As the largest storm in a decade nears Florida, the Caribbean starts to dig out.

Hurricane Matthew smashed Haiti particularly hard this week, bringing high winds and rainfall of up to 40 inches in some areas. The death toll, as Reuters reports, is well over 500, and hundreds of thousands of homes have been damaged. Food supplies and potable water are in short supply, and up to 80 percent of crops in some regions have been destroyed. The government says 350,000 people need urgent aid, and tens of thousands remain in shelters. Public health officials fear a rise in cholera cases on island, which was introduced to the nation by U.N. peacekeepers in the wake of the 2010 earthquake, which Haiti is still recovering from.

Matthew also slammed Jamaica, Cuba, the Bahamas, and the Dominican Republic before turning northward. While the islands of the Caribbean are not major producers of greenhouse gases, they are especially vulnerable to the effects of climate change due to their size, elevation, remoteness, and concentration of infrastructure along coastlines. And those effects include both sea-level rise and stronger, more damaging hurricanes — hurricanes that look like Matthew.