One of the most powerful Atlantic hurricanes in recent years has hit Haiti, bringing 145mph (230km/h) winds, heavy rain and dangerous storm surges.
Hurricane Matthew, a Category Four storm, made landfall at the south-western tip at about 11:00 GMT.
The US National Hurricane Center (NHC) said Haiti was "getting everything a major hurricane can throw at them".
Haiti's Interim President Jocelerme Privert said a number of people had been killed so far.
"We've already seen deaths. People who were out at sea. There are people who are missing. They are people who didn't respect the alerts. They've lost their lives," he said.
Matthew is expected to bring up to 40in (102cm) of rain to some parts.
Haiti is one of the world's poorest countries and many of its residents live in wooden or corrugated steel shacks in areas prone to flooding.
The NHC said the hurricane had already caused extensive damage and flooding in Haiti's south-west and was moving north at about 15km/h.
Social media footage from the southern coastal town of Les Cayes showed palm trees being bent sideways and buildings with damaged roofs.
"Part of the problem in Haiti is it's quite mountainous and Matthew is a slow-moving hurricane so it could deliver large amounts of rain," the NHC's John Cangialos told the BBC.
"Best advice for anyone in Haiti is hopefully get somewhere, the safest place you can be, to ride this out."
Fear of thefts
Authorities in Haiti have urged people to stock up on food and water and secure their homes. Thousands are still living in tents following a huge earthquake in 2010.
The mayor of Haiti's largest slum in the capital Port-au-Prince, Frederic Hislain, called on the government to evacuate some 150,000 people whose homes are threatened.
Haitian officials say that about 1,300 emergency shelters have been built, enough to accommodate 340,000 people. Both airports in Haiti are closed.
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But some Haitians have refused to go to shelters, fearful of having their possessions stolen.
One local in Port-au-Prince, however, said the community would unite in the face of the storm's danger.
"We are communicating amongst ourselves thanks to our own means. We will tell the people how the situation is. If things are bad then we will come together."
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An NHC statement said: "On the forecast track, the eye of Matthew will move near eastern Cuba later [on Tuesday], and move near or over portions of the south-eastern and central Bahamas [on Tuesday night] and Wednesday, and approach the north-western Bahamas on Wednesday night."
About 13,000 people were evacuated from high-risk areas in neighbouring Dominican Republic, which is also expected to get battered by rains and winds, according to the country's civil defence chief.
Heavy rain and winds have already hit parts of Jamaica, with floodwaters blocking roads in the capital Kingston.
A hurricane alert is in place for six eastern Cuban provinces and residents are being moved from low-lying areas.
Some 700 spouses and children of US service members have been flown out of the Guantanamo Bay base, which is just 80km from where the storm could make landfall.
It is also predicted to hit the US east coast later in the week. Florida and parts of North Carolina have declared states of emergency.
Hurricane Matthew is the region's most powerful since Felix in 2007.
Hurricane scales
Category one: sustained winds of 74-95mph (119-153 km/h); some damage and power cuts
Category two: winds of 96-110mph (154-177 km/h); extensive damage
Category three: winds of 111-129mph (178-208 km/h); well-built homes suffer major damage
Category four: winds of 130-156mph (209-251 km/h); severe damage to well-built homes, most trees snapped or uprooted
Category five: winds of 157 mph (252 km/h) or higher; high percentage of homes destroyed, area uninhabitable for weeks or months
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