When hurricane Sandy struck, Fifi Bouille was giving birth in a refugee camp. There were no medics around, only her sisters. Throughout the three-hour labour, rain beat down on the tent and fierce winds tugged at the canvas.

Not long after the umbilical cord was cut, the gusts were so great that the sisters feared the covering would be ripped from above them, so the first-time mother had to carry her newborn son through muddy paths in the middle of the the storm to find new shelter "I was terrified my baby might die," says Bouille, who is now sharing a tent with six others. The danger of the storm has passed, but she is now faced by a new concern: how to feed her child and herself.

The hurricane did not just take their tent, but their cooking utensils, bedding and meagre supplies of food. On Wednesday, she had one meal of corn. On Thursday, nothing.

"I need food, but I don't have enough money to buy it," she says. "Tell people we need nappies, cooking utensils, protein."

Bouille is not alone in fearing that Sandy's aftermath may be more terrible than the storm itself for Haiti. Although the world's attention has mostly focused on the hurricane's impact on the United States, the short-term suffering and long-term consequences for this Caribbean nation – the poorest country in the western hemisphere – are far greater because so many people already live permanently on the edge of catastrophe.

Bouille moved to the Marassa refugee camp after her home and family were destroyed by a devastating earthquake in January 2010. As with the storms before and after, the impact of that disaster was worsened by high levels of poverty, dire infrastructure and weak governance.

Almost three years after the earthquake, 350,000 people in the capital of Port-au-Prince are still living in camps for displaced refugees.

Over the past three years, hundreds who now live in the Marassa camp have been forced to flee twice: from homes destroyed in the quake, to tents which were ripped and flooded in the storm, and to a temporary shelter in a fire station. Since Sandy struck, the camp's inhabitants have rebuilt their simple church made of sheets of corrugated iron, but are still waiting for new tents and food supplies.

Community leaders say cholera and hunger stalk the 3,500 camp residents, and starvation had claimed one life shortly before Sandy struck. Aid groups such as Oxfam have helped, but humanitarian support has ebbed in the past two years.

"We need food," said Mogaline Richard. "There have been promises, but nothing has come yet."

Haitians of proud of their country's origins. Later this month, people will celebrate the great battle fought by sugarcane slaves against their French overlords that led to the establishment of the world's first black-led republic in 1804.

But Johan Peleman, head of the United Nation's Office for the Co-ordination of Humanitarian Affairs, warns: "This country is very vulnerable. It has the world's worst cholera epidemic and 3.5% of people in the capital are still living in tents."

Haiti was only hit by Sandy's tail, but 54 people died and 20 are still missing. Prime minister Laurent Lamothe described it as a "disaster of major proportions". There is little resentment that the US gets far more attention. Instead, the mood is more one of resignation that a catastrophe in a poor country is less of a story.

"This is not the first nor the last disaster we will have. We have seen so much worse that we are relieved there is only this," noted Emmelie Prophete–Milcé, a writer based in Port-au-Prince. "In New York disasters do not happen every day so the media have a good catch. In Haiti the disasters come every day. Well, almost."

Even before Sandy, Haiti had more cholera cases than the rest of the world put together. Almost 6% of the population have been affected and 7,500 people have died.

To respond to the rush of cases this month, Médecins Sans Frontières have opened an extra cholera treatment centre in Carrefour, where the tents are now almost filled with 158 patients, including many young children.

Ezechial Maxi, a journalism student, came in on Monday after being turned away by the general hospital. "The doctors were on strike because they have no medicine and they're not getting paid. I was crying. I knew I had cholera and thought I was going to die."

After being put on an IV drip with a simple rehydrating formula, he has now almost fully recovered.

Cholera is a disease of the poor. It is not difficult to avoid or treat if basic sanitation and clean water are available. But in much of Port-au-Prince, this is not the case. Many road are flooded. Street markets keep their food on the wet, rubbish-strewn and easily contaminated floor.

Sandy will add to those risks, but, says Joan Arnan, the head of MSF's mission in Haiti: "When it goes away, there'll still be cholera and misery in this country. The problem here is structural. We're talking about a very fragile country that cannot respond. Unless there is more support for the international community, this situation will repeat itself every time there is a big storm."

More than any single disaster, the danger is from a steady accumulation of problems and not just in the city.

Sandy turned dirt roads and paths into deep, fast running streams in the village of Jacquet in the district of Gantheir, an hour north-east of Port-au-Prince. About three-quarters of the people in this community of 2,850 people had their homes destroyed. Most of the homes were built from the same mud that gushed down from the denuded mountainside. All that was left of the school was a few dozen breeze blocks, upended desks and a twisted blackboard that still had the lesson notes "history needs its documents" chalked up in French. The nearby football pitch and farm fields were filled with mud and rocks.

Downstream, homes made of mud walls and tin roofs had either collapsed or been flooded. There were already seven people to a small room in some of them. Now the community is squashed tighter in the few homes that remain dry and strong.

"The water came into our homes at midnight. There was just a little at first, but by 4am it had turned into a torrent of mud that took away almost everything we owned," said Yanick Thelemarque, a mother of seven who has only eaten one meal in the past two days.

Food insecurity is growing. More than 70% of crops, including bananas, plantains and maize, were destroyed in the south of the country, officials say.

"Our harvest is gone and we don't have enough money to buy anything so, after we brush our teeth in the morning, our mouths are empty for the whole day," Thelemarque said.

For several villagers, this was the second or third time in three years that a disaster had ruined their homes.

Jean-Tholere Cenat, a farmer, lost his house and crops of potatoes, beans and leaks. "The flood left us alive, but took our spirits," he says. "Tell people we need food and housing."

In the past food shortages have led to violence. The anger is already evident here. After the deputy mayor came to hear their problems, an irate crowd came away yelling: "We're hungry!"

Local people say it was not always this way. "Life was better for us 20 years ago, when schooling was free and a little land was enough to feed and family," says Jean-Carlo Prosper, who runs a non-governmental organisation that works with Oxfam to ease the problems and help people rebuild. "Now everything is more expensive. There are more people and the soil quality is worse because it has to be constantly cultivated."

On the radio, people hear how the US has suffered as a result of Sandy and they sympathise. But, although it was the same storm, its impact seems to have played out in two different worlds.

Reports that electricity was slowly being restored in New York contrasted here with villages that had no electricity to begin with.

Dieula Geffrard lost her home and her husband in the 2010 earthquake. The refugee tent she and her four children moved into afterwards was destroyed by a storm the same year.

Her portable home in Kafou Desruissaux, about an hour's drive from Port-au-Prince, has now been inundated with mud.

"My home wasn't strong enough to withstand the floods, which took away my bed, clothes and shoes," she says.

She counts herself lucky, though, to be alive. After the waters subsided , she found the body of her neighbour, the town tailor. "This place has been forgotten," says Geffrard, "Please help us."

Additional reporting: Jean-Daniel Delone