PORT-AU-PRINCE, Haiti -- Hurricane Tomas flooded camps of earthquake refugees, turning some into squalid islands Friday as it battered Haiti's rural western tip, while largely sparing the vast homeless encampments in the shattered capital.
Aid workers rushed to guard against the spread of disease as the storm moved into the region where thousands are infected with cholera.
Driving 85 mph winds and a lashing storm surge battered Leogane, a seaside town west of Port-au-Prince that was 90 percent destroyed in the Jan. 12 earthquake.
In one refugee camp, dozens of families carried their belongings through thigh-high floodwaters to a taxi stand on higher ground, huddling under blankets and a sign that read "Welcome to Leogane."
"We got flooded out and we're just waiting for the storm to pass. There's nothing we can do," said Johnny Joseph, a 20-year-old resident.
Four deaths were confirmed by Haitian officials, all people attempting to cross rivers by car or on foot in the mountainous region to the west of Leogane, on Haiti's far southwestern tip. Two more people were missing in Leogane.
Tomas had earlier killed at least 14 people in the eastern Caribbean. On Friday it came ashore as a Category 1 hurricane, pummeling Haiti's southern peninsula, before moving on to the rest of the country, eastern Cuba and the Bahamas.
It could be days before the storm's impact is known as reports filter in from isolated mountain towns cut off by the flooding. But as officials took stock and aid workers rushed to contain flood damage and the widening cholera epidemic, the storm left harsh reminders of poverty's toll on the Caribbean nation.
"We have two catastrophes that we are managing. The first is the hurricane and the second is cholera," President Rene Preval told the nation in a television and radio address.
He could have included a third. Ten months after the magnitude-7 earthquake shook the capital to the ground, the devastation can still be seen in scores of collapsed buildings and sprawling refugee camps.
The disasters mingled in Leogane, where milky brown floodwaters filled quake-cracked streets and cut off a camp that was home to hundreds of refugees.
"We have an assessment team there now and there's a couple towns that have been damaged from some flooding and some wind damage," said Steve McAndrew, head of operations for the American Red Cross.
The storm's center was about 50 miles (80 kilometers) south of Great Inagua Island after it lashed Port-au-Prince, where a thick gray canopy of clouds hung over the capital and a steady downpour turned streets into flowing canals that carried garbage through the city. By late Friday, its wind speeds had diminished to 75 mph (120 kph).
Haitian authorities had urged the 1.3 million Haitians left homeless by the earthquake to leave the camps and go to the homes of friends and family. Buses were sent to take those who wanted to evacuate to shelters.
But many chose to stay, fearing they would come back to find that they had been evicted from the private land where they have been camped out since the quake, living in donated plastic tarps, or that their few possessions would be stolen before they returned.
A near-riot broke out amid a poorly coordinated relocation effort at the government's flagship camp at Corail-Cesselesse when residents began overturning tables and throwing bottles to protest what they saw as a forced removal.
About a third of the camp's nearly 8,000 residents ultimately went to shelters in a nearby school, church and hospital, American Refugee Committee camp manager Bryant Castro said. But there was no space for many others, who were forced to ride out the storm in the open.
"Yet again there is very poor planning and last minute decision-making that scares people who have already had zero communication about what their future holds," Oxfam spokeswoman Julie Schindall said.
In Leogane, protesters took to the streets in the pouring rain, beating drums and blasting horns as they lambasted officials for failing to build a canal along a river that has overflowed repeatedly in the past. Flood waters filled people's homes, swirling around the furniture and framed pictures.
"When it rains the water rises and causes so much damage. We want them to dig a canal to move the water," said Frantz Hilair, a 28-year-old motorcycle taxi driver. "We have a mayor and the deputy, but they don't do anything."
Local authorities put the blame on the federal government.
"They have a reason to be mad. The central government hasn't done anything here," Deputy Mayor Wilson St. Juste said.
Farther north in Gonaives, a coastal city twice inundated by recent tropical storms, police evacuated more than 200 inmates from one prison to another.
Poverty has steadily worsened in Haiti over the last century, with an unending spiral of political upheaval, flawed international intervention, frustrated aid attempts and natural disasters. Post-quake reconstruction has barely begun or even been funded; less than 38 percent of the money pledged for rebuilding has been delivered, including a promised $1.15 billion from the United States.
Aid workers are concerned the storm will worsen Haiti's cholera epidemic, which has killed more than 440 people and hospitalized more than 6,700 others.
Preval called on Haitians to help stop the spread of the disease.
"Water is going to bring the bacteria, and people who are moving around can infect other areas," he said in his radio broadcast. "Use hygiene, cook the food you are eating, boil the water you are cooking with so we don't have the epidemic of cholera abscess into something even worse."
U.S. Marines were standing by on the USS Iwo Jima off the coast with relief supplies.
As the hurricane neared Cuba's eastern tip, that country's crack civil defense forces evacuated 800 people from Baracoa, a city that often floods during inclement weather.
Meanwhile, a cold front hammered the western part of the island with heavy rains and a storm surge that flooded some low-lying parts of the capital, Havana, and closed the seaside Malecon thoroughfare.
In the Dominican Republic, to the east of Haiti, floods damaged at least 1,700 homes and forced the evacuation of more than 8,000 people, emergency operations director Juan Manuel Mendez said.
A hurricane warning was issued for the southeastern Bahamas and the Turks and Caicos Islands, on the storm's path once it emerges from the strait between Haiti and Cuba.
The eye of the storm was expected to pass over Great Inagua Island about two hours before midnight, according to a government statement that warned people to remain indoors.
"Residents should not be deceived by this brief calmness," it said.