Baby Dutchy can't stand up anymore. Foggy-eyed on his grandmother's arm, the 6-month-old boy was lethargic, sickly and covered with mosquito bites. But because his mother and grandmother said they weren't among the first 200 patients to sign up for treatment Friday, the overwhelmed Haitian Red Cross physicians at the Hospital of Independence told them to come back on Saturday.

"We'll come back tomorrow. What can we do?" said the grandmother, Dorvilema Joseph, who lost two sons when Tropical Storm Jeanne ravaged this city on Sept. 18. She doesn't want the aftermath to take her increasingly sick grandson.

Three weeks after Haiti's worst natural disaster in years, in which about 3,000 people were killed or are missing, this battered city is trying desperately to attend to its sick, feed its hungry, keep drinking water flowing and remove tons of mud and debris that make downtown look a landfill.

On Friday, U.N. peacekeeping troops patrolled the city in white armored personnel carriers, teams from CARE and other international aid agencies zipped around in four-wheel-drive trucks, and everywhere -- in homes, offices, shops and hospitals -- people struggled with vast piles of mud and heaps of wreckage.

"The situation is still precarious," said Yves-Andre Wainright, Haiti's environment minister and coordinator of the disaster relief effort for Haiti's interim government, which took office after Jean-Bertrand Aristide resigned as president under U.S. pressure in February.

Anne Poulsen, a spokeswoman for the U.N. World Food Program, said nearly 1,400 tons of food -- about 424,000 individual packages -- had been distributed in Gonaives since the flooding, which affected about 200,000 people. But Wainright said 40,000 people in three hard-hit outlying areas had still received no emergency aid because roads there have been washed out and agencies here do not have helicopters equipped to move large supplies of food.

As emergency food was being distributed Friday morning, Clairesina Pierre, 76, waited near the front of a line of at least 1,000 people hoping for a ration that included Japanese canned mackerel and lentils from the United States. The barefoot grandmother, who lost her home in the floods and is living with friends, said it was her third attempt to get food. The first two times, she said, "I didn't get anything because they were pushing me and I fell down."

As she spoke, a fistfight between two women behind her turned into a rock-throwing melee involving dozens of people, including a woman who was left bleeding from her temple. Magulie Elisier, who is eight months pregnant with her third child, ducked as the stoning started. She had been in line, standing in flimsy plastic sandals, since before dawn.

"My house is destroyed. I'm living with friends. I can't eat and I can't feed my kids. I didn't have any water for three days after the flood. Things are just awful," she said, watching the fighting and patting her enormous belly. "And now I may have to go home with nothing in my hands."

Political violence in Haiti, which officials have attributed largely to Aristide supporters demanding his return from exile in South Africa, has claimed at least 20 lives since it began Sept. 30. The violence, in which some people have been beheaded, has created chaos in the capital and stranded tons of aid at the city's commercial port.

Abner Vilme, Gonaives' police chief, said there had been no such violence here. That was good, he said, because the police station was destroyed and 40 of his 50 officers lost their uniforms and other equipment when their homes were flooded. "We'd have to leave, because we don't have the guns or equipment to deal with that," Vilme said of the prospect of violence. Wearing jeans and a T-shirt, he said he had lost all but one of his uniforms, which he was saving for a scheduled visit Saturday by Haiti's interim president, Boniface Alexandre, and the interim prime minister, Gerard Latortue.

Wainright said at least 8,000 people were living in shelters here, plus another 2,700 in shelters in St. Marc, a two-hour drive south. He estimated that at least 30,000 people remained homeless, and thousands more had moved in with friends or relatives to escape homes battered by the storm. The city was still without electricity.

Wainright said most people had access to drinking water, which was being distributed at 44 points around this Caribbean port city in the northwest corner of Haiti. He said the water is coming from a well built by CARE International and two water filtration plants built by French aid agencies. The city's regular system of wells, pumps and treatment plants was destroyed by the storm, and the government does not have the means to repair them.

"Mud. We are sick of it," said Alcius Filacieu, 42, who was caked from his bare feet to his weary face as he helped clear a friend's sunken house. Filacieu and his 13-year-old son are now sleeping atop the remains of their wrecked house; his wife and five other children have moved to another friend's house in the countryside.

"Our main need right now is heavy machinery," said Wainright, adding that the government had no means of clearing away all the mud from streets and cleaning out storm drains, even as water began rising again Friday from overnight rains that had again run down off surrounding mountains denuded of trees.

Wainright said government officials intend to rebuild the city in a way that would prevent a similar disaster. They have dusted off an urban growth plan for Gonaives written in 1997 and a 1999 plan by a German firm for a new waste management and drainage system. He said plans were already in the works to build a new neighborhood on higher, safer ground. "We want to use this disaster as an opportunity," he said.

Pierre Celse Prophete, a doctor at the Hospital of Independence, pointed to stains on the wall, 10 feet high, where floodwaters had reached. Workers were clearing mud from the grounds, hoping to reclaim the destroyed first floor. Prophete said doctors had only the most basic supplies with which to handle gastric problems, skin disease and malaria since the floods and had been forced to send some patients home because they were too sick for the hospital's staff to deal with. He said they could barely cope with the 200 patients waiting to see doctors on Friday.

"We don't have enough of anything," he said.

A Haitian girl walks with a child through a neighborhood in Gonaives, Haiti, destroyed by floods caused by Tropical Storm Jeanne on Sept. 18. Conditions there are "still precarious," the environment minister said.