There is now just one department in Haiti that has not yet reported a case of cholera, Grand'Anse. Within days of the passage of Tomas the disease spread from the central parts of the country, where the outbreak began, into the largest and most important city in the country, Port-au-Prince. Standing water and damage to infrastructure, both from Tomas and the earthquake, have facilitated the spread of the disease. At this point it is likely only a matter of time before Grand'Anse reports its first infection.
Further complicating the situation is the spread of cholera into the Dominican Republic, the country that Haiti shares the island of Hispaniola with. The Dominican Republic has a better developed health system and was not nearly as impacted by Tomas, nor the earthquake. None-the-less, Tomas did leave standing water in northwestern parts of the Dominican Republic, making it easier for the water-borne disease to spread. Due to the epidemic on the other side of the border, the Dominican Republic has tried to better regulate the border, but illegal crossings remain a problem, and pressure is growing. There are now as many as three suspected cases of cholera in the Dominican Republic.
In Port-au-Prince cholera is now rapidly spreading, with more than 80 people having been hospitalized. Half of the cities 2.5 to 3 million residents living under tents and tarps, without access to clean drinking water. These circumstances suggest that the disease will continue to spread throughout the city.