The death toll from the massive earthquake that struck Haiti on Saturday rose as rescuers worked against the clock to find survivors who may be buried under rubble as a massive storm looked to be headed straight toward the Caribbean country. The official death increased to at least 1,297 people with 2,800 more injured, according to Haiti’s civil protection agency. But the real toll is expected to be several times higher as homes have been flattened, hospitals are overwhelmed, and authorities haven’t even been able to reach some of the worst-affected neighborhoods. Southwestern Haiti has been hit the hardest with much of the devastation focused around the city of Les Cayes as the quake’s epicenter was around 78 miles west of the capital of Port-au-Prince.

While rescue workers tried to reach survivors there was an impending sense of doom amid fears that the devastation could soon worsen thanks to Tropical Storm Grace that is expected to hit Haiti Monday night. The storm is likely to bring flooding and landslides that would make rescue operations even more difficult. The U.S. National Hurricane Center forecast as much as 15 inches of rain in some southern parts of Haiti. “The most important thing is to recover as many survivors as possible under the rubble,” said Prime Minister Ariel Henry, who declared a one-month state of emergency. “We have learned that the local hospitals, in particular that of Les Cayes, are overwhelmed with wounded, fractured people.”

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Even before the earthquake struck, Haiti’s health services were already struggling with an increase in COVID-19 cases amid a vaccination campaign that has barely gotten off the ground. “Basically, they need everything,” a pediatrician with the nonprofit Health Equity International said. The quake also struck at a time when Haiti has been engulfed in political crisis following the assassination of President Jovenel Moise on July 7. That crisis is having practical effects as the only road linking Port-au-Prince with some of the worst hit areas is controlled by criminal gangs. “It has been a war zone for a long time. Fuel cannot get through. Supplies cannot get through. Ambulances cannot get through,” said Jean William Pape, a prominent Haitian doctor. That meant rescuers often had to rely on helicopters and small planes.

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The United Nations warned that violent gangs are “hindering the capacity of humanitarian actors to operate normally and reach affected populations.” The country’s prime minister is calling for “structured solidarity” in an effort to prevent the mismanagement that marked the rescue efforts after the devastating 2010 earthquake that killed as many as 300,000 people. For now there appeared to be a sliver of good news as a United Nations reconnaissance mission to the affected areas found “less significant damages than initially expected.” The United States Agency for International Development has sent a 65-member search-and-rescue team to Haiti that includes four dogs. But the agency warned that Tropical Storm Grace was “potentially exposing people to further devastation in a matter of days.”

*This post has been updated with new information since it was first published.

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