Doctors are performing amputations without electricity or running water while waste from this city's shattered sewage system contaminates mud and floodwaters, infecting wounds that threaten to turn gangrenous.
More than a week after the passage of Tropical Storm Jeanne, the calamity in the northwest city of Gonaives has overwhelmed Haitians and foreign rescue workers.
Thousands remain hungry. Jean-Claude Kompas, a New York doctor who rushed to his native Haiti to volunteer his services last week, says he has treated 30 people for gunshot wounds received in fights over scarce food. Another of his patients was a child whose finger was chopped off with a machete _ possibly also over food.
Jeanne killed more than 1,500 and left 200,000 homeless in the northwest city of Gonaives. With another 1,000 people reported missing, the toll is sure to rise.
"It's sad but true that the missing will slowly be started to be counted among the dead," said Brazilian army Gen. Augusto Heleno Ribeiro Pereira, in charge of a U.N. peacekeeping force in Haiti.
On Saturday, Pereira rushed 100 Uruguayan and 50 Argentine troops to Gonaives, where gangsters and ordinary citizens have been looting food aid. They reinforced 600 international troops and police in the city.
Pereira said many storm survivors are suffering from diarrhea while others, including many children, had infected wounds. Some had gangrene and Argentine doctors had performed at least three amputations under primitive conditions, he said. Most injuries are gashes from collapsing roofs or pieces of zinc roof hidden by the mud that still covers the city, where most walk barefoot.
"They have minimal conditions," said Pereira. "You have to understand that there isn't even a hospital there. It's very difficult."
Gonaives' general hospital was half buried in mudslides and floodwaters believed to have killed many patients.
A makeshift hospital has been set up in two rooms of the State University, with six stretchers on the floor of one room serving as a ward, and two tables in the second room an operating theater. On Sunday, doctors amputated the gangrenous leg of a man who died the next morning.
Hours later, doctors rushed an expectant mother to a table, gave her a local anesthetic, and cut open her abdomen in a bid to save her baby. The child was stillborn. After trying to resuscitate it, a Brazilian army chaplain gave the infant the last rites. The mother then held the baby before the corpse was taken away and doctors stitched up her abdomen.
Kompas said most cases he treated were open wounds infected by bacteria in the contaminated water, including ones that can lead to gangrene.
He expected to see cases of tetanus soon and said he, another Haitian doctor and a handful of Argentinian army medics cannot cope with the scores of people needing treatment daily.
"There are no X-ray machines, not enough antibiotics, not enough anesthesia, so a lot of procedures are very rudimentary," he said.
A spokesman for the Argentine troops, Lt. Col. Gaston Irigoyen, said military officers have been discussing ways to prevent gangrene and other infections, such as wider use of antibiotics and antiseptics.
Irigoyen said several particularly sick patients were evacuated to a military hospital the Argentinians have set up at their base in the capital, Port-au-Prince.
Many nations and aid groups have sent planeloads of relief supplies to Port-au-Prince. But getting them to Gonaives, and then to the people who need them most, is a challenge.
Normally, it would take four hours to drive the concrete road _ worn to bedrock in parts _ that runs 90 miles northward from the capital to this city. Since the storm, a 4-feet-deep lake has formed just before the entrance to Gonaives; the lake is now littered with mired aid trucks that could not make it through.
On the other side of Gonaives, National Route 1 _ the main highway linking the capital to the country's second-largest city, Cap-Haitien _ has been cut. "It's like a canyon, not a road anymore," said Andrea Pagnoli of the World Food Program, who last week used donkey and mules to carry food to a cut-off community northeast of Gonaives.
Chilean troops in the U.N. force have been ferrying supplies by helicopter from Cap-Haitien, but not enough.
Communications are difficult, with landline telephone service cut, cellular telephones providing only patchy service and even satellite telephone connections difficult.
With most residents homeless and without the means to barter, they are at the mercy of the elements and criminal gangs that roam at will.
Even before the storm, most residents of Gonaives, as in other Haitian cities, used wells and springs for water. There are always shortages of running water and electricity in Haiti. Medical care is abysmal, with 1,000 physicians to serve a population of 8 million, and the vast majority of doctors based in Port-au-Prince.
Medicines are in short supply, but also cost more than the average Haitian, who makes less than $1 a day, can afford.
China is expected to send 130 police to Haiti to help bolster the U.N. peacekeeping force, a State Department official said Monday night. It is believed the deployment would be China's first in the Western Hemisphere.