PORT-AU-PRINCE, Haiti (AP) — The sun shone down on Stanley Joliva as medical staff at an open-air clinic hovered around him, pumping air into his lungs and giving him chest compressions until he died.

Nearby, his mother watched.

“Only God knows my pain,” said Viliene Enfant.

Less than an hour later, the body of her 22-year-old son lay on the floor wrapped in a white plastic bag with the date of his death scrawled on top. He joined dozens of other Haitians who have died from cholera during a rapidly spreading outbreak that is straining the resources of nonprofits and local hospitals in a country where fuel, water and other basic supplies are growing scarcer by the day.

Sweat gathered on the foreheads of staff at a Doctors Without Borders treatment center in the capital of Port-au-Prince where some 100 patients arrive every day and at least 20 have died. Families kept rushing in this week with loved ones, sometimes dragging their limp bodies into the crowded outdoors clinic where the smell of waste filled the air.

Dozens of patients sat on white buckets or lay on stretchers as IV lines ran up to bags of rehydrating fluids that gleamed in the sun. So far this month, Doctors Without Borders has treated some 1,800 patients at their four centers in Port-au-Prince.

Across Haiti, many patients are dying because say they’re unable to reach a hospital in time, health officials say. A spike in gang violence has made it unsafe for people to leave their communities and a lack of fuel has shut down public transportation, gas stations and other key businesses including water supply companies.

Enfant sat next to her son’s body as she recalled how Joliva told her he was feeling sick earlier this week. She had already warned him and her two other sons not to bathe or wash clothes in the sewage-contaminated waters that ran through a nearby ravine in their neighborhood — the only source of water for hundreds in that area.

Enfant insisted that her sons buy water to wash clothes and add chlorine if they were going to drink it. As Joliva grew sicker, Enfant tried to care for him on her own.

“I told him, ‘Honey, you need to drink the tea,’” she recalled. “He said again, ‘I feel weak.’ He also said, ‘I am not able to stand up.’”

Cholera is a bacteria that sickens people who swallow contaminated food or water, and it can cause severe vomiting and diarrhea, in some cases leading to death.

Haiti’s first major brush with cholera occurred more than a decade ago when UN peacekeepers introduced the bacteria into the country’s biggest river via sewage runoff at their base. Nearly 10,000 people died and thousands of others were sickened.

The cases eventually dwindled to the point where the World Health Organisation was expected to declare Haiti cholera-free this year.

But on October 2, Haitian officials announced that cholera had returned.

At least 40 deaths and 1,700 suspected cases have been reported, but officials believe the numbers are much higher, especially in crowded and unsanitary slums and government shelters where thousands of Haitians live.

Worsening the situation is a lack of fuel and water that began to dwindle last month when one of Haiti’s most powerful gangs surrounded a key fuel terminal and demanded the resignation of Prime Minister Ariel Henry. Gas stations and businesses including water companies have closed, forcing an increasing number of people to rely on untreated water.

Shela Jeune, a 21-year-old hot dog vendor whose 2-year-old son has cholera, said she buys small bags of water for her family but doesn’t know if it’s treated. She carried him to the hospital where he remains on IV fluids.

“Everything I give him to eat, he just throws it up,” she said.

Jeune was among dozens of mothers seeking treatment for their children on a recent morning.

Lauriol Chantal, 43, recounted a similar story. Her 15-year-old son would vomit as soon as he finished eating, prompting her to rush him to the treatment center.

While at the center, her son, Alexandro François, told her he felt hot.

“He said to me … ’Mama, could you take me outside to wash me or pour water over my head?’” she said.

She obliged, but suddenly, he collapsed in her arms. The staff ran over to help.

Children younger than age 14 make up half of cholera cases in Haiti, according to UNICEF, with officials warning that growing cases of severe malnutrition also make children more vulnerable to illness.

Haiti’s poverty also has worsened the situation.

“When you are unable to get safe drinking water by tap in your own home, when you don’t have soap or water purifying tablets and you have no access to health services, you may not survive cholera or other waterborne diseases,” said Bruno Maes, Haiti’s UNICEF representative.

Perpety Juste, a 62-year-old grandmother, said one of her three grandchildren became ill this week as she fretted about how their situation might have led to her sickness.

“We spent a lot of days without food, I cannot lie,” she said. “Nobody in my house has a job.”

Juste, who lives with her husband, five children and three grandchildren, said she used to work as a house cleaner until the homeowners fled Haiti.

The increasing demand for help is squeezing Doctors Without Borders and others as they struggle to care for patients with limited fuel.

“It’s a nightmare for the population, and also for us,” said Jean-Marc Biquet, a project coordinator with the organisation. “We have two more weeks of fuel.”

Life is paralysed for many Haitians, including Enfant, as she mourned her son’s death. She wants to bury him in her southern coastal hometown of Les Cayes, but cannot afford the 55,000 gourdes ($430) it would cost to transport his body.

Enfant then fell quiet and gazed into the distance as she continued to sit next to her son’s body — too stunned, she said, to stand up.