Tropical Storm Noel has caused floods and mudslides as it lashed Haiti and the Dominican Republic.
Whole families have been swept away, with many dead or still missing.
In Haiti floodwaters rushed through the shanty town of Cite Soleil in the capital, Port-au-Prince, where UN soldiers set up makeshift shelters for storm refugees.
Hundreds of volunteers have joined the Dominican Republic's civil defence force to help rescue stranded people in communities cut off by widespread flooding.
The authorities have warned people to remain on high alert with heavy rain expected to cause further destruction.
Noel is the deadliest storm in this part of the Caribbean since Tropical Storm Jeanne hit Haiti in 2004, triggering floods and mudslides that killed more than 2,000 people.
Rescue services are struggling to reach remote towns in the Haitian countryside, and fear the death toll could rise.
Haiti is especially vulnerable to flash floods and mudslides because most of its trees have been felled to make charcoal.
In the Dominican Republic, people climbed onto roofs or into trees to escape the flood waters.
The US National Hurricane Center has issued a tropical storm warning for Florida's south-east coast as the storm heads towards the Bahamas.