Haiti’s cholera outbreak death toll is likely “much higher” than reported and cases are expected to rise, the WHO said Tuesday, warning the country’s multiple crises would complicate response efforts. The crisis-wracked Caribbean nation said Sunday that at least seven people had died from cholera, raising fresh fears of a resurgent epidemic nearly three years after Haiti’s last confirmed case. Multiple suspected cases have been detected in Carrefour-Feuilles on the edge of the capital Port-au-Prince, and in the coastal neighbourhood of Cite Soleil. The areas are entirely controlled by gangs and access to them has been very difficult since the end of July. Conditions in Haiti have worsened in recent weeks with blockades, fuel shortages, protest marches, looting and general strikes. “This situation greatly complicates the humanitarian response,” World Health Organization spokesman Christian Lindmeier told reporters in Geneva. “The situation is evolving rapidly, and it is possible earlier cases have been undetected.” He said the death toll figures could be “much higher”. “With the humanitarian situation as it is, the sanitary situation, and the gang-controlled areas where there’s hardly any access to control, to test or even to bring in assistance, we should expect, unfortunately, cases to be higher, and to rise,” he said. Lindmeier said a request was being prepared to be submitted to the international coordination group for the procurement of oral cholera vaccines. However, global vaccine availability is limited with demand outstripping supply. Cholera is an acute diarrhoeal infection in the small intestine causing sometimes fatal dehydration.