There is no food, so along the road through the mountains there are children begging for something to eat. Most of the trucks rumble past with donations for somewhere else. But one stopped here the other day with sacks of rice, beans and dried herring, setting off a stampede.

Valleur Noel, a trim, short man with a checkered shirt and a shiny crucifix, climbed to the top of the tailgate and told everyone to calm down. It was futile. His organisation, Pwoje Men Kontre, had 412 bags of food, a gift from the German ambassador and US donors. Within minutes there were people pouring through a notch between the mountains, hollering and stumbling down the rocky hillside toward the truck.

"No pushing, no pushing!" Noel yelled. "There is enough for everyone!"

It wasn't true. The latecomers got nothing. But many others did, and Figaro Phito, 29, hugged his sack with both arms, like a pillow. "This will keep us alive until another donation arrives," he said. "Because that is our only way to survive right now."

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A month after Hurricane Matthew blasted through southwestern Haiti, the region is a blighted, apocalyptic landscape of wrecked homes and growling hunger. At least 800,000 people need food urgently, according to the United Nations, including more than two-thirds of families in the worst-hit departments of Grand'Anse and Sud.

Emergency help is arriving, but there is not enough of it, and it will take several more weeks to reach remote mountain communities where officials say the destruction was total.

As the sun rises on badly hit town of Jeremie, young men stand in the rubble that were once seaside homes. Photo / Washington Post photo / Sarah L. Voisin
As the sun rises on badly hit town of Jeremie, young men stand in the rubble that were once seaside homes. Photo / Washington Post photo / Sarah L. Voisin

The desperation is so explosive that truckloads of food and medical supplies have been looted by crowds gathered along the roadways. A teenage boy was killed on Tuesday by police in the city of Les Cayes, where hungry crowds burned tires and blocked roads. Haitian police shot four people, one fatally, on October 26 in the coastal village of Dame Marie, where the arrival of an aid shipment sent crowds surging onto the docks.

The October 4 hurricane hit some of the poorest places in the Western hemisphere. It smashed fishing villages and shredded mountain hamlets with the force of a bomb blast, obliterating crops, killing livestock and leaving fruit trees as bare as matchsticks.

Haiti, a country still digging out from its devastating 2010 earthquake, will need months of emergency aid to stave off famine, according to relief groups and government officials. More than 141,000 storm victims are in shelters, and those are just the ones with someplace to go.

"We are sleeping under the trees," said Jeudina Alexis, 63, who hadn't eaten in two days but now had a sack of food from Noel to carry home up the mountain.

In some towns, 80 to 90 per cent of homes were destroyed by Matthew's 140-mile-per-hour winds. The Category 4 storm converted tin roofing panels into flying razors and broken tree branches into spears.

The death toll stands at 546, according to the government, but local officials have reported more than twice that many killed.

Some remote mountain villages are so inaccessible that government emergency workers say they will not be able to reach them until the end of November. One man who walked out of the mountains recently after hiking two days told authorities that too many people had died in his town to bury the bodies, so villagers burned them and put the ashes in the river.

The United Nations has raised just one-third of the $120 million in emergency funding it says it needs to help 750,000 people, including 315,000 children, get through the next three months.

Noel has told his donors he will need to feed people for even longer. "If they plant sweet potatoes and corn, it will be three or four months before they can harvest, but they don't have seeds," he said.

The storm-hit areas have reported at least 3500 suspected cholera cases in recent weeks, but some of the outbreaks are happening in far-off settlements where help has yet to arrive.

The aid organisation Doctors Without Borders recently sent staff by helicopter to one village, Pourcine, to investigate reports of a patient with cholera, only to find 20 stricken from it. The disease spreads rampantly once the bacteria enters the water supply. "We are sending materials to contain the epidemic, but there are people dying from cholera every day," said Emmanuel Massart, the group's field coordinator in Grand'Anse.

It is largely a challenge of distribution. Tim Callahan, the US official in charge of the American emergency response, said the US government has delivered 34 metric tons of water treatment tablets to Haiti, enough to supply the entire country for three months. But getting them to families is another matter because roads are impassable or nonexistent in the worst-affected areas.

