The eye of Hurricane Matthew passed north of Haiti by Tuesday afternoon, but the true impacts of the storm could unfold in the months and years to come.

The country is one the least-developed places in the world and still reeling from the shock of the 2010 earthquake that killed 200,000, led to a cholera epidemic and destroyed crucial infrastructure and government services.

The last Category 4 storm to hit Haiti was Hurricane Cleo in 1964, which clipped the southwestern tip of the nation. Hurricane Flora made a more direct landfall as a Category 4 in 1963, killing up to 8,000 and causing an estimated $180 million damage.

Haiti is a cruel case where the dollar loss from Matthew might not be high simply because the country is already incredibly poor. But a lower price tag only masks the true devastation likely to be felt by millions.

“When a lot of people live with a low baseline, with few investments or assets, it can look like they didn't really suffer a lot of damage,” Amir Jina, an economist who studies development at the University of Chicago, said. “Essentially, ‘when you've got nothing, you've got nothing left to lose.’”

Haiti sits at the confluence of circumstances that could magnify Matthew’s impacts

On Tuesday, the United Nations Office for Disaster Risk Reduction (UNISDR) described Haiti as a “textbook example of all the risk factors that could come together in advance of the arriving natural hazard.”

Being hit by a Category 4 storm is catastrophic enough, but the background conditions in Haiti will magnify the impacts in a way unlike anywhere else in the western hemisphere.

Haiti ranks second-to-last on the human development index, an index compiled by the United Nations based on a number of statistics including life expectancy, inequality and income. That makes it by far the least developed country in the western hemisphere.

Hurricane Matthew Haiti

A man walks on the streets of Port au Prince as Hurricane Matthew approaches.

Nearly 40 percent of Haitians work in agriculture, largely as subsistence farmers. Haiti has dealt with drought over the past few years, due in part to El Niño, leaving farmers with poor harvests and increasing food insecurity.

Denis McClean, a spokesperson for UNISDR, said a third of Haiti’s population is already dealing with food shortages due to the drought and Matthew could compound that by providing too much of a good thing. The storm has the potential to drop up to 40 inches of rain in Haiti’s Tiburon region, scouring topsoil of nutrients.

That’s an ongoing concern for the country, where deforestation has left only 2 percent of its original forests standing.

“The greater Tiburon watershed has been repeatedly identified by national studies as having comparatively severe environmental degradation, risk for malnutrition and high levels of multi-dimensional elements of poverty,” Alexander Fischer, a PhD candidate at Oxford and former associate director of the Haiti Research and Policy Program at the Earth Institute, said.

In other words, the worst impacts of Matthew are hitting one of the most vulnerable parts of one of the poorest countries in the world.

Fischer said a 2011 flood in the region is instructive of what could unfold with Matthew. Up to a foot of rain fell over three days in the southwestern part of Haiti, washing away roads and houses, destroying clean water infrastructure and taxing medical facilities in the region.

“These are only immediate visible impacts,” he said. “More critical impacts on subsistence farming, damage to homes and (financial) savings impacted communities — and especially the most vulnerable families — long after the floods.”

The 2010 earthquake is still a huge issue today

It’s been six years since an earthquake left 200,000 dead and displaced 1.5 million, but the effects are still reverberating throughout the country.

Roughly 60,000 people are still living in tents or makeshift homes. Those homes provide little protection from the elements and could help the spread of disease in the wake of the storm.

Haiti earthquake aftermath

A tent city in Port au Prince in the wake of the January 2010 earthquake. Roughly 60,000 people are still living in tents six years after the quake.

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The specter of cholera epidemic also looms on the horizon. UN workers unwittingly sparked a cholera outbreak in 2010 that killed 10,000 and standing water in the wake of Matthew raises the risk of another outbreak in the coming weeks.

The earthquake also destroyed Haiti’s National Meteorological and Hydrological Service. Though the World Meteorological Organization has helped rebuild some of Haiti’s weather network, there are still large gaps and Matthew could wipe out some of that work.

Having only a partial network left Haiti with a number of blind spots for Matthew and losing any pieces of its fledgling weather network could leave the country with an even bigger gap in preparing for future storms.

“(This is the) severest test for Haiti since the 2010 earthquake,” McClean said.

What comes next for the country depends on how Haiti and the international community respond in the near-term. But the impacts of Matthew will likely linger long after the storm has dissipated.

“There's no doubt that a hurricane like this will slow development and will still have an effect for many years,” Jina said.