolstering local organizations. Making things worse, UN peacekeepers arrived in the country only to help cause a massive cholera epidemic that later killed thousands.

This time around, the Haitian government is trying to avoid a repeat of that fiasco. Officials have said they will take charge of the recovery efforts, rather than allowing NGOs to swarm in with little accounting of where the money actually goes.

In a statement, Haitian ambassador to the United States Paul Altidor said the country would like to “avoid mistakes from the past” and encouraged donors “to work with the local organizations and institutions on the ground in order to gain their input on the actual needs of the affected communities.”

—If you want to donate to Haiti, read this advice from the Center for Global Development. They note that money is far more effective than water bottles or clothing. Also: “There are a number of excellent Haiti-based organisations, like Zanmi Lasante and TiKay Haiti, who are best placed to understand and address local needs, but who struggle for funding.”