The outbreak erupted in the Artibonite River valley in central Haiti in mid-October and initially seemed to have been contained, but the toll from the chronic diarrheal disease has since soared to 643 dead and just under 10,000 people being treated in hospital.

Some 115 cases and a first death have been confirmed in Port-au-Prince, while reports came in from northern Haiti of villagers on foot dying on the way to hospital and taxi drivers too scared to help.

Most of the estimated 1.3 million Haitians living in refugee camps are in tent cities around the capital and water-borne cholera could spread easily in the unsanitary conditions where supplies are shared for cooking and washing.

"The epidemic of cholera, a highly contagious disease, is no longer a simple emergency, it's now a matter of national security," the director of the Haiti's health ministry, Gabriel Thimote, told a press conference Tuesday.

Haitian authorities have been warned to prepare for the worst if cholera spreads in the capital, which is still largely in ruins after a January earthquake that killed more than 250,000 people.

"Port-au-Prince is a large urban slum with very poor water and sanitation conditions. This is ripe for the rapid spread of cholera. We have to be prepared for it," said top UN health official Jon Andrus.

Leading humanitarian organization Doctors Without Borders (MSF) said it was extremely concerned at the increase in the number of patients with cholera-like symptoms in the capital.

"The increasing numbers of cases of suspected cholera in our facilities throughout Port-au-Prince are certainly alarming," said Stefano Zannini, MSF head of mission in Haiti.

MSF, which runs the Saint Catherine's Hospital in the Cite Soleil slum where the capital's first cholera fatality was confirmed, said it was constructing an additional 320-bed facility in the city's Sarthe neighborhood.

Oxfam said it had a team of 25 staff working around the clock with a water, hygiene and sanitation program reaching about 100,000 people to distribute soap, water purification tablets, buckets and rehydration salts.

"It is a very serious development that cholera has spread in Port-au-Prince," the organization said in a statement.

"However, it is understandable. With heavy rains and flooding over the weekend, in an environment where there is poor sanitation, waterborne diseases like cholera spread very rapidly."

In addition to the one confirmed death, laboratories are testing samples from two more patients that died with cholera-like symptoms in the capital.

Desperate scenes were described in the northern town of Gonaives where some 60 people were said to have died with cholera-like symptoms in the past few days. In the Artibonite region, which includes Gonaives, 42 deaths were recorded in one day alone on Tuesday.

"Sick people died on the way to the hospital, the bodies were covered in blankets and left near the town cemetery," mayor Adolphe Jean-Francois told AFP.

The Pan American Health Organization, a regional office of the UN's World Health Organization, gave a stark assessment of the situation based on the model of a massive Peruvian cholera outbreak in 1991.

"Extrapolating from Peru's experience, one might expect upwards of 270,000 cases if Haiti's epidemic continues for several years, as did Peru's," Andrus, the organization's deputy director, told a Washington press conference.

Hurricane Tomas, which claimed more than 20 lives in Haiti at the weekend, aggravated the situation as it dumped heavy rains that caused rivers, including the believed source of the cholera, the Artibonite, to flood.

Although easily treated, cholera has a short incubation period and causes acute diarrhea that can lead to severe dehydration and death in a matter of hours.

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