Before devastating the eastern seaboard of the United States, Hurricane Sandy wreaked destruction on the Caribbean, causing at least 71 deaths.

While spared the direct brunt of the storm, Haiti suffered the highest human toll, with 54 dead and another 20 missing. Cuba had 11 people killed, while the Dominican Republic and the Bahamas each had two dead, and Jamaica and Puerto Rico each had a single fatality.

The storm has exacerbated the food crisis in Haiti, a developing cholera infestation in eastern Cuba, and the threat of Dengue fever in the Dominican Republic. The storm is also intensifying the political crisis of Haitian President Michel Martelly and may have political implications in Cuba, with the damage to nearly 250,000 acres of crops posing the threat of food shortages and a further decrease in the living standards of the working class.

In Cuba, the storm also damaged at least 200,000 homes, mainly in the eastern part of the country, which has some of the worst housing problems. A number of the deaths were caused by houses collapsing on their occupants. Hurricane Sandy has also raised fears about increased spread of disease.

Earlier in the summer, Cuba had experienced its first cholera infections in 100 years. Known for its advanced medical system, Cuba has provided personnel and support to Haiti for many years. Cuba is less than 50 miles across the Windward Passage from Haiti, and the disease, which was reintroduced to Haiti by the United Nation’s MINUSTAH troops in 2010, was likely spread to Cuba from there. To date the Cuban government has said only that the disease was found in polluted wells in the eastern part of the country, but heavy rains from Hurricane Sandy have now increased the risk of contagion.

In the Dominican Republic, the government issued a warning that Sandy’s rains might lead to a spread of cholera and of Dengue fever, which is carried by mosquitoes. Cholera spread across the border from Haiti to the Dominican Republic in late 2010.

The heavy toll in terms of fatalities in Haiti is directly bound up with the protracted social catastrophe there. Nearly three years after the devastating earthquake of 2010, an estimated 500,000 Haitians still do not have permanent homes, with many still living in tents.

There have been reports of people drowning while trying to cross swollen rivers, a tragedy so common that the government issued public advisories about it before the storm. The flooding also is leading to an increase of cholera cases in Port-au-Prince and the country’s south, some areas of which received more than 20 inches of rain from Sandy. The disease had already killed more than 7,400 Haitians before the hurricane.

Sandy hit Haiti on October 24 and 25. By the 29th, Reuters was reporting 86 new cases of cholera in the Port-au-Prince camps housing people still homeless from the earthquake. On October 31, alterpresse.org reported eight cholera deaths and 78 new cases in the southern towns of Maniche and Dori, which had seen no cases before the storm. Storm waters in the swollen Cavaillon river cut off Dori from medical aid, and alterpresse reported cases of people swimming across the river just to obtain cholera medication.

The effects of the hurricane are also deepening the food crisis in Haiti. An estimated 70 percent of banana and corn crops in the south of the country were destroyed. This area had been spared the effects of a drought that caused damage to northern crops in the spring and early summer. Hurricane Isaac, which hit Haiti in August, also damaged crops.

Even before Sandy, food prices in Haiti were spiking. August figures from the Institut Haitien de Statistique et d’Informatique (Haitian Institute of Statistics and Information) showed a yearly increase of 6.8 percent. General inflation in the capital saw a .7 percent monthly rise, while in the west and south it went up 1 percent. Tellingly, the price of food grown in Haiti increased by 1.3 percent in one month, while imports—largely from US agribusinesses which are favored by “free trade agreements”—went up only .7 percent.

Food prices had already led to political unrest. (See “Martelly government cracks down on Haitian protests”) The government of President Michel Martelly has now proclaimed a 30-day state of emergency under the pretext of managing food supplies, but with an eye to suppressing the protests. Martelly did not bother to consult the legislature, even though his predecessor Rene Preval made that gesture before declaring a state of emergency after the earthquake.

It is clear that Martelly fears the response of workers to the crises. After making a show of handing out bottled water during the storm, he flew to Paris and gave an interview to the television network France 24. In it, he discussed the possibility of a “coup” against his government and declared that “today, there is a force for maintaining order which is there, that force of the United Nations and the international community which is watching over Haiti.”

Haitian workers are taking Martelly’s measure while he hides behind UN troops. On October 31, Le Nouvelliste reported a protest of several hundred people in the city of Leogâne, in streets still flooded from the storm. Leogâne was devastated by the 2010 earthquake, but is now joining in protests which began mostly in the capital and the country’s north during September. In addition to raising grievances against the national government, a grouping of 54 organizations is calling for the ouster of the city’s mayor, who stands accused of embezzling funds and threatening the protesters.

A recent survey of 200 countries and their vulnerability to climate change listed Haiti as the most vulnerable on the planet, in large measure due to the threat from floods and mudslides.