At least seven people have been killed by Hurricane Dorian in the Bahamas with millions told to leave their homes in Florida as the storm heads north.
Experts say it is now the most powerful storm to hit a Caribbean island after reaching sustained winds of 185mph and gusts of up to 220mph.
Bahama's Prime Minister Hubert Minnis said: "We can expect more deaths to be recorded. This is just preliminary information.
"Marsh Harbour has suffered, I would estimate, in excess of 60% damage to their homes."
He also said the shantytown known as The Mud and The Peas has been "completely destroyed or decimated".
Aid agencies believe as many as 13,000 homes in the Bahamas have been destroyed or severely damaged and more than 60,000 people are in need of food supplies.
Matthew Cochrane from the Red Cross said: "What we are hearing lends credence to the fact that this has been a catastrophic storm and a catastrophic impact."
The country's health minister, Duane Sands, said Dorian has devastated the health infrastructure in Grand Bahama and the main hospital is now out of use because of severe flooding.
Mr Sands said crews were trying to airlift up to seven kidney failure patients from Abaco who had not received dialysis since Friday.
Forecasters predict within the next 36 hours Dorian will come "dangerously close" to Florida's east coast.
It is also expected to skim Georgia and South Carolina - and perhaps strike North Carolina - later in the week with the US National Hurricane Center warning that, even if landfall does not occur, the system is likely to cause a storm surge and severe flooding.
More than two million people have been told to leave their homes and the federal government has granted a request for a disaster declaration for North Carolina in anticipation of the storm's impact on the state
"Don't tough it out. Get out," US Federal Emergency Management Agency official Carlos Castillo said.
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