Marc Arthur Saint Fleur, 41, lies on a mattress in the sun on his roof in the fishing village of Carpentier in Port-Salut, Haiti. Photo / Washington Post / Sarah L. Voisin
Marc Arthur Saint Fleur, 41, lies on a mattress in the sun on his roof in the fishing village of Carpentier in Port-Salut, Haiti. Photo / Washington Post / Sarah L. Voisin

The 2010 earthquake killed at least 200,000 and damaged many of the government buildings in the Haitian capital, Port-au-Prince. The city was largely spared by the recent storm, and that has allowed the Haitian government to take a more active role in directing the relief effort, Callahan and others say.

Peter Mulrean, the US ambassador to Haiti, said the fact that so many international relief organisations were doing post-quake reconstruction left them better prepared to respond to the hurricane.

Unlike in the post-quake period, when aid efforts were often haphazard and inefficient, international relief organisations have been coordinating their donations and activities with Haitian officials, using the network of modern, air-conditioned emergency response centers set up in every region after the earthquake.

"We want Haitian institutions to come out stronger than before," Mulrean said.

But the man-made disasters of Haitian politics remain an obstacle. Last year's contested presidential election led to a political impasse and the installation of a caretaker government. New elections are scheduled for November 20, but it's hard to see how Haitian officials can deliver and count ballots in hurricane-hit areas.

Making matters worse, the public schools that double as polling stations are being used as homeless shelters.

At the Lycee Nord Alexis in Jeremie, the battered capital of Grand'Anse, children sleep on the cement floors of classrooms, some naked or clothed in adult-sized T-shirts that hang below the knee. Food comes irregularly. The blind, disabled and maimed lie around in dark, stifling rooms, swarmed by mosquitoes.

Guerline Brumaches, 40, was languishing in a corner, naked from the waist up, with a suppurating wound the size of a baseball on her swollen left foot where she had been cut by flying debris. A month-old chemistry lesson was written on the chalkboard above her. Flies nibbled at her foot.

"If I lose my foot, I don't know what I'll do," she said.

The school had no running water. One of the stairwells had become a latrine. Xavier Charlemagne, 20, said there were several hundred people sleeping every night in the classrooms and corridors.

"We're not leaving until they give us tarps," he said.

Merline Charles, 21, sits on a concrete slab which once was her home with her son, Sander Dore, 1, and her daughter, Widlove Adonia, 4. Photo / Washington Post / Sarah L. Voisin
Merline Charles, 21, sits on a concrete slab which once was her home with her son, Sander Dore, 1, and her daughter, Widlove Adonia, 4. Photo / Washington Post / Sarah L. Voisin

Jeremie is the only town with large-scale daily food distribution in Grand'Anse, in part because it is the only place with armed security to suppress potential rioting. The UN World Food Program gives out 1000 one-month rations of rice, chickpeas and cooking oil each day in the central plaza, in the shadow of a 200-year-old cathedral with a ripped-off roof.

But the sight of so many convoys headed to Jeremie has stirred resentment in towns that say they are not getting their share. At one highway junction where a broken-down truck carrying beans had been attacked a day earlier, dozens of young men lingered on a recent day, watching for signs of mechanical trouble among the vehicles groaning up the pass, as if stalking wounded herd animals.

"We are starving, too," said Ricardo Dauphin, 29, alongside dozens of other men in the town of Carrefour Charles, watching UN trucks roll by in a cloud of dust, escorted by police and Brazilian soldiers.

There is no electricity across a wide swath of southern Haiti where utility lines are down, so at night families burn storm debris and garbage with huge bonfires that leap into the darkness and foul the air.

On a muddy hillside near the town of Cavaillon, scores of people have settled in crude lean-tos made of sticks, plastic and tattered bedsheets. The nearby river flooded in the storm, forcing those living along the banks to higher ground.

Olicia Jean-Louis, 23, said her widowed mother was washed away in the storm, along with the family's house and all the secondhand footwear they used to sell in the market. Now Jean-Louis was in charge of her siblings, ages 12, 10, 5 and 2. The youngest ones had started calling her "mama," she said.

None of them had eaten that day, Jean-Louis said. It was raining again, and the 2-year-old boy, naked, leaned into her threadbare blue dress, his nose running.

Asked what she would do next, Jean-Louis shook her head.

"I will rely on you," she said. "Can you help me?"