A major earthquake struck southwestern Haiti early Saturday, collapsing buildings and historical cathedrals in a nation still struggling to recover from a devastating quake that left more than 300,000 dead over a decade ago and was already in chaos after a presidential assassination last month.

At least 225 people have died, according to Haiti’s Office of Civil Protection, which manages the island nation’s disaster relief. But the U.S. Geological Survey, issuing a “red alert” for the disaster, estimated fatalities could stretch into the thousands.

“High casualties and extensive damage are probable and the disaster is likely widespread. Past red alerts have required a national or international response,” the survey said.

The USGS placed the quake at magnitude at 7.2, as did the Puerto Rico Seismic Network, with the epicenter about 75 miles west of the capital of Port-au-Prince. If verified, it would make the seismic event stronger than the 7.0 quake that left much of the city in ruins 2010. Tremors were felt all the way in Jamaica.

There were reports of deaths, injuries and panic in several cities along the Tiburon, the country’s southwestern peninsula. It’s less densely populated than the capital but images posted on social media underlined that there could be many more casualties. Some showed collapsed homes and the Catholic cathedral turned to rubble in Les Anglais, which is part of Jeremie in the Grand Anse region.

Claude Prepetit, Haiti’s chief seismologist, said that the South and Grand Anse regions had been considered the least at-risk for quakes. ”For me, this was a surprise and it shows us that an earthquake is something that is totally unpredictable,” he said. “There was nothing to say that this morning there would have been an earthquake and it would had occurred in this area.”

He said the damage might not be as widespread at the 2010 quake, but warned aftershocks would still topple buildings. ”This is why we are asking people not to run back into buildings,” he warned. “Wait on the evaluations.”

Prime Minister Ariel Henry, who declared a state of emergency for one month, was touring the damage with the The United Nations Humanitarian Air Service and planned to brief the public Saturday afternoon.

For those affected, the experience of yet another major earthquake was terrifying. Former Haiti Prime Minister Rosny Smarth, who lives in Cavaillon in the south, said he was at home when he felt the ground rumbling.

“I ran out with my brother,” said Smarth, who retired to the region from Port-au-Prince last year. “A lot of homes in Cavaillon have been destroyed.”

Sacred Heart church is damaged after an earthquake Saturday in Les Cayes, Haiti. Delot Jean/Associated Press

Destruction was also reported in the coastal city of Les Cayes after the ground shook at 8:29 a.m. ET. Among the missing is at least one prominent political leader, former Senator Gabriel Fortune, who several Haitian blogs reported was buried underneath the rubble in Les Cayes.

“A lot of houses have been destroyed, a lot of people are injured and were taken to the hospital,” Valince Georges posted on Facebook with a photo of a destroyed two-story house. “A lot of aftershocks.”

The prime minister’s office said that the emergency responders had been activated and were assessing the damages. Some of the area, controlled by violent gangs, may be challenging survey by ground crews.

International humanitarian organizations immediately responded with offers to help as did the Biden administration: “The President and Vice President were briefed by the National Security Advisor and the Secretary of State on the earthquake this morning in Haiti. The President authorized an immediate US response, and named USAID Administrator Samantha Power as the senior US official to coordinate this effort.”

In a video widely shared on Haitian social media networks, an unidentified man said he was out exercising when he felt the ground rattle. In the video, dust clouds and rubble overtake the streets of the southwestern Haitian city.

“A huge earthquake has just hit Aux Cayes,” the man said in Creole, comparing the destruction to the disaster of Jan. 12, 2010. “For what I am seeing, it is the equivalent of the January 12.”

The catastrophic 2010 earthquake struck near Port-au-Prince, killed over 300,000 people and destroyed the homes of 1.5 million people. It also left 1.5 million others injured. The quake collapsed over 100,000 structures in the Caribbean nation, which sit in an active seismic zone.

The nation, ranked among the poorest countries in the Western Hemisphere, has a long history of deadly natural disasters, even before the 2010 earthquake. Since 2000 alone, the country had been raked by hurricanes. In 2004, Jeanne triggered massive flooding that killed over 3,000 people, mostly in the town of Gonaives. Heavy rain from four hurricanes in 2008 caused widespread flooding and crippled vital agricultural regions.

The quake hit hard the South and Grand Anse provinces on Haiti’s southwestern peninsula, a region also decimated by Hurricane Matthew, a Category 4 storm, in 2016. The hurricane killed over 500 people and displaced thousands while devastating infrastructure and crops.

Political instability also has hampered recovery — with Haiti thrown into a deep crisis of volatility since last month when President Jovenel Moise was assassinated. His July 7 murder inside his private residence remains unsolved, even though police have arrested over 40 persons. On Friday, the judge put in charge of further investigating the assassination plot and bringing charges against those arrested withdrew, citing concerns for his safety and a lack of security.

Making emergency response even more complicated is that the four regions struck by the quake has been cut off by violent armed gang warfare at the southern entrance of Haiti’s capital. Since June 1, the gang clashes have forced the displacement of over 16,000 Haitians from their homes in the poor neighborhood of Martissant.

If that wasn’t enough, Haiti is in the cone for Tropical Storm Grace, which could be approaching by late Monday.

“This is one of the most untimely things that can happen when it comes to Haiti,” said Skyler Badenoch, CEO of Hope for Haiti, a local charity that employs about 60 people and provides health services.

“There is a tremendous amount of worry for the safety of our team and their families and what this means for the country and the region,” Badenoch said. “The first thing we are laser-focused on is trying to contact everybody on the phone, to hear their voice and make sure they are OK. We know there is a lot of emotional stress when it comes to earthquakes.”

Even as damage assessments were ramping up, the country also was still seeing a string of smaller aftershocks. The USGS has recorded multiple additional quakes: including a magnitude 5.2 quake some 12 miles from Cavaillon, a magnitude 4.1 quake about 5 miles from Petit Trou de Nippes, and a magnitude 4.4 quake about 2 miles from Aquin. All originated near the epicenter of the first earthquake Saturday morning.

Aftershocks are a common occurrence following big earthquakes but unnerving for residents and potentially dangerous in areas with heavily damaged structures..

The U.S. Tsunami Warning System also forecast “hazardous tsunami waves” along some of the Haitian coastline, with waves 3 to 9 feet higher than the average tide height possible. Videos show water flowing through Les Cayes, as people ran through the streets asking where it was coming from.

Haiti has two prominent fault zones. A continuation of the Septentrional fault runs through the north of Hispaniola, while the Enriquillo-Plantain Garden fault zone, runs through the south of the major Antille. The Saturday morning earthquake happened over the Enriquillo-Plantain Garden fault zone, where the magnitude 7.0 earthquake struck in 2010.

“It is an event that is possibly related to the event of more than 10 years ago,” said Victor Huerfano, director of the Puerto Rico Seismic Network. “It’s the same fault.”

The Puerto Rico Seismic Network continues to study the event and monitor the region for aftershocks.

“The event was so strong, that still hours later, there are seismic signals arriving,” he said.

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