The most powerful Caribbean hurricane has hit the country perhaps least able to withstand it.
Haiti, one of the world poorest countries is still recovering from a 2010 earthquake, which killed more than 200,000 people, along with a cholera epidemic that followed.
Save the Children's country director in Haiti, Kevin Novotny, told SBS News many of Haiti's 11 million residents live in homes that are flimsy and prone to flooding.
"Many of the houses, particularly on the coast, you'll have houses that have either palm front of tin roof, tin sheet roofing, concrete walls for most cases, and in some cases wood. So certainly not built to withstand 140 mile an hour winds," he said.
However, Mr Novotny said many people refused to evacuate, fearing they might lose the few possessions they have.
"People often, in a particular area like that they don't have much, you'd rather stay and protect it than run away from it. Looting might not be as big of an issue as just the the fact they might just come back to nothing," he said.
Far to the north, the first evacuations were ordered in the United States as coastal dwellers prepared to flee the approaching monster storm, expected off the east coast later this week.
The death toll stood at seven -- three in Haiti and four in the Dominican Republic -- but was certain to rise as dangerous Matthew bruised its way on.
The full scope of its toll, both human and material, remained unclear. Civil protection officials in Haiti said they were struggling to communicate with the south after Matthew's furious wind and rain blew down telephone lines.
The bridge that collapsed was on the only road linking Port-au-Prince to the peninsula that makes up southern Haiti.
"It's going to be difficult to find an alternative route," civil protection spokesman Edgar Celestin told AFP.
Next-in-line Cuba was hit late in the afternoon on its eastern tip.
The northern eyewall -- the most destructive part of a hurricane, just outside the eye -- "is already pounding" the eastern tip of the island, the US National Hurricane Center said.
Americans girded for a taste of nature's fury. South Carolina said it would start evacuating 1.1 million people from its coast starting Wednesday and try to get them at least 160 kilometers (100 miles) inland. Georgia declared a state of emergency in 13 counties.
"It's not going to be a fast evacuation. It could take up to several hours," South Carolina Governor Nikki Haley said. "If you can leave early, do that."
'Extremely dangerous'
Matthew made landfall in Haiti shortly after daybreak as an "extremely dangerous" Category Four storm -- the maximum is five -- near the southwestern town of Les Anglais, packing top winds of around 230 kilometers per hour, the US National Hurricane Center said.
It marked the first time in 52 years that a Category Four storm made landfall in Haiti.
Matthew began battering Haiti late Monday with strong winds and rising sea levels, before barreling ashore some 400 kilometers west of the capital Port-au-Prince.
Even before making landfall along the southern edge of a jagged peninsula on Hispaniola -- the island that Haiti shares with the Dominican Republic -- Matthew was blamed for at least three deaths in Haiti, with fears that the toll could climb.
Four more deaths were reported later in the Dominican Republic.
After Cuba, the storm is expected to hit the Bahamas late Tuesday or Wednesday.
The hurricane was forecast to dump 38 to 63 centimeters (15 to 25 inches) of rain over southern Haiti with up to a meter possible in isolated areas.
Rising waters already have caused extensive flooding in and around the flimsy homes and buildings in Haiti's southwest.
More than 9,000 Haitians have been evacuated to temporary shelters at area schools and churches, the Interior Ministry said.
But civil protection forces have struggled with locals who refused to leave some of the most vulnerable areas.
They included the capital's destitute, densely populated neighborhoods, including Cite Soleil -- where a fifth of the half-million residents face serious flooding risks -- and the seaside Cite L'Eternel.
CARE Australia's country director in Haiti, Jean-Michel Vigreux, told SBS News there were also concerns for children, who had been separated from their families.
A police officer helps residents climb down from a pickup after been evacuated prior the arrival of Hurricane Matthew, in Tabarre, Haiti. Source: AAP
"We heard already that children came to a shelter with no relatives, no parents or adults," he said.
"That means there are definitely families that have been separated. And we will have to reconnect the children with their parents as quickly as possible."
Mr Vigreux said the latest disaster highlighted the need for long term solutions.
"We need to always work within the perspective that will always be recurring [disasters] and therefore it's better to transform the capacity of the population to be able to cope with those shocks," he said.
"There's nothing we can do about the disasters themselves - its a natural phenomenon. But we can certainly prepare the population to be much more resilient."
First deluge, then mudslides
Part of the seaport city of Les Cayes was underwater after being deluged by Matthew, which now is blamed for triggering mudslides.
"We have already recorded a landslide between Les Cayes and Tiburon" in Haiti's Sud department, Marie-Alta Jean-Baptiste, director of Haiti's civil protection, told AFP.
Haiti is home to almost 11 million people, many living in fragile housing.
Thousands are still living in tents in Haiti after the country's massive earthquake in 2010. Erosion is especially dangerous because of high mountains and a lack of trees and bushes in areas where they have been cut for fuel.
The head of one international relief group warned not just about the physical ravages from Matthew, but health risks as well.
"As it struggles with Zika and a prolonged cholera epidemic, this hurricane is a natural disaster that compounds an already desperate public health situation," said Gary Gottlieb, the CEO of the group Partners in Health.
UNICEF said it worries in particular about the plight of Haiti's vulnerable children.
"Water-borne diseases are the first threat to children in similar situations -- our first priority is to make sure children have enough safe water," the group said.
Mr Novotny said while the full scale of the damage was still being assessed, it was clearly a huge setback for the country.
"I think we've probably gone back about a year or a year and a half of progress, just overnight," he said.
"If you look at the damage, particularly along the south, along the infrastructure for roads, schools, clinics, major bridges out. So from an infrastructure and development perspective, I think we've gone backwards."
Blankets, plastic sheeting
Interim President Jocelerme Privert urged Haitians to do what they could to get out of the path of the storm.
"My countrymen, do not be stubborn, do not say 'God is good' and will take care of you," he said in an address on Monday.
"We have no interest in risking your lives."
In nearby Jamaica, officials said the army and military reserves were called up to help deal with hurricane damage. Buses were also sent to flood-prone areas to move residents to shelters.
USAID said it has dispatched an elite disaster response team to Haiti, Jamaica and the Bahamas.
It also is sending some $400,000 in assistance to aid groups in Haiti and Jamaica for "critical relief to those impacted by the storm," and emergency relief supplies, including blankets, plastic sheeting and collapsible water containers.
The Red Cross has also deployed disaster teams to the countries most severely affected by Matthew.
People stand on the coast watching the surf produced by Hurricane Matthew, on the outskirts of Kingston, Jamaica, Monday, Oct. 3, 2016. Source: AP
Cuba has evacuated some 316,000 people from the east of the island, where Matthew was expected to hit later Tuesday.
"No one likes to leave their homes, but the sea is going to rise and that is very dangerous," said Pedro Gonzalez, a retired chef who had to leave a fishing islet where he lives, off the city of Santiago.
Forecasters predict the hurricane could hit the US East Coast around midweek. Florida and parts of North Carolina have declared states of emergency.
President Barack Obama on Tuesday postponed a trip to South Florida, where he had planned to attend a campaign event in support of Democratic presidential candidate Hillary Clinton.
With AFP.
