LEOGANE, Haiti -- Standing on a raised piece of pavement across from the makeshift home where she has lived for the past 10 months, Violet Nicola threw up her hands.
"Our houses are broken again. I've lost my things. They don't do anything for us. We never see them," she said, referring to aid groups. "Since the water has come in here, we're mired in more problems."
Below her feet, thigh-high muddy brown water extended in every direction along the downtown's main street on Friday. The floodwaters seeped inside Nicola's tarp-covered shelter, washing away her belongings.
Hurricane Tomas left Haiti's capital city of Port-au-Prince relatively unscathed. Leogane, some 29 kilometers west and at the epicenter of January's earthquake, was drenched in rain.
The humanitarian group Save the Children says at least 35,000 people in Leogane may have been affected by flooding. Sewage and trash carried by moving water "will make conditions even more conducive to deadly cholera bacteria," the group said in a press release.
The death toll from a three-week-old cholera epidemic has risen to at least 501, according to the Haitian Ministry of Health.
The Haiti Epidemic Advisory System, an independent bio-surveillance network, reported new suspected outbreaks of cholera in towns across Haiti's central region on Saturday.
The peak of the cholera epidemic will come "earlier and faster" because of Hurricane Tomas, Christian Lindmeier, a World Health Organization press officer, told IPS.
A report from the Ministry of Health says nearly half of the victims died in their communities, not in hospitals. "The challenge is getting to them in time for the mortality rate not to rise too much," Lindmeier said.
Reached by IPS on Saturday evening, many humanitarian organizations said they spent the day conducting surveys of the destruction wrought by Tomas, not distributing relief to those displaced from their dwellings.
The USS Iwo Jima, a warship turned floating hospital touted as a centerpiece of the U.S. response to the storm, is anchored near Haiti.
The ship's only response so far, at the request of the Haitian government, has been to conduct aerial damage assessments, according to its public information officer. "I don't have any of the feedback yet," officer Jacqui Barker said. "There is no intel right now."
In Grand Goave to Port-au-Prince's west, 189 shelters in seven different camps were damaged. Pinchinat camp in Jacmel, to the south, was torn apart by torrential rains, according to an internal summary of damage assessments by the shelter-oriented cluster of aid groups.
"There is currently no humanitarian response planned for this camp," the document says.
"Tents were down all over the place. It was pouring down rain and everyone was drenched. Shelters had been set up, but there was no one providing transportation to these shelters," local resident Gwenn Mangine wrote in a post on Facebook.
Aid workers told IPS that in Cite Soleil, an oceanside slum on Port-au-Prince's northern edge, trash-filled canals overflowed into at least one camp. No one has received aid yet, they said.
Across Haiti, "Almost no shelter materials have been distributed. IOM is still conducting assessments," Leonard Doyle, press officer for the International Organization for Migration (IOM), told IPS.
The day before Tomas passed Haiti, aid workers planned for some earthquake victims in low-lying areas like Cite Soleil to be evacuated from their camps.
Mackendy Laguerre, a member of IOM's Cite Soleil camp management team, said two Cite Soleil camp communities would be moved into a church, if they consented.
As ominous dark clouds swirled overhead, Laguerre pointed to the church across the street. The ramshackle structure appeared to be constructed of tacked-together metal sheets. It was marked with red paint by an engineering team after the earthquake, marking it as structurally unsound and prone to collapse.
The residents of the two nearby camps, Cozbami and Immaculee, refused to evacuate. Rosemond Joseph said people in his camp were afraid their belongings would be stolen if they left.
One woman told IPS, "We're going to die." Fortunately, Cite Soleil was not as hard hit as feared.
After a one-day storm blasted through Port-au-Prince on Sept. 24, aid workers did not commence distributions of tents and tarps to over 10,000 families whose shelters were destroyed until an additional day had passed. Those families spent two nights in a row under the stars or huddled with friends and family.
The shelter cluster of humanitarian groups - charged with keeping solid cover over the heads of 1.3 million people still living in makeshift camps - circulated a document entitled "Lessons learnt".
It called for a "system in place to ensure there are sufficient replacement and contingency stocks of shelter materials available in country." At that point, miraculously, Haiti had been spared another crisis despite a highly active hurricane season.
Over one month later, as Hurricane Tomas approached, the United Nations made a desperate appeal for shelter materials, citing a shortage of 150,000 tarpaulins. "We need emergency shelter. We need water and sanitation supplies. And we need as much of it as possible in place before Hurricane Tomas hits," said Nigel Fisher, the top U.N. official in Haiti.
"We were depleted by the storm on the 24th and it takes a while to build the stocks," U.N. spokesperson Imogen Wall told IPS.
She pointed to the need to constantly re-supply camps with new shelter material, adding, "If you have tarpaulins, it doesn't make sense to leave tarps in warehouses."
Wall said hurricane shelter capacity is "very limited". She referred to some hurricane shelters in Leogane, but shelter cluster documents say they were empty during and after Tomas.
"It doesn't make sense in a country this poor to put up single-purpose structures," she said.
A Nov. 5 shelter cluster document outlining its response to Tomas says 100,000 families were potentially affected by the storm, with current stocks estimated to cover just 64 percent of them. It notes that 20,000 additional tarps are stuck in Haitian customs.
Officials say neither the cholera outbreak nor flooding from Tomas will have any impact on planning for the upcoming Nov. 28 election.