People and communities in Cuba, Jamaica, Haiti, the Bahamas and the United States have been badly hit by Hurricane Sandy since 24 October.
Nearly 40 people died after the storm battered the East Coast of the United States 48 hours ago.
The most affected areas in the USA are New York City, Long Island and the south of New Jersey, although the storm also caused floods and power outages in Connecticut, Massachusetts, Rhode Island, Pennsylvania, Delaware, Virginia, Maryland, North Carolina and Washington DC.
In the Caribbean, the storm had an impact in at least five countries, mainly Cuba, Jamaica, Haiti and the Bahamas where work is now being done on post-disaster damage and needs assessment.
Hurricane Sandy has left 68 people dead across the Caribbean and many more are reported missing. In general, it has directly and indirectly affected a population of more than 4.5 million people.
The Pan American Health Organization has offered a sobering assessment of the health situation across the region.
In Jamaica some damage was reported to the roofs of several hospitals and health centres; however the majority of the damage was in administrative and kitchen areas of the facilities. There are some problems with access, but all hospitals are currently functioning, though some are using generators and water storage.
Many primary health centres remain closed. Several roads are blocked which may impede access to health care services in some places. A total of 136 shelters have been established and 1,900 people were evacuated. The Pan American Health Organization (PAHO/WHO) has deployed one dengue expert and one disaster management expert to Jamaica.
In Haiti, 54 confirmed deaths were reported, with 20 injured and 20 missing while 12,947 people were evacuated to 102 shelters around the country. More than 18,000 families have been affected. Strong rains and flooding caused damage to main routes, roads and bridges in Haiti.
An increase in the number of cholera alerts has been received, especially in the departments of South, Southeast, low Artibonite and Ouest which are mainly in Metropolitan areas, and particularly from several IDP camps and areas which are difficult to access. Several Cholera Treatments Centres (CTC) were affected by strong winds and flooding. The CTC in Baradères was destroyed. Several NGOs , PAHO/WHO and the Ministry of Health are assuring case management in the area.
The major concern is access to health services and restocking of supplies.
In Cuba, 11 deaths have been reported, nine in Santiago de Cuba and two in Guantánamo. Several hospitals have been affected in all provinces as well as 375 health centres. Two hospitals experienced severe damage: the General Teaching Hospital in Mayarí and the General Teaching Hospital in Banes in the Holguín Province. All hospitals report some type of damage, although all of them report that they are able to function.
More than 820,000 people (only in Santiago and Holguin provinces) are currently lacking a running water supply.
Cuba has the response capacity for public health and disease surveillance; however, the situation is being monitored in case additional help is necessary.
In the Bahamas, two deaths have been reported. The areas most affected are Grand Bahama, some of the Southern Islands (Cat Island, Rum Cay, Long Island) and Abaco (particularly Treasure Cay) where there are a large number of vulnerable populations.
Reports indicated flooding and damage to the roofs of the health clinics in different locations. Migrant Haitian communities have been severely affected by hygiene and sanitation issues. The Ministry of Health is currently assessing the full extent of the problems in key areas such as Abaco.