After Hurricane Gustav made landfall last week, Tropical Storm Hanna caused serious damage to Haiti's coastline on September 1 and 2. Many towns are flooded and remain difficult, if not impossible, to access. According to authorities, 25,000 to 30,000 houses were destroyed and up to 500 people have died nationwide. People have very little access to food and clean water, and major crops have been destroyed. On Thursday, September 4, an MSF team of eight medical and non-medical personnel arrived in Gonaïves to clean out the Rabouteau Health Center, the only working structure (out of four health centers and one hospital) after the floods. Thanks to the support of the local population, MSF was able to clean the facility, supply medicine, and restart the operating room. On September, 5, MSF performed 110 consultations, treated 49 injured people and carried out 16 surgical procedures. On Saturday, people started fleeing the city by the thousands to seek refuge, after authorities warned of the arrival of Hurricane Ike. The Rabouteau Health Center MSF is supporting remains the only working health structure in the town. A critical concern is the lack of access to clean water for the city's inhabitants. All the local sources of water were contaminated as a result of the flooding. This concern is compounded by the fact that most of the local medical staff have fled the area. MSF has not been able to reach many areas of the city given the flooding, making it difficult to properly assess the scope of needs of the population. Also on Saturday, an MSF physician went to Saint Michel de l'Atalaye, where 400 people have been stranded without food or water for five days. MSF brought one child to Gonaïves for surgical care and distributed food and water from the World Food Program. A three-person MSF team went to Cap Haïtien to assess the emergency response capacities and establish local contacts to help immediately assess needs in aftermath of Hurricane Ike. MSF teams have not been able to reach many of the flooded areas on the eastern side of the community. Hospitals and health structures are reported to have been seriously damaged in this area. Flooded areas between Gonaïves, Port de Paix and Cap Haïtien cannot be reached while towns like Enry or Gros Morne, which were strongly affected by Hanna, have not received any assistance. MSF is still pushing to gain access to these areas, though the coming hurricane might limit their ability to reach these areas. Existing MSF activities in Port-au-Prince are continuing. The organization provides medical and surgical care at la Trinité trauma center; emergency obstetrical care in Jude Anne Hospital; and emergency health-care services and essential health services through mobile clinics in the Martissant slum. A mobile clinic team went to the La Saline slum earlier this week. Ike, a category four hurricane, has now reached Haiti's neighborhood and rains have started again.